World Neurosurg
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The benefits of the right transradial approach for anterior circulation lesions using a 6F Simmonds guiding sheath have been reported. However, this technique can be anatomically challenging in the type I aortic arch. Furthermore, to the best of our knowledge, no studies have reported on neurointervention using a Simmonds guiding sheath and the left transradial approach. We devised a novel technique using the contralateral subclavian artery as an "anchor" to reform the Simmonds curve, named the subclavian artery anchoring technique (SCAT). The purpose of the present study was to evaluate the feasibility, safety, and usefulness of neurointervention with the SCAT for patients with a type I aortic arch treated with the right transradial approach and patients treated with the left transradial approach. ⋯ The results of the present study have shown that this technique is a feasible, safe, and useful method for patients with type I aortic arch treated with a right transradial approach or a left transradial approach. SCAT makes up for a deficiency in the transradial approach with a 6F Simmonds guiding sheath.
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Parasellar meningiomas involving the cavernous sinus and Meckel's cave pose a management challenge because of invasion around neurovascular structures and the pituitary gland. The management options range from aggressive resection to focused radiotherapy alone. We present a strategy for these tumors that includes endonasal bony decompression, partial tumor removal, and stereotactic radiotherapy (SRT) in select cases. ⋯ Endonasal bony decompression and selective tumor removal, followed by SRT, appears to be a reasonable treatment option for most previously untreated parasellar meningiomas. For patients who have undergone previous debulking and RT, new targeted treatment strategies are needed.
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To lower external ventricular drain (EVD)-related infection rates, in April 2013, our institution enacted a major protocol change, switching from routine EVD replacement every 5 days to EVD replacement only when clinically indicated. In the present study, we evaluated the effect of this change on nosocomial EVD-related infections. ⋯ The findings from our study strengthen an increasing body of evidence suggesting the importance of inoculation of skin flora as a critical risk factor for EVD-related infections, underscoring the importance of drain changes only when clinically indicated and that, as soon as clinically permitted, catheters should be removed.
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The present study compared the clinical functional outcomes and new vertebral compression fractures (NVCFs) between percutaneous vertebroplasty (PVP) and conservative treatment (CT) in patients with severe pain due to acute osteoporotic vertebral compression fractures (OVCFs). PVP has been increasingly used for the treatment of pain in patients with OVCFs. However, the effectiveness of the procedure and whether it causes NVCFs has remained controversial. ⋯ Compared with CT, PVP provided a rapid decrease in pain and an early return to daily life activities, without an increase in the incidence of NVCFs.
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High-dose bevacizumab delivered via super selective intra-arterial cerebral infusion (SIACI) is one promising clinical trial combination for patients with glioblastoma (GBM). Although both continuous intravenous and intra-arterial administration of bevacizumab, and rechallenge with intravenous bevacizumab, have demonstrated improved survival, this is the first description of rechallenging GBM with SIACI of bevacizumab. ⋯ This is the first report to highlight the effect of rechallenging a patient with SIACI of bevacizumab following disease progression after initial bevacizumab treatment and subsequent alternate clinical trial failure. There is a need to conduct further clinical trials to evaluate the benefits of rechallenge with SIACI versus intravenous bevacizumab for GBM and further explore theories of bevacizumab resistance.