World Neurosurg
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Aneurysmal subarachnoid hemorrhage (aSAH) is a common neurosurgical disorder with high morbidity and poor prognosis, and the associated delayed cerebral ischemia (DCI) is a key factor contributing to poor prognosis. Despite extensive research on the risk factors associated with DCI development, the evidence remains conflicting. Therefore, this meta-analysis of case-control studies aimed to investigate the risk factors for DCI occurrence during hospitalization in patients with aSAH. ⋯ Patients with aSAH who have a Hunt-Hess scale score ≥4, a modified Fisher scale score ≥3, a WFNS scale score ≥4, IVH, pre-existing hypertension, cerebral vasospasm, a high WBC count on admission, ICI, and female sex are at high risk of DCI and hence should be carefully monitored in the intensive care unit.
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Epilepsy surgery offers a vital treatment option for drug-resistant mesial temporal lobe epilepsy (mTLE), with Temporal Lobe Resection (TLR) and Magnetic Resonance-guided Laser Interstitial Thermal Therapy (MRgLITT) being fundamental interventions. This meta-analysis specifically examines seizure outcomes at extended follow-up periods exceeding 24 months, visual field deficits as measured by perimetry, and complication rates both overall and categorized based on duration as minor (transient <6 months) or major (persistent >6 months) to inform clinical decision-making. For seizure freedom, TLR was superior, with 72.5% [65.6%, 78.5%] of patients achieving postoperative seizure freedom compared to 57.1% [51.2%, 62.7%] for MRgLITT (P-value <0.01). ⋯ TLR provides superior seizure freedom but comes with an increased risk of transient complications. Although there was no statistical significance in visual field deficits, the trend suggests a higher frequency with TLR. The study's extensive data analysis, including rigorous sensitivity checks, ensures the robustness of these conclusions, reflecting a comprehensive analysis of the available data at this time point.
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Posterior ring apophysis separation (PRAS) associated with lumbar disc herniation (LDH) is a relatively rare form of disc herniation. This study aims to evaluate the clinical effectiveness of unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) in the treatment of PRAS with LDH. ⋯ UBE and PELD possess strong clinical effectiveness for treating PRAS with LDH. Although the UBE group had a longer mean operative time and LOS, with more Hb loss, the UBE group had a lower recurrence rate. Therefore, UBE remains safe and innovative for the treatment of PRAS with LDH.
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Patients with brain metastases (BrM) from esophageal cancer have poor prognosis, the incidence of which is expected to rise due to improved survival from the primary tumor and increased neuroimaging. We aimed to identify patient and esophageal cancer characteristics associated with shorter survival in patients with BrM and, secondly, to compare the prognosis of patients with HER2 overexpression. ⋯ The median survival from esophageal-to-brain metastasis was 8.4 months. Patients with a single lesion, KPS score >70, and treatment with surgical resection was correlated with improved survival. Further, HER2+ patients had distinct patient and BrM characteristics.
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Flow diverters (FDs) carry the risk of thromboembolic complications associated with the device and bleeding complications associated with dual antiplatelet therapy. We hypothesize that an antithrombotic surface-coated FD (ASCFD) would have less acute thrombus formation and better endothelialization on the device surface compared with uncoated FD. ⋯ In the rabbit model, the ASCFD is associated with less thrombus formation at the acute stage, less inflammation, less vessel injury, and better endothelialization on the device surface compared with the PFD.