World Neurosurg
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Randomized controlled trials comparing endovascular thrombectomy (EVT) versus EVT preceded by intravenous thrombolysis (EVT + IVT) for acute ischemic stroke due to large artery occlusion remain controversial. This systematic review and meta-analysis seek to compare these 2 modalities. ⋯ EVT is non-inferior to EVT + IVT. In centers capable of both EVT and IVT, if timely EVT is feasible, it is reasonable to skip bridging IVT and keep rescue thrombolysis at the discretion of the interventionist for patients presenting within 4.5 hours of anterior ischemic stroke.
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Although magnetic resonance imaging is the primary modality of investigation for determining the extent of posterior ligamentous complex (PLC) injuries in lower lumbar fractures (LLF) (L3-L5), the reliability of computed tomography (CT) has not been well defined. The main objective of this study is to analyze the diagnostic accuracy of combined CT findings for detecting PLC injury in patients with LLF. ⋯ Among the various CT parameters, facet joint diastasis (FJDS > 4.2 mm and FJDA > 3.5 mm) is the most reliable factor in determining PLC injury.
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Postoperative surgical site hematoma (SSH) following lumbosacral surgery carries significant morbidity and increased length of stay (LOS). Intravenous tranexamic acid (ivTXA) has been shown to reduce SSH rate. Topical TXA (tTXA) could benefit patients with contraindications to ivTXA. However, this has not been widely studied. We sought to demonstrate that a quality improvement (QI) protocol using tTXA with/without ivTXA in patients undergoing elective open and minimally invasive lumbosacral surgery could decrease the SSH rate and LOS with no increase in associated complications. ⋯ Our Quality Improvement (QI) project successfully increased compliance with the use of tTXA. Post-implementation rate of SSH requiring evacuation and LOS was significantly lowered with no associated complications.
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Currently, tranexamic acid (TXA) is the most widely used antifibrinolytic agent in spine surgery and has been proven to reduce perioperative blood loss. However, the safety of high-dose regimens remains in established. ⋯ This retrospective case series demonstrates that the use of high-dose TXA provides is potentially safe and efficacious in adult patients undergoing complex spine surgeries. However, further investigations are required before the true safety and optimal dosing can be determined for high-dose TXA.
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Letter Retracted Publication
Spinal dysraphism-perspectives from a Southeast Asian paediatric neurosurgical unit.