World Neurosurg
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Antiplatelet therapy is common and complicates the operative management of subdural hematomas (SDH). The risk of reoperation inferred by antiplatelet medication and the ability of platelet transfusion to reduce hemorrhagic complications in patients presenting with antiplatelet associated SDHs are poorly defined. ⋯ Antiplatelet medication was not a significant predictor of reoperation following evacuation of an acute or mixed-density SDH. In patients on antiplatelet medication, preoperative platelet transfusion did not reduce reoperation rates.
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The term anterior communicating (ACom) aneurysm is often broadly used to classify any aneurysm formed on the A1-A2 junction, A1, A2, or ACom arteries. Aneurysm location has been associated with rupture risk, so whether an aneurysm is truly formed on the ACom artery can critically affect treatment decisions. The aim of this study was to reclassify broadly termed ACom aneurysms into 4 subgroups (A1, A2, true ACom, and A1-A2 junction) based on their location. ⋯ We found only 13% of the aneurysms initially referred to as ACom to be true ACom aneurysms. A more nuanced approach to ACom aneurysm classification may better guide management strategies.
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An integrated multimodality approach can be effective in treatment of high-grade dural arteriovenous fistulas. Nevertheless, this requires a high level of efficient cooperation between different departments, underlying a degree of bias in the decisional process. In comparison, hybrid capability, integrating these modalities in one hand, may allow aggregating multimodality treatment strategies by pooling their individual benefits, leading to a more holistic view of the consequences of each modality. ⋯ Hybrid capability has great potential in the treatment of complex neurovascular lesions. It remains to be seen if a single surgeon with hybrid capability can supersede the current multidepartmental practice and achieve better outcomes.
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When lumbar stenosis involves spondylolisthesis, many surgeons include fixation. Two recent trials have shown no consensus to definitive treatment. We aimed to add to the discourse of fusion versus decompression in patients with lumbar spondylolisthesis by providing a large-scale generalizable study. ⋯ Unplanned return to the operating room and major and minor adverse events were greater for patients undergoing fusion. This could influence future decision-making in lumbar spondylolisthesis. This study indicates that further investigation is warranted but that decompression may be associated with less morbidity in the properly selected patient.
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The present study evaluated the relationships among perioperative hyperchloremic metabolic acidosis (HCA), hyperchloremia, and postoperative acute kidney injury (AKI) in patients who had undergone craniotomy for intracranial hemorrhage (ICH). ⋯ Perioperative HCA was independently related to an increased incidence of AKI after craniotomy for ICH. An increase in Cl- levels and perioperative hyperchloremia were associated with increased development of HCA but were not significantly related to the development of postoperative AKI.