World Neurosurg
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The indications for mechanical thrombectomy (MT) have expanded since the American Heart Association/American Stroke Association reported its first guidelines for MT in 2013. Multiple subsequent randomized clinical trials of MT have proved its efficacy, including the DAWN (DWI [diffusion weighted imaging] or CTP [computed tomography perfusion] Assessment with Clinical Mismatch in the Triage of Wake-up and Late Presenting Strokes Undergoing Neurointervention with Trevo) and DEFUSE-3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke-3) trials. The current guidelines from the American Heart Association/American Stroke Association provide class I support for the use of MT for the following indications: 1) internal carotid artery (ICA)/M1 middle cerebral artery (MCA) occlusion, symptom onset <6 hours, National Institutes of Health Stroke Scale score of ≥6, Alberta Stroke Program Early Computed Tomography Score of ≥6; and 2) large vessel occlusions in the anterior circulation, symptom onset 6-16 hours, and meeting the DAWN or DEFUSE-3 eligibility criteria. ⋯ In clinical practice, these class I and IIa indications for MT have been well followed. However, many other potential indications are available, including 1) M2 or M3 MCA occlusion, symptom onset <6 hours; 2) Alberta Stroke Program Early Computed Tomography Score <6, ICA or M1 MCA occlusion, symptom onset <6 hours; 3) National Institutes of Health Stroke Scale score <6, ICA or M1 occlusion, symptom onset <6 hours; 4) tandem occlusions; and 5) posterior circulation occlusion <6 hours. The present review analyzed the available data to provide support for further prospective clinical trials regarding these potential indications.
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Comparative Study
Comparison of Satellite Sign and Island Sign in Predicting Hematoma Growth and Poor Outcome in Patients with Primary Intracerebral Hemorrhage.
Satellite sign (SS) and island sign (IS) are novel noncontrast computed tomography (CT) predictors of hematoma growth. The aim of this study was to compare diagnostic performance of IS and SS in predicting hematoma growth and functional outcome in patients with intracerebral hemorrhage (ICH). ⋯ IS seems to be an optimal shape irregularity imaging marker for predicting hematoma growth and functional outcome in patients with ICH.
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Review Case Reports
Meningioma Presenting with Spontaneous Subdural Hematoma: A Report of Two Cases and Literature Review.
Although meningiomas are considered benign, encapsulated brain tumors, their distinct intracranial location can lead to devastating complications. Although a highly vascularized tumor, a rarely reported complication of meningioma is hemorrhage. To the best of our knowledge, only 19 cases of meningioma presenting with a subdural hematoma have been reported. ⋯ We comprehensively reviewed the pertinent data for meningiomas presenting as subdural hematomas. The mechanism of hemorrhage in meningiomas remains unclear. Therefore, further studies are required to investigate the possible mechanisms of bleeding in such tumors.
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Review Case Reports
A rare case of the postoperative symptomatic cyst formation after the resection of a large convexity meningioma.
Symptomatic cyst formation after brain tumor resection is a rare complication of the early postoperative phase. We describe a complicated case of postoperative symptomatic cyst formation after gross total removal of a convexity meningioma. ⋯ Even though formation of symptomatic cystic lesions after brain tumor resection is rare, neurosurgeons should be aware of such early postoperative complications and their management strategies.
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Checkpoint immunotherapy (CIT) is an emerging and exciting treatment modality for the treatment of cancer. Much excitement has ensued in the potential of CIT to revolutionize the treatment and prognosis of brain metastases. ⋯ However, several questions have arisen, in particular, the timing at which SRS and CIT should be administered relative to each other. We reviewed the reported data and attempted to offer a potential answer to this question.