World Neurosurg
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Large or giant paraclinoid aneurysms have been treated with various strategies, including clipping, coiling, and parent artery occlusion (PAO). In addition, flow diverters (FDs) have been introduced for the management of these aneurysms. The aim of this study was to examine the management of unruptured large/giant paraclinoid aneurysms in Japan when FDs were being introduced by a nationwide survey. ⋯ All treatment modalities offer high rates of complete occlusion and good clinical outcomes. Coiling has the disadvantage of high rates of recurrence and retreatment. Clipping and PAO have the disadvantage of a high rate of major procedure-related complications; however, PAO can provide comparable treatment outcomes even in cases with refractory giant aneurysms. FDs are the optimal choice for the management for large/giant paraclinoid aneurysms due to its safety and efficacy.
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Frailty refers to a state of weakness that can arise due to age or illnesses, and frailty predisposes individuals to several adverse health outcomes. This has been postulated to prognosticate the outcome of various surgeries, including surgeries for various spine conditions; however, no meta-analysis has validated this finding. ⋯ This study revealed that high frailty according to the modified 5-Item Frailty Index is correlated with an increased risk of readmission, extended length of hospital stay, postoperative complications, nonroutine discharge, postoperative in-hospital mortality, and reoperation following spine surgeries for any pathology of the spine.
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The aim of this study was to synthesize existing knowledge regarding the anatomy of the cavernous sinus (CS), critically evaluate the current anatomical hypotheses concerning its walls, to conduct anatomical dissections and develop a comprehensive understanding of the connective tissue structure of the CS. ⋯ The dural anatomy of the CS involves an intricate interplay between the meningeal and periosteal dural layers, which is elucidated more effectively through the application of fundamental principles informed by embryological development.
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Patients receiving anticoagulation therapy develop intracerebral hematomas, which are difficult to evacuate during endoscopic surgery. Insufficient thrombin activation results in the gradual conversion of fibrinogen to fibrin, forming dense fibrin bands (FBs) that harden the hematoma. We aimed to investigate the factors contributing to hematoma hardness. ⋯ Tough hematomas were histologically characterized by high FB density. Preoperative PT-INR and APTT may predict the presence of tough hematomas.