World Neurosurg
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The COVID-19 pandemic has had a profound impact on the global delivery of health care. Recent data suggest a possible impact of the pandemic on patterns of neurotrauma. The aim was to assess the impact of the pandemic on the incidence of neurotrauma, with a focus on cranial gunshot wounds (cGSWs) at a large Midwestern level 1 trauma center. ⋯ Despite the government-mandated shutdown, we observed an increase in the number of neurotrauma cases in 2020. There was a significant increase in the incidence cGSWs in 2020, with an increase in assaults and self-inflicted injuries. Further investigation into socioeconomic factors for the observed increase in cGSWs is warranted.
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In certain cases, the closing force of a single vascular clip is not sufficient for complete aneurysmal occlusion, and the use of multiple clips, or clip stacking, is required. Many stacking techniques have been described in the literature, such as in tandem stacking and overstacking. ⋯ Although this technique has been cited as a potential resource for certain aneurysms, descriptions of its characteristics and advantages are scarce. The purpose of this technical note was to discuss our experience with the piggyback clipping technique and use of a booster clip for a partially embolized and recanalized saccular posterior communicating artery aneurysm in a 50 year-old patient.
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To describe open reduction internal fixation (ORIF) with posterior C1-C2 instrumentation without fusion to treat displaced atlantoaxial fractures with later instrumentation removal. ⋯ Displaced atlantoaxial fractures have been traditionally managed with halo-vest immobilization closed reduction or ORIF with fusion. ORIF without fusion and subsequent hardware removal is an alternative approach. This strategy preserves mobility at C1-C2, avoids halo-vest immobilization, and appears to be a safe option for treatment of atlantoaxial fractures.
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Traumatic brain injury (TBI) disproportionately affects low- and middle-income countries (LMICs). In these settings, accurate patient prognostication is both difficult and essential for high-quality patient care. With the ultimate goal of enhancing TBI triage in LMICs, we aim to develop the first deep learning model to predict outcomes after TBI and compare its performance with that of less complex algorithms. ⋯ We present the first use of deep learning for TBI prognostication, with an emphasis on LMICs, where there is great need for decision support to allocate limited resources. Optimal algorithm selection depends on the specific clinical setting; deep learning is not a panacea, though it may have a role in these efforts.
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Case Reports
Failure of flow diverter endothelization visualized with optic coherent tomography technology.
We report a case of an intracranial aneurysm of the left posterior inferior cerebellar artery, which was treated with a flow-diverting stent. One year later at follow-up, the patient presented with new symptoms due to mass effect in the posterior fossa and a 3-fold enlargement of the aneurysm. Digital subtraction angiography showed an increase in size of the aneurysm with jet flow into the sac. ⋯ Parent vessel sacrifice was performed by coiling of the left vertebral artery. The patient had a codominant right vertebral artery and tolerated the procedure well. Two years later, follow-up magnetic resonance angiography showed significant decrease of the size of the aneurysm and symptom regression, with a modified Rankin scale of 1 (functionally independent).