World Neurosurg
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This meta-analysis of published randomized controlled trials (RCTs) aimed to investigate the efficacy and safety of endovascular therapy (ET) for patients with acute ischemic stroke. ⋯ The findings of this meta-analysis suggest the incidence of a modified Rankin Scale score of 0-2 in patients who received ET was significantly increased. Moreover, the harmful effects of ET might exist due to greater risk of asymptomatic IH, subarachnoid hemorrhage, and non-intracerebral bleeding, and these results should be verified by further large-scale long-term RCT.
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A high-riding vertebral artery (HRVA) has been defined as a C2 isthmus height of ≤5 mm and/or internal height of ≤2 mm measured 3 mm lateral to the border of the spinal canal. Its reported prevalence has varied widely. If overlooked during the approach for craniocervical fusion, injury to the vertebral arteries can occur, affecting the outcome. The present meta-analysis aimed to provide the pooled prevalence of HRVAs. ⋯ Craniocervical fusion should be preceded by examination of the vertebral arteries at the level of C2 because the presence of HRVAs is common and might preclude the safe insertion of transarticular or transpedicular screws.
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Review Case Reports
Neurological Complications of Preoperative Embolization of Spinal Metastasis: A Systemic Review of the Literature Identifying Distinct Mechanisms of Injury.
Preoperative embolization of spinal metastases may improve outcomes of resection by reducing surgical blood loss and operative time. Neurologic complications are rarely reported and the mechanisms leading to injury are poorly described. ⋯ Neurologic injury is a risk of preoperative embolization of spinal metastasis from either compromise of spinal cord vascular supply or cranial stroke from reflux of embolic particles. Postprocedural tumor swelling rarely leads to clinical deficit. Awareness of these complications and the presumed mechanisms of injury may aid clinicians in implementing interventions and in counseling patients before treatment.
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Hematoma expansion (HE) is associated with poor outcome in patients with intracerebral hemorrhage (ICH), but the impact on patients with an left ventricular assist device (LVAD) is unknown. We aimed to define the occurrence of HE in the LVAD population and to determine the association between HE and mortality. ⋯ HE occurrence appears to be similar in LVAD and non-LVAD patients. HE has a significant impact on LVAD ICH mortality, underscoring the importance of adequate coagulopathy reversal and blood pressure management in these patients.
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Comparative Study
Microvascular Decompression Versus Stereotactic Radiosurgery for Trigeminal Neuralgia: A single institution experience.
Microvascular decompression (MVD) is the standard surgical procedure for patients with medically refractory trigeminal neuralgia (TN). Stereotactic radiosurgery (SRS) has gained increasing popularity as a less invasive technique. We report our institution's outcome in the surgical treatment of TN (MVD vs. SRS), taking patient's age and gender into consideration. ⋯ Factoring in patients' age and gender, both MVD and SRS can achieve a favorable outcome for medically refractory TN, although BNI scores of IV and V were more common with SRS.