World Neurosurg
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Intracerebral hemorrhage (ICH) is the most devastating form of stroke, with thalamic hemorrhages carrying the worst outcomes. Minimally invasive (MIS) endoscopic ICH evacuation is a promising new therapy for the condition. However, it remains unclear whether therapy success is location dependent. Here we present long-term functional outcomes after MIS evacuation of spontaneous thalamic hemorrhages. ⋯ Among patients with ICH undergoing medical management, those with thalamic hemorrhages have especially poor outcomes. This study suggests that MIS evacuation can be safely performed in a thalamic population. It also presents long-term functional outcomes that can aid in planning randomization schemes or subgroup analyses in future MIS evacuation clinical trials.
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Carbamazepine (CBZ) is the first-line therapy for trigeminal neuralgia (TN), and microvascular decompression (MVD) is considered to be an effective surgical treatment for TN. However, the effect of preoperative CBZ treatment on MVD outcome is not clear. ⋯ For patients with classical TN, a longer preoperative medication history of CBZ treatment had no significant effect on short-term outcome of MVD, but CBZ treatment was associated with a poor long-term outcome following MVD.
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Technical skill acquisition is an essential component of neurosurgical training. Educational theory suggests that optimal learning and improvement in performance depends on the provision of objective feedback. Therefore, the aim of this study was to develop a vision-based framework based on a novel representation of surgical tool motion and interactions capable of automated and objective assessment of microsurgical skill. ⋯ Automated and objective analysis of microsurgery is feasible using a mask region convolutional neural network, and a novel tool motion and interaction representation. This may support technical skills training and assessment in neurosurgery.
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This paper uses head and neck magnetic resonance angiography (MRA) images in the diagnosis of acute ischemic stroke (AIS), as well as the neurologic rehabilitation and the effect of rehabilitation treatment in patients with acute stroke. ⋯ Examination can effectively assess cerebral hemodynamic changes, the severity of ischemia, and accurately distinguish between infarct area and penumbra. MRA images of the head and neck can accurately detect the location and degree of cerebral artery stenosis. The combination of the two methods can not only accurately diagnose AIS, but also evaluate the condition and efficacy of the disease, and provide an imaging basis for the clinical choice of reasonable treatment options. Comprehensive rehabilitation care can significantly improve the neurologic function and quality of life of prospective patients.
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This study aims to examine the risk factors that can cause intraoperative rupture (IOR), and especially, the role of surgical experience. To our knowledge, this is the first study to analyze the effect of the surgeon's experience on the IOR rate in 2 different perspectives. ⋯ Increased surgical experience reduces the IOR rate from 10%-11% to 4%-5% after an average of 250 aneurysm operations. However, this rate does not decrease further with more experience. To our knowledge, a learning curve regarding IOR is presented for the first time in the literature.