World Neurosurg
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Comparative Study
Comparison of the CRASH-predicted and real outcome of TBI in a retrospective analysis of 417 patients.
The aim of this retrospective study was to externally validate the CRASH (Corticosteroid Randomisation After Significant Head Injury) clinical calculator as a prognostic tool. Mortality at 14 days and an unfavorable outcome (i.e., Glasgow Outcome Scale score <4) after 6 months were the primary endpoints. ⋯ The CRASH calculator is a good predictor of outcome in traumatic brain injury at 14 days and 6 months with high sensitivity and specificity. It does not replace clinical judgment of the physician treating the patient in the emergency department, but it constitutes a useful additional tool.
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Case Reports
Radial Arterial Access for Thoracic Intraoperative Spinal Angiography in the Prone Position.
Verification of complete occlusion or resection of neurovascular lesions is often performed using intraoperative angiography. Surgery for spinal vascular lesions such as arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) is typically performed with the patient in the prone position, making intraoperative angiography difficult. No standardized protocol is available for intraoperative angiography during spinal surgery with the patient in the prone position. We have described our experience using radial artery access for intraoperative angiography in thoracic spinal neurovascular procedures performed with the patient in the prone position. ⋯ Radial artery access for intraoperative angiography during spinal neurovascular procedures in which selective catheterization of a thoracic branch is necessary is feasible, safe, and practical.
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M2 occlusions represent 16%-41% of all middle cerebral artery occlusions, with >50% of functional independence achieved. The American Heart Association/American Stroke Association 2018 guidelines suggest that, with a level of evidence B-R, thrombectomy with stent retrievers may be appropriate for selected patients with M2 or M3 occlusions. The purpose of this study is to illustrate a new technique of distal (M2-M3) thrombectomy. ⋯ This technique allows a safe and effective distal thrombectomy for M2-M3 occlusions.
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Historically, practicing neurosurgeons have been key drivers of neurosurgical innovation. We sought to describe the patents held by U.S. academic neurosurgeons and to explore the relationship between patents and royalties received. ⋯ Few U.S. academic neurosurgeons (7.8%) receive royalties and hold patents (4.7%), with an even smaller select group having a patent h-index of ≥5 (1.6%).
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Letter Review Case Reports
Successful Surgical Management of Traumatic Intracranial Hemorrhaging after Revascularization Surgery for Moyamoya Vasculopathy: A Case Report and Review of Literature.
Traumatic intracranial hemorrhaging associated with revascularization surgery for moyamoya vasculopathy is a potentially devastating problem that requires meticulous management, including surgery. However, only a few studies on this subject have been reported, and the clinical characteristics are poorly understood. We report a case of successful surgical management for a patient with traumatic intracranial hematoma managed with encephalo-duro-arterio-myo-synangiosis (EDAMS). The purpose of this article is to clarify the specific features of clinical scenarios, hemorrhagic sites, and operative techniques by reviewing all published cases. ⋯ In moyamoya vasculopathy, intrinsic collaterals or de novo anastomoses from revascularization surgery are easily injured, even with mild head trauma. Furthermore, the administration of antiplatelets agents increases the risk of hematoma development. Sacrifice of collaterals can lead to acute cerebral infarction. During emergency surgery for traumatic intracranial hematoma, a careful surgical strategy is needed to preserve the collateral supply.