World Neurosurg
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The purpose of this study was to analyze the risk factors for 14-day mortality in pediatric patients undergoing early decompressive craniectomy (DC) after traumatic brain injury (TBI). ⋯ In children undergoing early DC after TBI, risk factors for 14-day mortality include younger age and higher ISS.
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Infection follow-up in patients stabilized with the Dynesys system. Infection rates were determined in patients who had ≥5 segments stabilized with the Dynesys system. ⋯ We report that long-level stabilization with the Dynesys system results in a high infection rate.
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A ruptured vertebral artery dissecting aneurysm (VADA) with a high clinical grade (Hunt and Hess grade 5) has a devastating prognosis. Because of the high rebleeding rate and location, rapid mortality can occur in patients owing to brainstem compression. Adjuvant decompression of the posterior fossa after securing the aneurysm may improve the outcomes of these patients. ⋯ Adjuvant decompression of the posterior fossa can improve outcomes in patients with Hunt and Hess grade V ruptured VADA.
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Superficial temporal artery-middle cerebral artery anastomosis is an established treatment for moyamoya disease. However, hemorrhagic cerebral hyperperfusion syndrome (CHS) leads to poor outcomes. This study aimed to identify predictors of hemorrhagic CHS based on regional cerebral blood flow (rCBF) in patients with moyamoya disease. ⋯ Predictors for hemorrhagic CHS were ≥30% rCBF increase when using method 1 and ≥50% increase when using method 2.
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Comparative Study
Assessment of Costs in Open Microsurgery and Stereotactic Radiosurgery for Intracranial Meningiomas.
Understanding costs of microsurgical or radiosurgical treatment of intracranial meningioma may offer direction in reducing health care costs and establishing cost-effective algorithms. We used the Value Driven Outcomes database, which identifies cost drivers and tracks changes over time, to evaluate cost drivers for management of intracranial meningioma. ⋯ Implementing protocols to reduce facility usage and imaging would mitigate total costs and improve resource utilization while maintaining high-quality patient care. Additional cost-effectiveness studies evaluating patients with true therapeutic equipoise will provide further guidance in these efforts.