World Neurosurg
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These video cases present some unique technical tenets for microsurgical clipping of proximal internal carotid artery aneurysms (Video 1). The first patient is a 49-year-old woman with a history of a prior ruptured and treated right middle cerebral artery aneurysm who was found to have growth of known left middle cerebral artery and left internal carotid artery ophthalmic segment aneurysms on radiographic studies. An intradural clinoidectomy with Sonopet, with proximal control at cervical carotid and wide sylvian fissure exposure with ample sharp dissection of the aneurysm anatomy, allowed safe clipping of the ophthalmic aneurysm in this case. ⋯ A similar controlled intradural clinoidectomy, with proximal cervical ICA control and aneurysmal segment trapping, allowed safe aneurysm exclusion. For patients with multiple aneurysms such as in these cases, the deeper proximal aneurysm should generally be treated first. The videos illustrate some key technical points in this regard.
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In Cambodia, the most common victims of traumatic brain injury (TBI) are men 20-30 years of age involved in motor vehicle collision. Secondary injury sustained by these patients occurs during the time period between initial insult and hospital admission. Strengthening prehospital systems for TBI in low- and middle-income countries (LMICs) such as Cambodia is therefore a key element of the development agenda for universal health equity. We report a retrospective analysis of the relationship between prehospital delays and TBI outcomes among patients from a large government hospital in Cambodia. ⋯ In a retrospective cohort of >2000 patients with TBI from Cambodia, we found that increasing IAD was associated with worsening outcome, especially beyond the 4-hour threshold. These data should inform development of prehospital guidelines for TBI care in LMICs.
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Review Case Reports
Rupture of Thrombosed Cerebral Aneurysm During Antithrombotic Therapy for Ischemic Stroke: Case Report and Literature Review.
Thrombosed cerebral aneurysm (TCA) can cause cerebral infarction. However, treatment of cerebral infarction due to embolism from TCA is controversial because of the risk of rupture, and no consensus has been established for the treatment of patients with this condition. ⋯ We suggest that antithrombotic therapy might be avoided for these patients. Early surgical treatment without antithrombotic therapy is recommended to prevent aneurysm rupture and recurrent distal embolism from the TCA.
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Primary central nervous system lymphomas (PCNSLs) account for 1%-2% of primary central nervous system tumors. Until recently, treatment has centered on biopsy, radiotherapy, and high-dose methotrexate, without a clear role for cytoreductive surgery. The objective of this article is to compare the impact of biopsy versus cytoreductive surgery in outcomes of patients with PCNSL, including postoperative complications and survival. ⋯ The treatment of PCNSL is challenging and ever-evolving. Earlier, smaller studies failed to show the benefit of cytoreductive surgery over biopsy in patients with PCNSL. Larger, more recent series seem to show the possible benefit of cytoreductive surgery in PCNSL. Future well-designed prospective studies may help further elucidate the role of resection in the modern treatment of PCNSL.
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Case Reports
Success and Failure of Percutaneous Minimally Invasive Direct Pars Repair: Analysis of Fracture Morphology.
Spondylolysis is a defect in the pars interarticularis that typically presents with axial back pain. Recently, minimally invasive spine techniques have increased in popularity and have been applied to the Buck technique of direct pars repair. ⋯ Minimally invasive direct pars repair can be performed safely and effectively with shortened hospital stays and reduced morbidity. Fracture morphology and orientation could be important predictors of the success of surgery.