World Neurosurg
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To report a newly developed intraluminal triple-balloon shunt designed to preserve the blood flow of both the internal carotid artery (ICA) and the external carotid artery (ECA) during carotid endarterectomy in patients with a previous ipsilateral extracranial-intracranial bypass, in whom hemodynamic cerebral ischemia might be caused by cross-clamping at the ICA as well as the ECA. ⋯ This novel shunt device can be used safely and effectively in cases requiring preservation of the blood supply to both the ICA and the ECA during carotid endarterectomy.
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This study sought to investigate outcomes after a novel nontransfer protocol for mild traumatic brain injuries patients with small intracranial hemorrhage (ICH) in a rural trauma center without neurosurgical capabilities. ⋯ Our 6-year study corroborates the low neurosurgical rate reported in the literature for mTBI with small ICH. Nontransfer protocols may lead to a more efficient use of hospital resources while providing safe, effective and economical health care.
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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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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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The UNIPLATE was developed to improve operative times and limit dissection at the lateral margins of the vertebral bodies. The distinguishing character of this plate is its thin design, which requires only one screw per vertebral level (monovertebral screw plate). Most cervical spine plates, in contrast, are designed for two screws per vertebral level (bivertebral screw plate). Limited reports of the biomechanical efficacy of the UNIPLATE are available, and to the authors' knowledge, this report represents the largest clinical study of its use. ⋯ There is an increased rate of reoperation for symptomatic pseudarthrosis after anterior cervical diskectomy and fusion surgery with the use of a monovertebral screw semiconstrained plate, particularly in two-level fusion surgeries. Use of the UNIPLATE system has since been abandoned at our institution in favor of bivertebral screw plating systems.