World Neurosurg
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This study examined the impact of neurosurgeons' experience on surgical timing and outcomes in aneurysmal subarachnoid hemorrhage (aSAH) and questioned the adherence to early surgery as recommended by recent guidelines. ⋯ Experienced neurosurgeons tend to favor delayed intervention for aSAH surgery. While experience positively influences early outcomes, its impact on long-term results is less significant. Future studies could lead to improvements in neurosurgical practices.
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The minimally invasive (MI) lateral approach to the TL junction for treating various spinal pathologies is quite challenging for spine surgeons due to this region's unfamiliar and complex anatomical structures. In addition, controversy still exists regarding approach selection, the need for rib resection, and diaphragm manipulation. ⋯ Intercostal subdiaphragmatic retroperitoneal access without rib resection is an alternative MI lateral approach to the upper lumbar spine. These reproducible techniques could help surgeons access the L1/2 disc level without unnecessary rib resection. Surgeons can utilize this technique for performing a single-level lateral approach at L1/2 or incorporate this MI technique with a standard lateral approach to the lower lumbar spine for performing sequential multilevel lateral fusion for patients diagnosed with adult spinal deformity (ASD).
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Anatomical dissection is a fundamental part of surgical education, but it can be challenging to visualize the subtle details of anatomy. Full-spectrum photography (FSP) is a technique that uses cameras that can capture light in a wider range of wavelengths compared to traditional cameras. This technical laboratory note introduces a method using noncontrast-dependent FSP to improve the visualization of neuroanatomical structures during cadaveric dissection for surgical neuroanatomy. ⋯ FSP offers a valuable enhancement to anatomical dissections and education. It provides a noninvasive means to characterize anatomical structures with greater clarity, highlighting features that may be challenging to observe with the naked eye or standard visible-light photography.
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The impact of statin pretreatment on outcomes for patients undergoing endovascular treatment of intracranial aneurysms remains uncertain. We aimed to conduct a systematic review and meta-analysis evaluating the efficacy and safety of statins in this population. ⋯ Statin pretreatment may decrease the risk of hemorrhagic complications and in-stent stenosis after endovascular aneurysm therapy but does not improve angiographic occlusion. An increased hazard of ischemic events was found. Further data are needed to validate these findings and clarify the role of statins in patients with aneurysms undergoing endovascular procedures.
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Moyamoya disease (MMD) is a rare cerebrovascular disorder marked by internal carotid artery narrowing, collateral neovascularization, and symptomatic cerebral ischemia. Select patients can benefit from direct bypass (STA-MCA bypass) by restoring blood flow to hypoperfused territories. Symptomatic contralateral stroke (CS) following STA-MCA bypass is a devastating, poorly understood complication. We investigate clinical and radiographic risk factors influencing CS incidence after bypass surgery. ⋯ CS patients following bypass had significantly higher pre-operative SBP, post-operative SBP goals below their average pre-operative SBP, and longer time from symptom onset to surgery compared to patients without CS. Patient-specific post-operative SBP management and timely surgical revascularization are crucial for preventing CS in MMD patients undergoing STA-MCA bypass.