World Neurosurg
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Plasticity is fundamental to normal central nervous system function and its response to injury. Understanding this adaptive capacity is central to the development of novel surgical approaches to neurologic disease. These innovative interventions offer the promise of maximizing functional recovery for patients by harnessing targeted plasticity. ⋯ Such synergistic approaches will create therapeutic options for patients previously outside of the scope of neurosurgery, such as those with permanent disability after traumatic brain injury or stroke. In this review, we synthesize the rapidly evolving field of plasticity and explore ways that neurosurgeons may enhance functional recovery in the future. We conclude that understanding plasticity is fundamental to modern neurosurgical education and practice.
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Clinically significant intratumoral hemorrhage historically has been reported in only a small fraction of vestibular schwannomas (VS). Patients with hemorrhagic VS are more likely to present with neurologic deficits and have worse outcomes than patients with nonhemorrhagic VS. The purpose of this study is to analyze characteristics that may predispose VS to hemorrhage and that may prove helpful in the management and treatment of VS. ⋯ Understanding the origins and clinical implications of intratumoral hemorrhage in VS could potentially assist in clinical decision making and patient counseling.
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Case Reports Comparative Study
Surgical versus nonsurgical treatment of subaxial cervical pedicle fractures.
Pedicle fractures in the cervical spine are common. They may occur in isolation or in combination with other concomitant fractures. Multiple classification systems have been introduced to provide a clinical framework when approaching these types of fractures; however, these systems do not provide guidelines for optimal treatment. Data regarding decision making are limited. Conservative treatment with orthoses may result in subluxation and instability requiring further treatment. Surgery may not be required in all instances because many of these injuries may heal without surgical intervention. ⋯ This study describes and classifies unique cervical pedicle fractures and associated injuries. Our findings suggest that surgical treatment results in definitive stability for these injuries compared with conservative therapy, particularly for pedicle fractures associated with comminuted lateral mass or initially displaced fractures. However, nondisplaced vertical split pedicle fractures and isolated single line horizontal fractures may be treated nonsurgically without occurrence of further instability. A larger prospective study is required to confirm these findings.
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Bow hunter's syndrome is a rare vascular phenomenon characterized by insufficiency of the posterior cerebral circulation induced by rotation of the head within normal physiologic range. The neurosurgical literature on evidence-based diagnosis and management of the disease is scarce, and reports are largely limited to case studies. ⋯ Decompression without fusion is a safe, reliable surgical option in patients with bow hunter's syndrome. Decompression is performed via a posterior approach for atlantoaxial vertebral artery compression and via an anterior approach for subaxial compression. Long-term complications include cervical instability, which may necessitate internal fixation and fusion.
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Multicenter Study
Delayed cerebral ischemia predicts neurocognitive impairment following aneurysmal subarachnoid hemorrhage.
Prior studies have shown that the incidence of neuropsychological deficits (NPDs) after aneurysmal subarachnoid hemorrhage (aSAH) is high despite excellent outcome according to neurologic grading scales. Delayed cerebral ischemia (DCI) occurs in 30% of patients after aSAH and significantly contributes to the mortality and morbidity of aSAH. We tested the hypothesis that DCI is associated with neuropsychological outcome. ⋯ Patients with evidence of DCI during their hospital course have a 5-fold increased risk of experiencing moderate to severe NPD compared with patients who do not develop DCI after aSAH. Secondary events occurring during acute hospitalization (DCI, hydrocephalus) may be more important to the overall neuropsychological outcome than hemorrhage (Fisher) and clinical severity (World Federation of Neurological Surgeons Grading System) scores at admission.