World Neurosurg
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Segmental arterial mediolysis (SAM) is a nonatherosclerotic, noninflammatory vascular disease, initially reported in 1976 by Slavin and Gonzalez-Vitale. SAM-associated cerebral aneurysms have been reported in limited cases, and the disease entity is not fully understood. Therefore, we propose a diagnostic and treatment strategy with a systematic review of previously reported cases and our cases. ⋯ SAM-associated cerebral aneurysms can be life-threatening because of the risk of rupture and can lead to successive IAH after SAH. However, the prognosis is relatively good if an operation is successful. Therefore, precise diagnosis is required for suspected cases at first, and appropriate surgical treatment is required. Moreover, appropriate management of successive IAH is required among patients with SAH.
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To clarify the association between skin autofluorescence of advanced glycation end-products (AGEs) and clinical outcomes and pain in patients with degenerative cervical myelopathy (DCM). ⋯ Noninvasive skin autofluorescence of AGEs may be a useful biomarker for pain symptoms in the lower limbs in patients with DCM.
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Evidence available to clinicians and patients to inform treatment decisions is ideally produced by randomized controlled trials (RCTs). The objective of this study was to assess the extent to which neurosurgical practice is supported by RCT-level evidence. ⋯ The RCT-level evidence supporting neurosurgical practice is varied and the outcomes tested remain predominantly heterogeneous. There remain important neurosurgical conditions where treatment strategies are not underpinned by high-quality evidence. Pragmatic RCTs, well-designed observational studies as well as robust audit and registry processes may provide the real-world evidence for treatment decisions in neurosurgical care.
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The objective of this study was to assess the therapeutic efficacy of minimally invasive puncture and drainage (MIPD) facilitated by a 3-dimensional (3D)-printed guide plate in the management of primary brainstem hemorrhage (PBH). ⋯ MIPD guided by 3D printing technology is more effective than conservative treatment in PBH cases without extensive hemorrhage. This approach can alleviate hematoma pressure earlier, mitigate neurological deficits, reduce HAP incidence, shorten hospital stay, and decrease mortality and disability rates associated with PBH.
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The application of the transorbital (TO) approach for vascular lesions has been scarcely explored. In this anatomic study, we examine the carotid and middle cerebral arteries from the TO perspective and investigate the feasibility of vascular clipping in a pseudovascularized model. ⋯ The TO approach provides anatomic access to the lateral and dorsal carotid siphon, complete posterior communicating artery, and proximal middle cerebral artery. This preliminary study suggests potential application in the elective treatment of paraclinoid and posterior communicating aneurysms.