World Neurosurg
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Traumatic brain injury (TBI) prediction models have gained significant attention in recent years because of their potential to aid in clinical decision making. Existing models, such as Corticosteroid Randomization after Significant Head Injury and International Mission for Prognosis and Analysis of Clinical Trials, are currently losing external validity and performance, probably because of their diverse inclusion criteria and changes in treatment modalities over the years. There is a lack of models that predict outcomes strictly pertaining to primary decompression after TBI. In this study, we aimed to develop an easy-to-use prediction model for predicting the risk of poor functional outcomes at 3 months after hospital discharge in adult patients who had undergone primary decompressive craniectomy for isolated moderate-to-severe TBI. ⋯ Our study provides a ready-to-use prognostic nomogram derived from prospective data that can predict the risk of having a GOSE of 1-4 at three months following primary decompressive craniectomy with high sensitivity, PPV, and low LR-.
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To construct a universally applicable nomogram using computed tomography perfusion parameters based on Rapid processing of PerfusIon and Diffusion software for evaluating the prognosis of acute anterior circulation large vessel occlusion treated by endovascular therapy. ⋯ Our nomogram can be used as a simple and reasonable tool to predict the prognosis of acute anterior circulation large vessel occlusion treated by endovascular therapy. The computed tomography perfusion parameter volumes of cerebral blood flow < 30% obtained by Rapid processing of PerfusIon and Diffusion software was an important predictive factor in this model.
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Double crush syndrome (DCS) is defined as multiple sites of compression along a single nerve. The combination of a compressive proximal lesion in the lumbar spine and a distal common peroneal nerve entrapment may result in compound nerve dysfunction. ⋯ This is the first series to report DCS with two active points of compression in the lumbar spine and lower extremity based on EMG and imaging findings. Common peroneal nerve decompression was found to improve average dorsiflexion strength.
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Both vertebral bone quality (VBQ) scores and paravertebral muscle quality can predict osteoporotic vertebral fractures (OVFs). This study aimed to compare the diagnostic value of opportunistic VBQ scores and sarcopenia for OVF and to determine if their combined use could enhance diagnostic efficacy. ⋯ The predictive value of MF CSA in anticipating OVF was marginally superior to that of VBQ and MF DFF. Furthermore, the concurrent utilization of VBQ and MF CSA substantially enhanced the diagnostic accuracy of OVF. Considering that both VBQ and MF CSA can be opportunistically obtained during routine examinations, individuals with a VBQ ≥3.46 and MF CSA ≤11.83 cm2 should be categorized as high risk for OVF, warranting timely preventive measures.
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Surgical management of blood blister-like aneurysm (BBA) is challenging and contentious because of high morbidity and mortality. Intraoperative neurophysiologic monitoring (IONM) is a well-established tool in intracranial aneurysm surgery, although its application in BBA surgery lacks reports. This study retrospectively analyzes the usefulness of IONM in BBA surgery between 2018 and 2023. ⋯ Our results show that IONM has low sensitivity (37.5%) and high specificity (100%) in detecting ischemic events during BBA surgery. The high rate of false-negative results in BBA-IONM suggests that its predictive value is limited particularly in complex maneuvers such as trapping and advanced vasoreconstruction, warranting cautious interpretation and further investigation of IONM modalities for BBA management.