World Neurosurg
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Case Reports
Surgical treatment for primary brainstem hemorrhage to improve postoperative functional outcomes.
It remains controversial whether primary brainstem hemorrhage (PBH) should be managed conservatively or treated promptly by surgical evacuation of the hematoma. In the present study, we discuss 5 cases of PBH that were treated surgically and the ability of surgical management to improve postoperative functional outcomes. ⋯ Because of the good results with these 5 patients with PBH, this surgical strategy could be encouraged with exclusion criteria for early initiation of rehabilitation strategies. We hope to increase our number of patients to accumulate further evidence.
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Microcatheter entrapment during embolization of brain arteriovenous malformations (AVMs) represents a potentially harmful technical complication. Although several techniques have been reported for endovascular catheter retrieval from an Onyx cast, such methods have never been demonstrated with acrylic glues. We report a case of removal of a glued microcatheter from an N-butyl cyanoacrylate (NBCA) cast using a microsnare. ⋯ Although it is not recommended as routine practice, snaring a glued microcatheter is feasible and can be used in selected cases as a last resort if thromboembolic complications are feared.
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Hypotension, a risk factor for increased mortality following traumatic brain injury (TBI), is traditionally defined as systolic blood pressure (SBP) <90 mm Hg. We aimed to redefine hypotension and determine its optimal threshold in patients with TBI. ⋯ The threshold for hypotension in patients with severe TBI should be redefined and modified by age, and patients ≤60 years old should be considered hypotensive at SBP <100 mm Hg, whereas in older patients, SBP <120 mm Hg should be diagnosed as hypotension.
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Intracranial dural arteriovenous fistulas (DAVFs) draining into the perimedullary venous system are rare and potentially life-threatening lesions often presenting as a myelopathy. The early and proper diagnosis of this rare disease is challenging because the symptoms are nonspecific. ⋯ Here we report a case of cervical myelopathy caused by intracranial DAVF with acute worsening after steroid administration. The lesion was successfully treated with endovascular Onyx embolization.
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Embolic occlusions of the common carotid artery (CCA)/internal carotid artery (ICA) and intracranial artery occlusions in acute ischemic stroke are associated with high morbidity and can benefit from endovascular therapy. However, the optimal endovascular strategy for these conditions is unclear. This study aimed to evaluate the feasibility of the pass-thrombectomy-protective thrombectomy (double PT) technique and the clinical outcome of treated patients. ⋯ The double PT technique is feasible and safe in treating initial embolic tandem occlusion of the CCA/ICA.