World Neurosurg
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Symptomatic lumbar spinal stenosis (LSS) leads to functional impairment and pain. While radiologic characterization of the morphological stenosis grade can aid in the diagnosis, it may not always correlate with patient symptoms. Artificial intelligence (AI) may diagnose symptomatic LSS in patients solely based on self-reported history questionnaires. ⋯ Our results indicate that ML can automate the diagnosis of LSS based on self-reported questionnaires with high accuracy. Implementation of standardized and intelligence-automated workflow may serve as a supportive diagnostic tool to streamline patient management and potentially lower health care costs.
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Flow diversion has evolved as a minimally invasive treatment for intracranial aneurysms. The Silk Vista Baby (SVB) can be navigated into small cerebral vessels because it can be deployed through a low-profile microcatheter. ⋯ Although the intraoperative foreshortening was not unexpected, the delayed postprocedural behavior of proximal foreshortening and subsequent prolapse of the SVB into the aneurysm have not been previously described. We would like to share this for awareness in this technical note.
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Complex middle cerebral artery (MCA) aneurysms incorporating parent or branching vessels are often not amenable to standard microsurgical clipping or endovascular embolization treatments. We aim to discuss the treatment of such aneurysms via a combination of surgical revascularization and aneurysm exclusion based on our institutional experience. ⋯ Cerebral revascularization by bypass followed by aneurysm or parent artery occlusion is an effective treatment option for complex MCA aneurysms that cannot be safely treated by standard microsurgical or endovascular techniques. Double-barrel bypass consisting of 2 STA branches to 2 MCA branches yields adequate flow replacement in most cases.
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Temporal changes in the volume of chronic subdural hematoma (CSDH) following middle meningeal artery (MMA) embolization vary. We aimed to determine whether CSDH density on computed tomography is related to hematoma resolution following particle MMA embolization. ⋯ Rapid resolution of CSDH following MMA embolization was associated with low hematoma density at 1-week postembolization. Based on hematoma density on computed tomography at 1-week postembolization, a 1-month follow-up would be sufficient in cases of low density, but a 3-month follow-up would be required in cases of high-density hematoma. Larger studies and clinical trials are needed to confirm our findings.
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The impact of Medicaid status on survival outcomes of patients with spinal primary malignant bone tumors (sPMBT) has not been investigated. ⋯ Medicaid patients may be less likely to receive surgery and suffer from poorer survival. These disparities may be especially prominent among minorities.