World Neurosurg
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Review Case Reports
Intracranial DAVF as a reversible cause of dementia: case series and literature review.
Intracranial dural arteriovenous fistulas (DAVFs) can manifest with a reversible form of dementia and parkinsonism that may be related to medullary venous hypertension and impaired cortical venous drainage. We report a consecutive case series of patients with DAVFs who presented with cognitive decline and report angioarchitecture and outcomes of treatment. ⋯ Cognitive decline is a rare but reversible manifestation of DAVFs that have impaired venous drainage of the transmedullary veins and associated medullary venous hypertension.
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Comparative Study
The Need For Grass Root Innovation In Developing Countries: A Case For Stationary Binder Clips In Scalp Hemostasis.
The primary training in any surgical practice starts with tissue handling and effective hemostasis. Neurosurgical procedures start with an incision in the scalp and require summative use of mechanical hemostats and bipolar coagulation to achieve hemostasis. Though Raney clips are the most popular and effective in maintaining hemostasis, their high cost and nonreusability become deterrents for routine use in resource-stricken environments. ⋯ Stationery binder clips are a cost-effective, ready-to-use alternative for standard Raney clips.
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Review Case Reports
Management of Choroid plexus tumors in infants and young children up to 4 years of age: An institutional experience.
Choroid plexus tumors (CPTs) are rare tumors characterized by papillary and intraventricular growth. The young age of presentation of such tumors, especially in infants, and the lack of consensus on adjuvant therapy in case of atypical choroid plexus papilloma (aCPP) and choroid plexus carcinoma (CPC) create dilemma for the management of such tumors. We discuss the presentation, management, complications, and outcome in 15 patients (children 4 years of age and younger) and review pertinent literature. ⋯ CPTs are challenging tumors in infants and very young children because of the potential for massive blood loss. CPP is associated with lesser blood loss and favorable outcome compared with aCPP and CPC. Massive blood loss in CPC and aCPP can be life threatening as has been shown in our series. CPC has a rapid proliferation potential as shown in one of our cases. Attempts at decreasing vascularization of such tumors should be made by various methods, including preoperative embolization and neoadjuvant chemotherapy; however, a consensus on this is lacking.
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Randomized Controlled Trial
Prediction of Objectively Measured Physical Activity and Self-Reported Disability Following Lumbar Fusion Surgery.
To investigate the predictive value of preoperative fear-avoidance factors (self-efficacy for exercise, pain catastrophizing, kinesiophobia, and depression), walking capacity, and traditional predictor variables for predicting postoperative changes in physical activity level and disability 6 months after lumbar fusion surgery in patients with chronic low back pain (LBP). ⋯ Patients with low levels of preoperative physical activity were more likely to increase their level of physical activity after lumbar fusion surgery, especially when their self-efficacy for exercise was high. However, most of these patients still had low levels of physical activity after surgery, and they may therefore need extra support in increasing their postoperative physical activity levels.
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Surgery for depressed skull fractures has developed over centuries to attain the consensus approaches currently used. This review outlines the last 200 years of development of surgical approaches to closed and open depressed skull fractures, fractures involving dural venous sinuses and ping-pong fractures involving infants. ⋯ However, experience has shown that each fracture category merits its own management strategies. Accepted approaches are based on observation only; there is little to no scientific evidence to support treatment for any fracture type.