World Neurosurg
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Advances in acute and long-term poststroke care have resulted in improved survival and functional outcomes for patients who have suffered large vessel ischemic strokes. For years, tissue plasminogen activator was the mainstay of treatment for acute stroke. Its use was previously limited to patients without known comorbid intracranial vascular pathology because of concern for bleeding risk. More recently, however, the use of tissue plasminogen activator in select patients with vascular anomalies has increased and is now largely thought to be safe. With the safety and efficacy of mechanical thrombectomy now proven for large vessel occlusions (LVOs), similar investigation is needed to assess procedural safety in patients with concomitant arteriovenous (AV) malformations or fistulae. ⋯ Although limited by small size, our series adds to the literature evidence that mechanical thrombectomy for LVO can safely be performed with concomitant dural AV fistulae and AV malformations.
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We evaluated the spinal cord injury range in patients with tethered cord syndrome (TCS) who had urinary incontinence. ⋯ DTI can detect the spinal cord damage range in patients with TCS. In the patients with urinary incontinence, the spinal cord damage was widespread, and the most severe lesion was at the fourth segment above the conus medullaris. This might indicate that decompression of the spinal cord should at least include the fourth segment above the conus medullaris.
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Occipitalization of the atlas (OA) often is associated with atlantoaxial dislocation and basilar invagination. The purpose of this study is to determine the biomechanical difference between normal and OA conditions in the craniovertebral junction and to further explore the rationale for development of atlantoaxial dislocation and basilar invagination using the finite element model (FEM). ⋯ The OA could result in hypermobility of the atlantoaxial segment and cause overstress in the transverse ligament and the lateral atlantoaxial joints. These changes explain the pathogenesis of atlantoaxial dislocation and basilar invagination associated with OA. Follow-up should be scheduled regularly due to the nature of the dynamic development of atlantoaxial dislocation and basilar invagination.
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To evaluate the efficacy and safety of posterior multiple-level asymmetrical Ponte osteotomies for rigid adult idiopathic scoliosis. ⋯ The surgical procedure of multiple-level asymmetrical Ponte osteotomy is a safe and effective technique, with reduced operation time, blood loss, and complications, and may offer an appropriate option to address the problems of rigid adult idiopathic scoliosis.
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Verapamil, a calcium-channel blocker, has shown promising results on cerebral vasospasm. However, it has not yet been accepted for treatment or prevention purposes because of the associated side effects. Although the effective results of nimodipine and nicardipine's intrathecal administration are well known, intrathecal verapamil has not been considered earlier. We used an experimental subarachnoid hemorrhage-induced vasospasm model for the evaluation of vasodilator and neuroprotective effects of intrathecal verapamil. ⋯ Our findings suggest that intrathecal verapamil can prevent vasospasm, oxidative stress, and apoptosis after experimental subarachnoid hemorrhage.