World Neurosurg
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To compare the safety and efficacy of stenting with drug-eluting stent (DES), stenting with bare mental stent (BMS), and angioplasty alone with drug-coated balloon (DCB) in patients with symptomatic vertebral artery origin stenosis (VAOS) who did not respond to aggressive medical management. ⋯ In patients with symptomatic VAOS who did not respond to aggressive medical management, stenting with DES shows superiority in the lowering the restenosis rate compared with stenting with BMS. Angioplasty alone with DCB is associated with the slowest progression of stenosis in spite of moderate residual stenosis.
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Intrameningeal cysts are rare lesions without definitive etiologies that can involve the dura or arachnoid mater. Spinal arachnoid cysts have been described, and several different etiologies have been hypothesized. This includes one-way valve mechanisms, traumatic herniation of arachnoid through the dura, and abnormal arachnoid membrane proliferation. To the authors' knowledge, no such descriptions exist regarding purely dural-based cystic lesions; however, the authors hypothesize similar mechanisms may be involved. Most notably, a traumatic injury to the dura leading to a one-way valve mechanism may allow for egress of cerebrospinal fluid between the dural layers, splitting them open. This progressive enlargement can lead to displacement of neural elements and subsequent neurological compromise. ⋯ Ventral panspinal cysts are an exceedingly rare cause of radiculopathy and myelopathy that can be resolved by an intracystic blood patch.
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To evaluate the reliability and usefulness of cervical flexion/extension magnetic resonance imaging (MRI) as a tool for decision-making regarding treatment of symptomatic cervical spondylosis. ⋯ Flexion/extension MRI studies were useful for assessing patients with cervical degenerative spine disorders regarding the surgical indication, direction of the approach, and use of multilevel instrumentation, especially for patients with early cervical myelopathy.
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Patients with multiple intracranial atherosclerotic stenoses often present with hemodynamic instability in 2 remote regions without a reciprocal vascular network. In this situation, revascularization to each region may be required. ⋯ In patients with severe hemodynamic instability in the remote unilateral MCA and contralateral anterior cerebral artery regions, as in our 2 cases, ipsilateral STA-MCA and ipsilateral STA-radial artery graft-contralateral A3 bypasses in one stage can be a treatment option.
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Both unfractionated heparin (UH) and low-molecular-weight heparin (LMWH) are routinely used prophylactically after traumatic brain injury (TBI) to prevent deep vein thrombosis (DVT). Their comparative risk for development or worsening of intracranial hemorrhage necessitating cranial decompression is unclear. Furthermore, the absence of a specific antidote for LMWH may lead to UH being used more often for high-risk patients. This study aims to compare the incidence of delayed cranial decompression occurring after initiation of prophylactic UH versus LMWH using the National Trauma Data Bank. ⋯ Despite the absence of a specific antidote, LMWH was associated with lower rates of need for post-DVT-prophylaxis in craniotomy/craniectomy. This finding questions the notion of UH being safer for patients with TBI because it can be readily reversed. Randomized studies are needed to elucidate causality.