World Neurosurg
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Early diagnosis of diabetes insipidus (DI), a complication following pituitary surgery, can avoid catastrophic results such as lethargy or even death. Measurement of arginine vasopressin (AVP) may help the early diagnosis, but its direct assaying is challenging. Copeptin, which is co-secreted in equimolar quantities to AVP, is suggested to be a reliable marker in prediction of postoperative DI. Therefore, this systematic review plus meta-analysis aims to discover this possible role. ⋯ Copeptin level was significantly lower in DI patients than in non-DI patients who underwent pituitary surgery. Early measurement, as soon as possible (from the first hour to 48 hours after the operation) of copeptin after pituitary surgeries has good, but not excellent, accuracy to exclude postoperative DI.
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Endovascular thrombectomy (EVT) is recommended for acute ischemic stroke (AIS) due to large-vessel occlusion. However, approximately 50% of patients still face poor outcomes post-procedure. This study aimed to assess whether a nomogram model that integrates CT angiography radiomics features and clinical variables can predict EVT outcomes in AIS patients. ⋯ Combining radiomics nomogram with clinical predictors could effectively forecast EVT outcomes in acute anterior circulation large vessel occlusion stroke patients.
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There is a dearth of literature regarding prognostic and predictive factors for outcome following pediatric decompressive craniectomy (DC) following traumatic brain injury (TBI). The aim of this study was to develop a random forest machine learning algorithm to predict outcomes following DC in pediatrics. ⋯ CRF and SRF models successfully predicted 6-month outcomes and mortality following DC in pediatric TBI patients. These results suggest random forest models may be efficacious for predicting outcome in this patient population.
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Five billion people worldwide lack access to safe, timely, and affordable surgical and anesthesia care. This deficit is greatest in low- and middle-income countries, especially for specialty surgical services including neurosurgery, due to insufficient personnel, resources, and infrastructure. The southeastern European nation of the Republic of Moldova is one such middle-income country. ⋯ This article provides the first-ever description of the history and current state of neurosurgery in Moldova and presents key recommendations to guide the international neurosurgery community in developing neurosurgical care in countries with an unmet need.
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Complete traumatic dorsal spondyloptosis with no neurological involvement is so rare due to the inherent stability of the thoracic spine, that only 2 other cases are reported in literature. A 31-year male with history of fall, and normal neurological examination was noted to have grade 5 dislocation at D7-D8, with locking of D7-8 bodies and expanded canal due to pedicle fractures accommodating the displaced spinal cord. As the excessive manipulation to achieve reduction was deemed too risky to be worthy, it was decided to do in-situ fixation without reduction. ⋯ Under O-arm navigation, pedicle screws were placed in D5,6,8,9&10, with D8 screws crossing onto D7. The rods had to be contoured in S shape and maneuvered across all screw heads. The patient has remained asymptomatic for more than 2 years after surgery.