World Neurosurg
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Prognosis of adult tuberculous meningitis patients undergoing a ventriculoperitoneal (VP) surgery is not well known. Prognostic models developed to predict the prognosis might help the clinicians immensely. ⋯ About 39% adult tuberculous meningitis patients die or remain disabled after VP shunt surgery. MRC grade III illness, papilledema, seizures and size of hydrocephalus are the most important baseline predictors that can help in prognostication. The nomograms developed may help the treating physician in prognostication.
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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.
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Cervical spinal stenosis most commonly occurs at the subaxial spine. C1-C2 stenosis is relatively unusual but can be present in certain congenital or syndromic conditions such as rheumatoid arthritis. ⋯ Decompression and stabilization of the segment were performed. This case is unique as this pathology occurred at an uncommon location, leading to an unusual degree of compression and resulting in surgical intervention.
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Dural arteriovenous fistulas (DAVFs) of the falx cerebri are extremely rare and may be associated with the falcine sinus. The distal dural supply from the anterior cerebral artery (ACA) comes via the pericallosal artery. ⋯ DAVF in the falx cerebri solely supplied by the distal dural supply of the ACA may be more suitable for surgical treatment rather than endovascular therapy. We herein describe a rare case of DAVF in the falx cerebri solely supplied by the distal dural supply of the ACA, which was treated with surgical ligation of the draining vein.
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Traumatic brain injury (TBI) prediction models have gained significant attention in recent years because of their potential to aid in clinical decision making. Existing models, such as Corticosteroid Randomization after Significant Head Injury and International Mission for Prognosis and Analysis of Clinical Trials, are currently losing external validity and performance, probably because of their diverse inclusion criteria and changes in treatment modalities over the years. There is a lack of models that predict outcomes strictly pertaining to primary decompression after TBI. In this study, we aimed to develop an easy-to-use prediction model for predicting the risk of poor functional outcomes at 3 months after hospital discharge in adult patients who had undergone primary decompressive craniectomy for isolated moderate-to-severe TBI. ⋯ Our study provides a ready-to-use prognostic nomogram derived from prospective data that can predict the risk of having a GOSE of 1-4 at three months following primary decompressive craniectomy with high sensitivity, PPV, and low LR-.