World Neurosurg
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Patients who survive intracranial hemorrhage (ICH) are at high risk of recurrence. The Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly (Age >65 years), Drugs/Alcohol Concomitantly (HAS-BLED) score has recently been developed to assess bleeding risk. ⋯ This study provided data on the risk of ICH recurrence stratified using the HAS-BLED score in patients after an ICH.
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Intraoperative ultrasound displays dynamic processes intraoperatively. Performing burr-hole biopsies under a real-time visual control is an interesting option for the neurosurgeon. However, the percentage of conclusive diagnoses obtained by this technique and the rate of complications must be evaluated in a larger series. ⋯ When intraoperative ultrasound-navigated biopsies were used they obtained a similar percentage of conclusive diagnoses as stereotactic biopsies. The complication rate is comparable as well. Emerging intracranial complications such as hemorrhages can be observed. However, their incidence cannot be decreased.
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Single fraction stereotactic radiosurgery (SRS) is a common adjuvant therapy for hormonally active pituitary adenomas when surgical resection fails to control tumor growth or normalize hypersecretory activity. Marginal doses of 20-24 Gy are used at many centers and here we report our outcome data in patients treated with a higher marginal dose of 35 Gy. ⋯ Time to endocrine remission was more rapid in patients treated with 35 Gy, as compared to previously reported literature using marginal doses of 20-24 Gy. Rates of endocrine remission and relapse, post-SRS hypopituitarism, and radiation-induced sequelae were not increased following higher dose treatment.
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A persistent primitive hypoglossal artery (PHA) is a rare congenital caroticobasilar anastomosis with a reported prevalence of 0.027%-0.26%. Intracranial aneurysms occur with a frequency of approximately 26% in the setting of PHAs. ⋯ We review the literature and discuss anatomic implications with respect to the extreme lateral infrajugular transcondylar exposure for clip ligation of a ruptured posterior inferior cerebellar artery aneurysm in the setting of a PHA.
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Case series have identified that de novo intracranial aneurysms occur. However, the risk for this occurrence has not been established. We examined the risk for the de novo intracranial aneurysm detection in a consecutive surgical case series. ⋯ There is a 10-year de novo aneurysm detection rate of between 10% and 16% after surgery. Smoking increases the risk of de novo aneurysm detection. Consideration needs to be given to surveillance angiography after aneurysm treatment.