World Neurosurg
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The impact of household economics on outcomes is not well understood. We examined the relationship of income and surgical outcomes, after controlling for numerous patient characteristics. ⋯ Patients matched on a multitude of characteristics, of lesser household income, had higher long-term mortality after brain tumor resection. Further understanding of this disparity should be sought and differences mitigated.
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Congenital intranasal encephaloceles (ECs) are rare malformations of the pediatric age, complex to diagnose and treat, above all if associated with genetic syndromes or concomitant dysmorphisms. The aims of the study were to report our experience in managing nasal ECS in children, to evaluate the efficacy and safety of the transnasal endoscopic repair, and to analyze in an overall way the surgical long-term outcomes. Moreover, we sought to contribute to the debate on pathogenesis of ECs, investigating possible related risk factors described in the literature. ⋯ Endonasal endoscopic management of congenital ECs is feasible in children, although regular long-term follow-up is essential. Furthermore, the surgical approach does not seem to affect patients' development and quality of life, although more studies and validated questionnaires are needed. No recurrent risk factors were observed able to justify a certain etiologic relation.
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Unilateral vertebral artery (VA) injury is thought to not result in serious complications. The dominant-side VA should be preserved, although the importance of the nondominant-side VA has not been discussed. The injury of VA terminating posterior inferior cerebellar artery (PICA-VA) may result in cerebellar infarction. The characteristics of PICA-VA were evaluated. ⋯ Whether PICA-VA injury causes complications is not obvious. However, PICA-VA should also be preserved considering that potential risks exist. If the VA is small or shows a large difference in diameter between sides, special care should be taken during cervical spine surgery.
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Brain metastasis is rare in patients with hepatocellular carcinoma (HCC). The combination of an anti-programmed death 1 inhibitor and an anti-vascular endothelial growth factor drug provides therapeutic opportunities for refractory patients. So far, there are no data on the efficacy of these combined therapies for patients with HCC brain metastasis. ⋯ This case report highlights the efficacy of toripalimab and apatinib in the management of brain metastasis from HCC.
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Case Reports
Double microcatheter technique within a 5 French guiding catheter for intracranial aneurysm: technical notes.
The double microcatheter technique (DMT) is a common technique for treating intracranial aneurysms with endovascular coiling. The DMT is usually performed with 6 Fr guiding catheters. However, to the best of our knowledge, this technique using 5 Fr guiding catheters has not been reported. We report a DMT using a 5 Fr guiding catheter and the thoughts and tenets to make this possible. ⋯ The DMT using a 5 Fr guiding catheter can be performed if the sum of the outer diameters of the 2 microcatheters is less than the inner diameter of the 5 Fr guiding catheter. This technique could be a safe and effective option for treatment of broad-necked aneurysms, especially in the case of an elderly patient with tortuous vasculature or posterior circulation.