World Neurosurg
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Hyponatremia has been frequently observed after aneurysmal subarachnoid hemorrhage (SAH), and some data have suggested a correlation with symptomatic cerebral vasospasm and poor outcomes. The present prospective study investigated sodium and water disturbances after aneurysmal SAH with regard to symptomatic vasospasm and patient outcomes. ⋯ Distinguishing early- and late-onset hyponatremia is of major relevance, because different therapeutic approaches are required. Only hyponatremia at discharge resulted in less favorable outcomes.
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Case Reports
Stabbing injury of the cervical spinal cord resulting in complete bilateral proprioception loss.
Direct penetrating trauma to the spinal cord as a result of stabbing is rare. The vertebral column is strongly suited to protecting the vital neural structures underneath, especially in the midline. ⋯ Owing to the strength of the protective elements of the osseous structures surrounding the spinal cord, direct stabbing injuries usually result in incomplete neurologic deficits. This is generally manifested as a Brown-Sequard syndrome because of the midline ligamentous structures and spinous processes deflecting injuries laterally. Our patient experienced a direct midline puncture, resulting in a unique case of bilateral dorsal column injury. These injuries are generally treated conservatively, in the absence of a retained foreign body. Spinal cord stabbing injuries are a rare entity with interesting clinical and anatomic correlations.
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To evaluate the 30-day outcomes of using the Enterprise stent to treat patients with hypoperfusion of symptomatic severe intracranial stenosis. ⋯ Enterprise stents were relatively safe in treating patients with hypoperfusion of symptomatic severe intracranial stenosis.
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A number of randomized controlled trials have shown the benefit of drain placement in the operative treatment of chronic subdural hematoma (CSDH); however, few reports have described real-life results after adoption of drain placement into clinical practice. We report the results following a change in practice at Helsinki University Hospital from no drain to subdural drain (SD) placement after burr hole craniostomy for CSDH. ⋯ The change in practice from no drain to use of an SD after burr hole craniostomy for CSDH effectively reduced the 6-month recurrence rate with no effect on patient outcomes, infections, or other complications.
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Cerebrospinal fluid (CSF) leak remains a significant complication of posterior fossa tumor surgery. The goal of this study was to evaluate the wound CSF leakage rate in pediatric patients who underwent fourth ventricle tumor resection in a single-site setting and to explore the association of CSF leakage with the length of stay in the intensive care unit (ICU) and with dural sealant application. ⋯ The low CSF leakage rate (2.8%) identified in this study was associated with a certain algorithm of patient management. There was no strong evidence that the CSF leakage rate was associated with the length of stay in the ICU or with dural sealant application.