World Neurosurg
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Pivotal trials have shown the tremendous efficacy of mechanical thrombectomy in proximal occlusions. However distal occlusions involving second-order branches of the middle cerebral artery and beyond, anterior cerebral and posterior cerebral arteries were not represented. In this study, we investigated the feasibility and safety of distal circulation mechanical thrombectomy. ⋯ Mechanical thrombectomy procedure for distal circulation strokes is as effective and safe as a proximal group. Though distal vessels supply smaller brain area; however, when symptoms are pronounced, the benefit of the procedure outweighs the risks.
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Vitamin D deficiency is a well-known cause of postoperative complications in patients undergoing orthopedic surgery. Orthopedic complications seen in vitamin D deficiency include nonunion, pseudarthrosis, and hardware failure. We seek to investigate the relationship between vitamin D deficiency and outcomes after lumbar spinal fusions. ⋯ Both preoperative and postoperative vitamin D levels were not significantly associated with an increased or decreased risk of pseudarthrosis, revision surgery, hardware failure, or 1-year VAS pain score after lumbar spine fusion surgery.
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Nearly 20% of individuals with an aneurysm will have multiple aneurysms-these individuals are at increased risk of subarachnoid hemorrhage. Treatment of bilateral aneurysms with flow diverters (FDs), or Pipeline embolization device, has not yet been established as an effective therapy. We evaluated the safety and efficacy of a 2-stage treatment of bilateral aneurysms with Pipeline embolization devices placed 6 months apart. ⋯ The results from the present study have demonstrated that 2-stage treatment of bilateral aneurysms with FDs is both safe and efficacious. The timing of contralateral FD stent placement is critical. We found that 6 months allows for adequate neurological recovery and stent endothelialization.
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The basal ganglia and thalamus are uncommon locations for infiltrating gliomas. Tumors here are usually managed with biopsy and adjuvant therapy, with relatively poor results. Rarely do patients undergo extensive surgical intervention. It seems reasonable to suggest that successful cytoreduction may help these patients. However, this hypothesis has not been studied because of the general view that it is not possible to remove deep-seated brain tumors with acceptable outcomes. ⋯ We present the results of our attempts to resect large gliomas infiltrating the basal ganglia in 4 patients. Our technique combined a contralateral, transcallosal approach with awake neuromonitoring. Our results suggest it is possible to remove these tumors with reasonable outcomes.
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We sought to assess the impact of 5-aminolevulinic acid (5-ALA) and low-field intraoperative magnetic resonance imaging (iMRI) on the extent of resection of high-grade gliomas (HGGs). Results are compared with those obtained when using 5-ALA and iMRI separately. ⋯ In our experience, combined use of iMRI and 5-ALA does not improve the studied variables when compared with those technologies when used separately, even though a slight tendency of a superior effectiveness is observed when using iMRI individually.