World Neurosurg
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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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Case Reports
H3k27m- Positive Primary Spinal Gliobastoma Presenting With Haemorrhage- A Rare Clinical Entity.
Primary spinal glioblastoma multiforme is a rare and aggressive spinal tumor with dismal outcomes CASE DESCRIPTION: We have presented an unusual case-the first, to the best of our knowledge, to be reported-with intratumoral hemorrhage and sudden-onset quadriplegia in a patients with primary spinal glioblastoma multiforme. The patient underwent emergency surgical decompression. The patient died after a prolonged intensive care unit stay. ⋯ The tumor was positive for histone molecular alteration, H3K27M.
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To evaluate the health-related quality of life (HRQoL) in patients with carotid stenosis and identify the predictive factors that affect the mental health status in patients after carotid endarterectomy (CEA). ⋯ Contralateral stenosis, dizziness improvement, and hoarseness may be the predictive factors that affect the mental health status in patients after CEA.
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A subset of patients with chronic subdural hematoma (CSDH) remains refractory to standard treatment with hematoma drainage by burr-hole craniotomy and irrigation. We recently reported the usefulness of middle meningeal artery (MMA) embolization for intractable CSDH in patients with multiple intractable risk factors. We present the midterm outcomes of MMA embolization in patients with intractable CSDHs. ⋯ Despite the known unfavorable outcomes of patients with intractable CSDHs, MMA embolization was not associated with recurrent CSDH or rehospitalization in our department in the current case series. MMA embolization should be considered a preferred therapeutic option for intractable CSDHs.
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Postoperative Pulmonary Complications Following Brain Tumor Resection: A National Database Analysis.
There is sparse literature that investigates the adverse effects of postoperative pulmonary complication (PPCs) specifically in postcraniotomy tumor patients. In this study, we describe the rate of PPCs, determine predictive factors, and delineate associations with adverse outcomes. ⋯ There are several predictive factors of PPCs in patients that undergo surgical resection of brain tumors, and PPC development is associated with numerous adverse outcomes. It is critically important to understand and, if possible, mitigate controllable circumstances that may reduce morbidity and mortality associated with PPCs.