World Neurosurg
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Review Multicenter Study
Decompressive craniectomy in children with severe traumatic brain injury: a multicentre retrospective study and literature review.
Severe traumatic brain injury (TBI) is the most common cause of disability in children. Refractory increased intracranial pressure can be a therapeutic challenge. Decompressive craniectomy can be proposed when medical management is insufficient, but its place is not clearly defined in guidelines. The aim of this study was to identify prognostic factors in children with TBI. ⋯ This study in a large population confirms that children with severe TBI treated by decompressive craniectomy can achieve a good neurologic outcome. Further studies are needed to clarify the use of this surgery in the management of children with severe TBI.
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Gross total resection of large intracranial meningiomas (LIMs) can be challenging and cause significant morbidity and mortality. The aim of this systematic review is to determine the clinical effectiveness and safety of stereotactic radiosurgery (SRS) either as primary or adjuvant therapy for LIMs with tumors ≥2.5 cm in maximum dimension (tumor volume ≥8.1 cm3). A total of 452 tumors in 496 patients (350 female [69.3%] and 146 male [30.6%]) with median age 60 years (48-65 years) were included. ⋯ Subgroup analysis revealed that there is 2-fold greater likelihood of improvement in clinical symptoms in patients with non-SS GKS than SS GKS (odds ratio 2.47; 95% confidence interval 1.38-4.44; P = 0.002). SRS is safe and effective in the treatment of LIMs as primary or adjuvant treatment. Further prospective studies are required to validate our results.
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After aneurysmal subarachnoid hemorrhage (aSAH), crystalloid fluids with a relatively high sodium concentration have been used to maintain the cerebral blood flow. However, the prophylactic delivery of water and sodium by intravenous (IV) infusion will not necessarily improve the prognosis of patients after aSAH, and the excessive supply of water and sodium can negatively affect the outcome. We hypothesized that the delivery of an optimal amount of water and sodium separately might improve the outcome after aSAH. ⋯ The separate delivery of optimal amounts of water and sodium could be a promising therapeutic strategy to improve the prognosis after aSAH.
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Randomized Controlled Trial Multicenter Study
Are Modic Vertebral End-plate Signal Changes associated with Degeneration or Clinical Outcomes in the cervical spine?
To report on the incidence of Modic changes (MCs) in patients with cervical radiculopathy due to a herniated disc. Presence of MCs was correlated to clinical outcomes and the presence of radiological degeneration. ⋯ MCs were not associated with neck pain, nor with arm pain. Furthermore, there was a tendency for a correlation between the presence of MCs and radiological degeneration.
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Intracranial atherosclerotic disease (ICAD) is a major cause of stroke worldwide. The optimal management of patients with symptomatic ICAD is controversial. Therefore, the aim of this systematic review is to compare medical management versus surgical bypass for the treatment of symptomatic ICAD. ⋯ Direct or indirect bypass surgery is a reasonable treatment option for appropriately selected patients with ICAD. Careful preoperative evaluation of hemodynamic parameters and the relevant donor and recipient vessels is crucial to maximizing the success of bypass for ICAD. Further studies remain necessary to clarify the roles of medical versus surgical management for ICAD.