World Neurosurg
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Recently, interspinous stabilization with the interspinous process device (IPD) has become an alternative to treat lumbar spinal stenosis. The biomechanical influence of different design features of IPDs on intradiscal pressure (IDP) and facet joint force (FJF) has not been fully understood. The aim of this study was to investigate the biomechanical performance of different IPDs using finite element (FE) method. ⋯ Compared with rigid fixation, the IPDs demonstrated less compensation at adjacent levels in terms of ROM, IDP, and FJF, which may lower the incidence of adjacent segment degeneration in the long term.
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Intracranial hemorrhage can be a devastating complication of endovascular thrombectomy (ET) after acute ischemic stroke increasing disability and mortality. Patients with low platelet count were excluded from major ET trials. This study explores the association between platelet count and intracranial hemorrhage after ET. ⋯ Risk of sICH after ET is low and comparable in patients with low and normal platelet counts. Low platelets should not exclude patients from undergoing intra-arterial therapy.
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Flow diversion is increasingly used for off-label treatments of distal circulation aneurysms. Reports of use in sub-2.0-mm vessels are scant. ⋯ Flow diversion can be safe and effective for aneurysms originating from vessels <2.0 mm in diameter. Heightened vigilance for the prevention and management of acute stent and vessel thrombosis is warranted in these cases.
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Diagnosis of idiopathic normal pressure hydrocephalus is based in clinical data, radiologic variables, and invasive cerebrospinal fluid (CSF) testing, such as the lumbar infusion test. Several neuroimaging findings are inconclusively related to improvement after CSF shunt surgery. CSF tests are invasive and have complications. The aim of this study was to select radiologic variables related to a positive lumbar infusion test so as to avoid this test in patients. ⋯ Owing to high positive predictive values of matched radiological variables, the lumbar infusion test could be avoided in the diagnosis of idiopathic normal pressure hydrocephalus. However, when 1 or 2 of the variables are negative, this invasive test should be performed.
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Case Reports
Distal Outflow-related Anterior Inferior Cerebellar Artery Aneurysm in Hemangioblastoma.
Anterior inferior cerebellar artery (AICA) aneurysm is a rare cerebral entity, and its presentation in association with a hypervascularized tumor is even more exceptional. In this study, we describe a patient with rare coexistent pathologic conditions in combination with a cerebellar hypervascularized tumor with an outflow-related AICA aneurysm. A 1-stage procedure to remove both lesions was carried out after meticulous discussion with patient. ⋯ At her 3-month follow-up visit, her condition remained stable for vasculopathologic states and neurologic functions. To our knowledge, this is the first published clinical experience regarding cerebellar HB coexistent with an AICA aneurysm that involved the efferent segment of the tumor's feeding vessel. Patients with coexistent vascular pathologic conditions should be aggressively treated, not by the wait-and-see practice, in case of unexpected rupture in the future.