World Neurosurg
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Delayed cerebral infarction after aneurysmal subarachnoid hemorrhage (aSAH) still remains the leading cause of disability in patients that survive the initial ictus. It has been shown that computed tomography perfusion (CTP) imaging can detect hypoperfused brain areas. The aim of this study was to evaluate if a single acute CTP examination at time of neurologic deterioration is sufficient or if an additional baseline CTP increases diagnostic accuracy. ⋯ Acute CTP examination in case of suspected vasospasm-induced neurologic deterioration after aSAH has the highest diagnostic accuracy to detect misery perfusion. Additional baseline CTP is not needed. The most sensitive parameter to detect critically perfused brain areas is TTD.
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Case Reports
Hemorrhagic Atypical Planum Sphenoidale Meningioma with Intermittent Vision Loss-A Rare Presentation of Apoplexy.
Symptoms that mimic pituitary apoplexy may be encountered with other neoplastic or infectious lesions. ⋯ As the most common benign intracranial tumors, meningiomas should remain in the differential for patients presenting with apoplectiform symptoms.
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Multicenter Study
Prognostic Discrepancy on Overall Survival Between Ambulatory and Non-ambulatory Patients with Metastatic Spinal Cord Compression (MSCC).
Contradictory results have been reported regarding the prognostic effect of ambulatory status in patients with metastatic spinal cord compression (MSCC). The aim of this study was to investigate whether ambulatory status is a significant predictor of overall survival in patients with MSCC and to distinguish the differences of predictors between patients who were ambulatory and those who were not ambulatory before operation. ⋯ Ambulatory status was not shown to predict the prognosis of patients with MSCC. prognostic factors should be distinguished between ambulatory and nonambulatory patients when choosing a therapeutic modality.
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Interhospital transfers for endovascular thrombectomy (EVT) evaluation have increased since the publication of landmark neuroendovascular stroke trials in 2015. The lack of guidelines to select potential EVT candidates prior to transfer can lead to instances where, despite considerable costs and transport risks, transferred patients do not ultimately undergo EVT. Our aim was to characterize the patterns and identify predictors for EVT on transfer. ⋯ A higher collateral score, the acquisition of CTA imaging at the referring centers, and a higher NIHSS score independently predicted EVT on transfer.
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To determine if there is a difference in reoperation rates for symptomatic nonunions in atlantoaxial (C1-C2) fusions with or without bone morphogenetic protein (BMP) using data from a national spine registry and to analyze the different types of bone grafts used in the non-BMP group. ⋯ Using one of the largest retrospective studies on C1-C2 fusions with and without BMP, we found no difference in reoperation rates for symptomatic nonunions. For the non-BMP group, we found that lamina (+/- allograft) or allograft alone may also be just as effective as iliac crest graft (+/- allograft) in having no reoperations for symptomatic nonunions.