World Neurosurg
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Review Case Reports
Misdiagnosis and delay of diagnosis in hemorrhagic meningioma: a case series and review of the literature.
To evaluate the clinicoradiologic characteristics of hemorrhagic meningiomas (HMs) that are missed or misdiagnosed on radiologic imaging studies. ⋯ Our study showed that in patients with HM with inadequate imaging evaluation, a small tumor associated with massive hematoma and atypical imaging features was more likely to be misdiagnosed.
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To explore the safe duration of temporary clipping of the parent artery under intraoperative electrophysiological monitoring. ⋯ Temporary intraoperative block is the risk factor for cerebral ischemia after operation. In this study, the temporary clipping time of the parent artery should not be longer than 6 minutes, and there is approximately 1 minute to adjust the current procedure after the electrophysiological warning to restore the baseline of intraoperative electrophysiological monitoring.
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To determine whether vertical laminar fracture (VLF) can distinguish between AO type A3 and A4 fractures. ⋯ We found VLF to be highly specific, sensitive, and reliable in detecting A4 fractures. A higher proportion of A4 fractures with VLF had radiographic parameters and neurological deficit than A4 fractures with no VLF. VLF could be used as a severity modifier to further discriminate A3 and A4 fractures regarding severity and potentially guide treatment decision making.
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The clinical outcomes of balloon kyphoplasty (BKP) for split-type osteoporotic vertebral fractures (OVF) are poor. These may be owing to the vertebral body bifurcating anteriorly and posteriorly when a load is applied and the filled cement being unstable. We report the usefulness of BKP combined with pediculoplasty using cannulated screws (vertebra-pediculoplasty) for OVF with a risk of cement dislodgement. ⋯ Vertebra-pediculoplasty could be an effective method for managing OVF with a high risk of cement dislodgement, which has been difficult to treat using conventional BKP.
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Review Meta Analysis
Effects of various therapeutic agents on vasospasm and functional outcome following aneurysmal subarachnoid hemorrhage - Results of a network meta-analysis.
Vasospasm and delayed ischemic neurologic deficits are the leading causes of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). Several therapeutic agents have been assessed in randomized controlled trials for their efficacy in reducing the incidence of vasospasm and improving functional outcome. The aim of this network meta-analysis is to compare all these therapeutic agents for their effect on functional outcome and other parameters after aSAH. ⋯ Our analysis showed that nicardipine prolonged-release implants and cilostazol were associated with the best chance of improving favorable outcome and mortality in patients with aSAH. However, larger multicentric studies from other parts of the world are required to confirm these findings.