World Neurosurg
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Bioinformatics analysis integrating microenvironmental factors and single cell analysis segregated the glioblastoma (GBM) subtype into 3 subtypes: proneural, classic, and mesenchymal. Mesenchymal GBM tends to have the worst survival but benefits from aggressive treatment protocols. Therefore, it is clinically meaningful to identify relevant biomarkers to distinguish the mesenchymal subtype. Moreover, in developing nations with limited resources, rigorous examinations are costly and inefficient for patient care. ⋯ By using available online glioma databases, our study provided an insight into the expression of POSTN as an independent predictor for patients with glioma (GBM and LGG) and could be useful for diagnostic simplification to identify high-risk groups.
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Ventriculostomy-related infection (VRI) is associated with potential serious morbidity, extended hospitalization duration, increased health care costs, and mortality. We assessed the effectiveness of a pragmatic risk-stratification pathway for external ventricular drain (EVD) management, allowing for surgical decision making, in reducing the rate of VRIs. ⋯ The introduction of a pragmatic evidence-based risk-stratification pathway, in which different options for EVD management are incorporated, results in low EVD infection rates across a multisite institutional practice. Our results are comparable to published protocols involving the implementation of standard care bundles and/or antibacterial EVDs alone, in reducing VRIs.
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Ultrasonographic elastography imaging visualizes the elastic properties of tissues to distinguish pathologic and healthy areas. Real-time elastography measures relative tissue hardness by evaluating changes in local strain in response to external forces. ⋯ We objectively describe the elastographic patterns of different types of brain tumors (i.e., gliomas, metastases, and meningiomas). We have identified differences in both the tumors and the peritumoral areas of these histologic types.
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Two main types of embolic protection devices have been used during carotid artery stenting (CAS): distal protection devices (DPDs) and proximal protection devices (PPDs). We compared the complications, clinical outcomes, and new ischemic lesions on diffusion-weighted magnetic resonance imaging (DWI) studies between patients who had undergone CAS using a DPD or PPD. ⋯ The number of new ischemic lesions per patient and the incidence of ischemic lesions found on DWI were significantly greater in the DPD than in the PPD group. The lack of differences in the periprocedural and 30-day adverse rates between the 2 groups suggests that cerebral microemboli might not be associated with the clinical outcomes. For patients with poor collateral status, DPDs should be used preferentially to avoid the neurologic compromise associated with PPDs.
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Quantitative magnetic resonance angiography (qMRA) using noninvasive optimal vessel analysis (NOVA) is a novel noninvasive imaging technique that is being increasingly used to measure blood flow in extracranial and intracranial arteries. By providing important quantitative flow data, NOVA qMRA can facilitate the management of cerebrovascular disease. While the same technology can also be applied to measure flow in intracranial and extracranial veins, NOVA quantitative MRV (qMRV) is only rarely used in neurovascular practice. ⋯ To the best of our knowledge, this is the first report of successful clinical application of NOVA qMRV in adult patients with intracranial arteriovenous malformations or dural arteriovenous fistulas. We propose that NOVA qMRV is a promising technique for noninvasive measurement of intracranial and extracranial venous blood flow and for monitoring treatment effectiveness in patients with intracranial arteriovenous shunt lesions.