Pub Date : 2020-12-30DOI: 10.1097/01.cne.0000734828.08438.5f
S. Bonasia, A. Bouthillier, T. Robert
arteries in humans, as it interests a diverse group of physicians: ear, nose, and throat specialists; neuroradiologists; neurologists; anatomists; and neurosurgeons. During the past century, many classifications of the ICA segmental division have been proposed, with the purpose to be helpful during clinical practice. Because each specialist who treats pathologies of or around the ICA needs different details, a universally shared classification is difficult to propose. Historically, the classifications that spread the most had some important characteristics: simplicity, easy to use, easy to remember, and reproducibility. In this overview, we present the most used classifications of the ICA with their respective clinical implications, pros and cons, to help the reader to orientate and to choose the most helpful classification in his clinical practice.
{"title":"Segmental Classification of the Internal Carotid Artery: An Overview","authors":"S. Bonasia, A. Bouthillier, T. Robert","doi":"10.1097/01.cne.0000734828.08438.5f","DOIUrl":"https://doi.org/10.1097/01.cne.0000734828.08438.5f","url":null,"abstract":"arteries in humans, as it interests a diverse group of physicians: ear, nose, and throat specialists; neuroradiologists; neurologists; anatomists; and neurosurgeons. During the past century, many classifications of the ICA segmental division have been proposed, with the purpose to be helpful during clinical practice. Because each specialist who treats pathologies of or around the ICA needs different details, a universally shared classification is difficult to propose. Historically, the classifications that spread the most had some important characteristics: simplicity, easy to use, easy to remember, and reproducibility. In this overview, we present the most used classifications of the ICA with their respective clinical implications, pros and cons, to help the reader to orientate and to choose the most helpful classification in his clinical practice.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"42 1","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2020-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44236084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-15DOI: 10.1097/01.cne.0000734696.04124.b8
Lorenzo Bertulli, T. Robert
{"title":"Embryologic Development of the Normal Craniofacial Arterial System: Part 1","authors":"Lorenzo Bertulli, T. Robert","doi":"10.1097/01.cne.0000734696.04124.b8","DOIUrl":"https://doi.org/10.1097/01.cne.0000734696.04124.b8","url":null,"abstract":"","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2020-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48036851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-30DOI: 10.1097/01.CNE.0000732592.98360.44
Kevin G. Kwan, R. C. Pena, J. Ullman
problem, with an estimated 27 million cases per year leading to subsequent hospitalization and possible mortality. Decompressive craniectomy (DC), the surgical removal of a portion of the skull with exposure of the dura mater, has long been used for the treatment of severe TBI as an established means of decreasing mortality. In a comparison of the 2 largest randomized clinical trials (RCTs) evaluating the efficacy of DC versus medical management for refractory intracranial pressures (rICPs) (DECRA 2011 vs RESCUEicp 2016 trials), one revealed no significant impact on surgically treated patient mortality, whereas the other demonstrated a clear reduction of patient fatality in the surgically treated arm, but at the expense of creating a larger cohort of survivors with severe incapacitation, at least in the short term. Although DC has remained a standard treatment of acute subdural hematoma (ASDH), it is only now being compared in a large RCT (RESCUE-ASDH) to emergent craniotomy, another widely accepted procedure. Such results demonstrate the persistence of clinical equipoise when determining the utility of DC versus medical management or craniotomy for patients with severe TBI resulting in rICPs. In this article, we review the indications, pathophysiology, surgical technique, complications, controversy, and ethical considerations involving DC.
{"title":"Decompressive Craniectomy in Management of Severe Traumatic Brain Injury","authors":"Kevin G. Kwan, R. C. Pena, J. Ullman","doi":"10.1097/01.CNE.0000732592.98360.44","DOIUrl":"https://doi.org/10.1097/01.CNE.0000732592.98360.44","url":null,"abstract":"problem, with an estimated 27 million cases per year leading to subsequent hospitalization and possible mortality. Decompressive craniectomy (DC), the surgical removal of a portion of the skull with exposure of the dura mater, has long been used for the treatment of severe TBI as an established means of decreasing mortality. In a comparison of the 2 largest randomized clinical trials (RCTs) evaluating the efficacy of DC versus medical management for refractory intracranial pressures (rICPs) (DECRA 2011 vs RESCUEicp 2016 trials), one revealed no significant impact on surgically treated patient mortality, whereas the other demonstrated a clear reduction of patient fatality in the surgically treated arm, but at the expense of creating a larger cohort of survivors with severe incapacitation, at least in the short term. Although DC has remained a standard treatment of acute subdural hematoma (ASDH), it is only now being compared in a large RCT (RESCUE-ASDH) to emergent craniotomy, another widely accepted procedure. Such results demonstrate the persistence of clinical equipoise when determining the utility of DC versus medical management or craniotomy for patients with severe TBI resulting in rICPs. In this article, we review the indications, pathophysiology, surgical technique, complications, controversy, and ethical considerations involving DC.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2020-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45022273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-30DOI: 10.1097/01.cne.0000723688.52449.d5
A. Larson, V. Nardi, G. Lanzino, W. Brinjikji, E. Scharf, L. Savastano
predict the risk of future ischemic events in patients with carotid artery stenosis based on ultrasound findings that assessed morphology and composition of plaque. However, with publication of landmark clinical trials, leading to a definition of the indications for treatment of symptomatic and asymptomatic patients, the focus was exclusively on the degree of stenosis rather than plaque morphology and composition. Therefore, over the past 30 years, decisions for invasive treatment have been based on degree of stenosis, and this is reflected in published guidelines. However, a growing body of scientific evidence suggests that a culprit plaque is not necessarily large and causing “clinically significant stenosis,” but vulnerable (ie, prone to rupture or to develop ulcers and erosions) and thrombogenic—leading to sudden occlusion, emboli, and subclinical microemboli with the potential to recur over time. The bulk of this research, which was mostly in the coronary arteries, has led to a broad awareness in the cardiology community of the importance of plaque morphology and composition, in addition to the degree of stenosis, in influencing the risk of future ischemic events. The concept of “unstable” plaque, independent from the degree of stenosis, has been the basis for intensive research in high-resolution intravascular imaging platforms and aggressive therapeutic measures. More recently, advances in noninvasive imaging that improved visualization of plaque features such as hemorrhage, and a better understanding of the mechanism leading to thromboembolic events, have raised awareness within the stroke community about the concept of “vulnerable carotid plaque.” This has led to the identification of patients with mildly stenotic but vulnerable plaque and whose cases would otherwise have been diagnosed as strokes of “undetermined source.” In this article, we briefly summarize pathologic, imaging, and clinical criteria of unstable plaque in patients with mild carotid artery stenosis, with case examples.
{"title":"Symptomatic Mild Carotid Artery Stenosis","authors":"A. Larson, V. Nardi, G. Lanzino, W. Brinjikji, E. Scharf, L. Savastano","doi":"10.1097/01.cne.0000723688.52449.d5","DOIUrl":"https://doi.org/10.1097/01.cne.0000723688.52449.d5","url":null,"abstract":"predict the risk of future ischemic events in patients with carotid artery stenosis based on ultrasound findings that assessed morphology and composition of plaque. However, with publication of landmark clinical trials, leading to a definition of the indications for treatment of symptomatic and asymptomatic patients, the focus was exclusively on the degree of stenosis rather than plaque morphology and composition. Therefore, over the past 30 years, decisions for invasive treatment have been based on degree of stenosis, and this is reflected in published guidelines. However, a growing body of scientific evidence suggests that a culprit plaque is not necessarily large and causing “clinically significant stenosis,” but vulnerable (ie, prone to rupture or to develop ulcers and erosions) and thrombogenic—leading to sudden occlusion, emboli, and subclinical microemboli with the potential to recur over time. The bulk of this research, which was mostly in the coronary arteries, has led to a broad awareness in the cardiology community of the importance of plaque morphology and composition, in addition to the degree of stenosis, in influencing the risk of future ischemic events. The concept of “unstable” plaque, independent from the degree of stenosis, has been the basis for intensive research in high-resolution intravascular imaging platforms and aggressive therapeutic measures. More recently, advances in noninvasive imaging that improved visualization of plaque features such as hemorrhage, and a better understanding of the mechanism leading to thromboembolic events, have raised awareness within the stroke community about the concept of “vulnerable carotid plaque.” This has led to the identification of patients with mildly stenotic but vulnerable plaque and whose cases would otherwise have been diagnosed as strokes of “undetermined source.” In this article, we briefly summarize pathologic, imaging, and clinical criteria of unstable plaque in patients with mild carotid artery stenosis, with case examples.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48172470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-15DOI: 10.1097/01.cne.0000721436.97052.8b
Jaafar Basma, J. Robertson, L. Michael
{"title":"Anatomic Triangles of the Jugular Foramen Region","authors":"Jaafar Basma, J. Robertson, L. Michael","doi":"10.1097/01.cne.0000721436.97052.8b","DOIUrl":"https://doi.org/10.1097/01.cne.0000721436.97052.8b","url":null,"abstract":"","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42876362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-30DOI: 10.1097/01.CNE.0000698200.67605.46
J. Khalifeh, Christopher F. Dibble, C. Dy, M. Boyer, W. Z. Ray
The operative strategy for nerve transfer in tetraplegia is tailored to the individual patient’s functional deficits and reinnervation goals. Information obtained from the history, physical examination, and electrodiagnostic studies permits the development of a strategy for nerve transfer based on the level of injury, a patient’s reinnervation priorities for functional recovery, and the available donor and recipient nerve pairings for transfer (Table 1). The operative techniques for nerve transfers to restore thumb and finger flexion, thumb and finger extension, and elbow extension have previously been reported. Descriptions of the surgical technique are located within the suggested readings. The objective of Part II in the current 2-part review article is to present results for the various reinnervation strategies and to suggest areas for future research in targeting upper extremity neurorestoration in tetraplegia.
{"title":"Nerve Transfers for Upper Extremity Reanimation in Tetraplegia: Part II—Reinnervation Strategies and Clinical Outcomes","authors":"J. Khalifeh, Christopher F. Dibble, C. Dy, M. Boyer, W. Z. Ray","doi":"10.1097/01.CNE.0000698200.67605.46","DOIUrl":"https://doi.org/10.1097/01.CNE.0000698200.67605.46","url":null,"abstract":"The operative strategy for nerve transfer in tetraplegia is tailored to the individual patient’s functional deficits and reinnervation goals. Information obtained from the history, physical examination, and electrodiagnostic studies permits the development of a strategy for nerve transfer based on the level of injury, a patient’s reinnervation priorities for functional recovery, and the available donor and recipient nerve pairings for transfer (Table 1). The operative techniques for nerve transfers to restore thumb and finger flexion, thumb and finger extension, and elbow extension have previously been reported. Descriptions of the surgical technique are located within the suggested readings. The objective of Part II in the current 2-part review article is to present results for the various reinnervation strategies and to suggest areas for future research in targeting upper extremity neurorestoration in tetraplegia.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":"1 - 6"},"PeriodicalIF":0.0,"publicationDate":"2020-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000698200.67605.46","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47375157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-30DOI: 10.1097/01.CNE.0000696344.86241.50
J. Khalifeh, Christopher F. Dibble, C. Dy, M. Boyer, W. Z. Ray
Traumatic spinal cord injury (SCI) leads to chronic impairment and disability. In the United States, the annual incidence of SCI is estimated as 54 cases per 1 million population, with a prevalence of greater than 250,000 persons currently living with the condition. Greater than 50% of SCIs occur in the cervical segments of the spinal cord, which can result in tetraplegia. Depending on the severity and level of injury, SCI may lead to varying degrees of motor and sensory loss in the neck, trunk, and upper and lower extremities. As recovery from a complete SCI is exceedingly rare, affected patients are left with permanent disability requiring lifelong medical care and rehabilitation. Patients with tetraplegia experience significant limitations in their mobility, ability to self-care, and participation restrictions in their education, employment, social relationships, and community engagement. They are often dependent on residual motor function and the assistance of caregivers to complete their activities of daily living. A survey of patients with tetraplegia indicated that regaining arm and hand function is rated as the highest priority, above autonomic functions of the bowel and bladder, walking ability, sexual function, and pain control. Therefore, therapeutic interventions that target functional recovery of the upper extremity have a significant impact on independence and quality of life. Operative reconstruction of the upper extremity in tetraplegia involves stand-alone or combined approaches using nerve transfers, tendon transfers, tenodeses, and/or joint stabilizations. The goal of surgery is improved strength and usability of the arm and hand, and occasionally reduction of muscle instability, pain with spasticity, or joint contractures. Tendon transfers have an established role as the mainstay approach to restore critical hand movements in
{"title":"Nerve Transfers for Upper Extremity Reanimation in Tetraplegia: Part I—Background and Operative Considerations","authors":"J. Khalifeh, Christopher F. Dibble, C. Dy, M. Boyer, W. Z. Ray","doi":"10.1097/01.CNE.0000696344.86241.50","DOIUrl":"https://doi.org/10.1097/01.CNE.0000696344.86241.50","url":null,"abstract":"Traumatic spinal cord injury (SCI) leads to chronic impairment and disability. In the United States, the annual incidence of SCI is estimated as 54 cases per 1 million population, with a prevalence of greater than 250,000 persons currently living with the condition. Greater than 50% of SCIs occur in the cervical segments of the spinal cord, which can result in tetraplegia. Depending on the severity and level of injury, SCI may lead to varying degrees of motor and sensory loss in the neck, trunk, and upper and lower extremities. As recovery from a complete SCI is exceedingly rare, affected patients are left with permanent disability requiring lifelong medical care and rehabilitation. Patients with tetraplegia experience significant limitations in their mobility, ability to self-care, and participation restrictions in their education, employment, social relationships, and community engagement. They are often dependent on residual motor function and the assistance of caregivers to complete their activities of daily living. A survey of patients with tetraplegia indicated that regaining arm and hand function is rated as the highest priority, above autonomic functions of the bowel and bladder, walking ability, sexual function, and pain control. Therefore, therapeutic interventions that target functional recovery of the upper extremity have a significant impact on independence and quality of life. Operative reconstruction of the upper extremity in tetraplegia involves stand-alone or combined approaches using nerve transfers, tendon transfers, tenodeses, and/or joint stabilizations. The goal of surgery is improved strength and usability of the arm and hand, and occasionally reduction of muscle instability, pain with spasticity, or joint contractures. Tendon transfers have an established role as the mainstay approach to restore critical hand movements in","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"42 1","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2020-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000696344.86241.50","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41511137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-15DOI: 10.1097/01.CNE.0000695876.49151.d3
R. Bram, S. Amin‐Hanjani
flow vascular abnormalities characterized by intertwined feeding arteries and draining veins with no intervening capillary network. Rudolph Virchow is credited with first describing cerebral AVMs in 1863 when he defined and differentiated several intracranial vascular pathologic entities. In 1928, Walter Dandy reported 8 cases and Harvey Cushing along with Percival Bailey described treatment of 16 AVMs with catastrophic results. At that time, Cushing was quoted as stating that surgical excision of an AVM was unthinkable because of significant risk of hemorrhage. These cerebrovascular lesions represent some of the most complex pathology within the scope of neurosurgery. Their management has significantly evolved over the past century and has garnered significant attention in the neurosurgical community. The serious consequences of an AVM-related intracerebral hemorrhage (ICH) combined with the pivotal role of the neurosurgeon in the multidisciplinary treatment of AVMs make this topic of importance to the practicing neurosurgeon. This review summarizes the epidemiology, natural history, and multimodality treatment of patients with unruptured AVMs.
{"title":"Unruptured Arteriovenous Malformations: Natural History and Management","authors":"R. Bram, S. Amin‐Hanjani","doi":"10.1097/01.CNE.0000695876.49151.d3","DOIUrl":"https://doi.org/10.1097/01.CNE.0000695876.49151.d3","url":null,"abstract":"flow vascular abnormalities characterized by intertwined feeding arteries and draining veins with no intervening capillary network. Rudolph Virchow is credited with first describing cerebral AVMs in 1863 when he defined and differentiated several intracranial vascular pathologic entities. In 1928, Walter Dandy reported 8 cases and Harvey Cushing along with Percival Bailey described treatment of 16 AVMs with catastrophic results. At that time, Cushing was quoted as stating that surgical excision of an AVM was unthinkable because of significant risk of hemorrhage. These cerebrovascular lesions represent some of the most complex pathology within the scope of neurosurgery. Their management has significantly evolved over the past century and has garnered significant attention in the neurosurgical community. The serious consequences of an AVM-related intracerebral hemorrhage (ICH) combined with the pivotal role of the neurosurgeon in the multidisciplinary treatment of AVMs make this topic of importance to the practicing neurosurgeon. This review summarizes the epidemiology, natural history, and multimodality treatment of patients with unruptured AVMs.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000695876.49151.d3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43789350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-01DOI: 10.1097/01.CNE.0000852676.65464.64
Peter F. Helvie, T. Jenkins, Brett D. Rosenthal, Alpesh A. Patel
patients after anterior cervical discectomy and fusion (ACDF). The reported incidence varies significantly, from as little as 3% to as high as 83%. The variability is thought to be from a lack of consensus on diagnostic criteria, screening, and expected outcomes. Fortunately, dysphagia after anterior cervical spine surgery is typically mild and transient. However, chronic dysphagia can prove to be a significant health burden on patients. Many factors are hypothesized as potential causes for dysphagia after an ACDF. Multiple patient risk factors and variations in surgical technique have been associated with increased rates of postoperative dysphagia. In addition, consensus for how to measure dysphagia clinically has not been well established. A more standardized method of studying dysphagia will be important for future studies to better understand this common and multifaceted problem established in anterior cervical spine surgery. Dysphagia is a common postoperative condition with which all spine surgeons should be familiar. This review will help educate the clinician on the possible causes of dysphagia, as well as patient and surgical characteristics that can help the surgeon counsel and potentially prevent postoperative dysphagia.
{"title":"Postoperative Dysphagia After Anterior Cervical Spinal Surgery","authors":"Peter F. Helvie, T. Jenkins, Brett D. Rosenthal, Alpesh A. Patel","doi":"10.1097/01.CNE.0000852676.65464.64","DOIUrl":"https://doi.org/10.1097/01.CNE.0000852676.65464.64","url":null,"abstract":"patients after anterior cervical discectomy and fusion (ACDF). The reported incidence varies significantly, from as little as 3% to as high as 83%. The variability is thought to be from a lack of consensus on diagnostic criteria, screening, and expected outcomes. Fortunately, dysphagia after anterior cervical spine surgery is typically mild and transient. However, chronic dysphagia can prove to be a significant health burden on patients. Many factors are hypothesized as potential causes for dysphagia after an ACDF. Multiple patient risk factors and variations in surgical technique have been associated with increased rates of postoperative dysphagia. In addition, consensus for how to measure dysphagia clinically has not been well established. A more standardized method of studying dysphagia will be important for future studies to better understand this common and multifaceted problem established in anterior cervical spine surgery. Dysphagia is a common postoperative condition with which all spine surgeons should be familiar. This review will help educate the clinician on the possible causes of dysphagia, as well as patient and surgical characteristics that can help the surgeon counsel and potentially prevent postoperative dysphagia.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"44 1","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48365959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.1097/01.CNE.0000695020.96579.55
A. Larson, L. Savastano, S. Rammos, W. Brinjikji
rosurgical condition that has a poor natural history. With an inhospital mortality of 16.7%, 1-year mortality of 32%, and only 21.1% of admitted patients returning home, cSDH remains a disabling and deadly disease. The incidence of cSDH greatly increases with age, with some estimates being as high as 18 per 100,000 individuals between the ages of 71 and 80 years. With an aging population and increased use of antiplatelet and anticoagulation medications, the incidence of cSDH is expected to exceed 60,000 new cases per year by the year 2030. Management strategies for cSDH vary widely and are subject to provider and institutional preferences. Traditional management avenues for cSDH have involved conservative management and open surgery. Conservative management has included observation, the use of corticosteroids, statins, osmotically active agents, platelet-activating factor inhibitors, and plasminogen activator inhibitors. Statins, in particular, have been demonstrated to be beneficial for patients with cSDH in recent randomized clinical trials. Surgical management includes options such as twist drill craniostomy at the bedside and open surgical drainage via burr holes or formal craniotomy. In a randomized clinical trial performed in 2009, the use of drains after burr hole drainage was associated with reduced recurrence and mortality at 6 months, thereby justifying the use of drains after burr hole drainage of cSDH. In general, patients who are asymptomatic or have minor symptoms with smaller hematoma volumes typically warrant conservative management, whereas patients with more severe symptoms and larger hematoma volumes require operative intervention. The success rate of each method in resolving the hematoma is variable, although surgical intervention is generally favorable in this regard and offers the advantage of an immediate decompressive effect. However, the recurrence rate of cSDH even after surgical evacuation is variable and may be as high as 37% by some estimates.
{"title":"Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: Rationale, Technique, and Results","authors":"A. Larson, L. Savastano, S. Rammos, W. Brinjikji","doi":"10.1097/01.CNE.0000695020.96579.55","DOIUrl":"https://doi.org/10.1097/01.CNE.0000695020.96579.55","url":null,"abstract":"rosurgical condition that has a poor natural history. With an inhospital mortality of 16.7%, 1-year mortality of 32%, and only 21.1% of admitted patients returning home, cSDH remains a disabling and deadly disease. The incidence of cSDH greatly increases with age, with some estimates being as high as 18 per 100,000 individuals between the ages of 71 and 80 years. With an aging population and increased use of antiplatelet and anticoagulation medications, the incidence of cSDH is expected to exceed 60,000 new cases per year by the year 2030. Management strategies for cSDH vary widely and are subject to provider and institutional preferences. Traditional management avenues for cSDH have involved conservative management and open surgery. Conservative management has included observation, the use of corticosteroids, statins, osmotically active agents, platelet-activating factor inhibitors, and plasminogen activator inhibitors. Statins, in particular, have been demonstrated to be beneficial for patients with cSDH in recent randomized clinical trials. Surgical management includes options such as twist drill craniostomy at the bedside and open surgical drainage via burr holes or formal craniotomy. In a randomized clinical trial performed in 2009, the use of drains after burr hole drainage was associated with reduced recurrence and mortality at 6 months, thereby justifying the use of drains after burr hole drainage of cSDH. In general, patients who are asymptomatic or have minor symptoms with smaller hematoma volumes typically warrant conservative management, whereas patients with more severe symptoms and larger hematoma volumes require operative intervention. The success rate of each method in resolving the hematoma is variable, although surgical intervention is generally favorable in this regard and offers the advantage of an immediate decompressive effect. However, the recurrence rate of cSDH even after surgical evacuation is variable and may be as high as 37% by some estimates.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"42 1","pages":"1 - 6"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000695020.96579.55","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41427412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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