World Neurosurg
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Obesity is an established risk factor for the development of acute ischemic stroke. However, its effect on clinical outcomes after acute ischemic stroke has remained controversial. In the present study, we evaluated the association of body mass index (BMI) on outcomes after mechanical thrombectomy (MT) for large vessel occlusion acute ischemic stroke (LVOS). ⋯ For LVOS patients treated with MT, a high BMI will not affect procedural success. However, it was independently associated with lower rates of functional independence in recanalized patients. Thus, the obesity paradox does not appear to pertain to MT, although larger prospective studies are necessary.
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Lumbar drains (LDs) are often used for temporary cerebrospinal fluid (CSF) diversion. However, limited data are available on the risk factors associated with complications. We reviewed our institutional LD data to identify the common indications and outcomes, including the risk factors associated with the occurrence of complications. ⋯ The most common complications in our institution were meningitis and low pressure headaches. Minimizing LD manipulation during CSF sampling could potentially decrease the risk of meningitis. Our protocol of continuing routine prophylactic antibiotics for patients with an indwelling LD might reduce the risk of meningitis; however, the results from a prospective cohort study would provide stronger evidence.
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Comparative Study
Microsurgical Techniques for Exposing the Internal Maxillary Artery in Cerebral Revascularization Surgery: A Comparative Cadaver Study.
The internal maxillary artery (IMAX) is currently considered one of the main donor vessels in extracranial-to-intracranial bypass surgeries. Four main techniques for harvesting the IMAX have been described: via the anterior medial infratemporal fossa (AMITF), the middle infratemporal fossa (MITF), the anterior lateral middle fossa (ALMF), and the lateral middle fossa (LMF). The advantages and limitations of these techniques have not yet been systematically evaluated and compared. ⋯ Advantages of the AMITF and MITF techniques include anatomic simplicity, absence of skull base drilling, and greater discretion in muscle dissection. These properties can simplify the anastomosis procedure compared with the ALMF and LMF techniques. Identification of the IMAX pattern is important before selecting the approach for this bypass operation.
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Practical ultrasound (US) training is essential to overcome operator dependence and optimize image acquisition. For intraoperative neurosurgical application, in addition to hand-eye coordination, ultrasound training should incorporate training for visuomotor and visuospatial skills, as well as 3-dimensional depth orientation. Our agar-based, low-cost model has been developed keeping these skill sets in mind. ⋯ Our customizable low-cost US training model is an effective and efficient tool for US training with high acceptance by neurosurgeons. It faithfully mimics various intraoperative tasks and helps clinicians gain confidence to use intraoperative ultrasound as an adjunct during the procedures. This model can be used by individual surgeons/departments for ongoing training, as well as for larger training courses and workshops.
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Comparative Study
Concurrent vs Staged Procedures for VPS and Cranioplasty: A 10-year Retrospective Comparative Analysis of Surgical Outcomes.
Many patients undergoing decompressive craniectomy will develop persistent hydrocephalus before cranioplasty. Therefore, surgeons must decide whether to perform ventriculoperitoneal shunt (VPS) placement and cranioplasty simultaneously or in staged procedures. With limited, conflicting data reported, this decision has often been made by personal preference. The objective of the present study was to compare the surgical outcomes between patients undergoing concurrent or staged VPS placement and cranioplasty. ⋯ Because of the trend toward a reduced reoperation rate, the significantly reduced rate of hospital-acquired infection, and the reduction in the number of surgeries, we recommend that patients awaiting cranioplasty in the setting of persistent hydrocephalus undergo concurrent VPS placement and cranioplasty rather than staged procedures.