World Neurosurg
-
Thromboembolic events are critical complications in neuroendovascular procedures, and dual antiplatelet therapy (DAPT) can reduce them. The effects of using aspirin and clopidogrel in DAPT are well characterized, but use of aspirin and ticagrelor has been less studied. ⋯ Our study showed that DAPT with ticagrelor (90 mg every 12 hours) and aspirin (100 mg/day) is a safe and effective alternative to DAPT with clopidogrel (75 mg/day) and aspirin (100 mg/day) for patients with an inadequate response to clopidogrel.
-
To investigate the incidence of and factors influencing postoperative delirium (POD) in Parkinson disease after deep brain stimulation (DBS) surgery. ⋯ The study findings provide convincing evidence of the relationship between visual dysfunction and the risk of POD. In view of the higher risk of POD, visually impaired patients with PD should undergo closer monitoring after DBS surgery.
-
The bleeding risk and outcome of pregnant women harboring intracranial arteriovenous malformations are still unclear, and no consensus has been achieved on management timing and strategy. ⋯ Women harboring intracranial arteriovenous malformations appear to have a greater risk of hemorrhage during pregnancy. There is an increased bleeding risk in the later stages of gestation, whereas delivery and puerperium are less risky phases. Outcomes are relatively good for the mother, with low rates of mortality and unfavorable sequelae, but there is a risk of miscarriage for the fetus. Intervention should be undertaken prophylactically before pregnancy or during early gestation if possible. For pregnant women who deferred treatment, multidisciplinary management is advised.
-
Review
Effect of lumbar discectomy or lumbar decompression on axial back pain - Results of a meta-analysis.
This meta-analysis evaluated the impact of lumbar disk herniation and lumbar spinal stenosis (LSS) on axial back pain and the extent of improvement of axial and radicular pain following lumbar decompression and discectomy surgery in patients with low back pain (LBP). ⋯ This meta-analysis provides evidence that lumbar discectomy and decompression are effective in improving axial LBP in patients with lumbar disk herniation and LSS.
-
Opioid use disorder is a worldwide economic and health concern. Opioid use seems to be increased in those who sustained traumatic brain injury (TBI). The aim of the current systematic review is to examine the prevalence of opioid use disorders among individuals with TBI. ⋯ Opioid use disorder is an imminent danger worldwide. Firm regulation for an opioid prescription for patients with TBI during hospitalization or in rehabilitation centers tackles co-existing behavioral problems, frequent follow-up, and the use of nonopioid medications as possible to control chronic pain in this vulnerable subgroup. Future prospective studies to measure the effect of different intervention methods to mitigate the increased risk of opioid use post-TBI are needed.