Stroke is the leading cause of disability in the United States. Extracranial atherosclerotic disease of the carotid artery accounts for up to 20% of all strokes. For symptomatic patients with significant extracranial carotid stenosis, prior trials have found better outcomes after carotid endarterectomy (CEA) compared with best medical therapy.1-5 Numerous studies have assessed endovascular treatment as an alternative to CEA.
Recent advances in the field of functional neurosurgery have profoundly affected the treatment of neurological conditions such as Parkinson disease and epilepsy. Current techniques of brain mapping make use of penetrating cortical arrays to provide adequate spatial resolution for neural recordings and neurostimulation; however, this technique comes with significant limitations. These methods generally require a craniotomy and cause brain tissue trauma, which can result in gliosis and blood-brain barrier disruption.1 Thus, minimally invasive techniques of brain recording have emerged as an area of interest, and the use of a transvenous conduit to implant a recording device has been proposed by Oxley et al.2 In their study, the authors implanted an endovascular device, a “stentrode,” into a cerebral vein and compared the cortical recordings obtained through this device to traditional electrode arrays implanted via craniotomy.
BACKGROUND: Traditional surgical options for the treatment of symptomatic lumbar spinal stenosis include decompression alone vs decompression and fusion; both options have potential limitations.
BACKGROUND: There continues to be considerable interest in the use of decompressive hemicraniectomy in the management of malignant cerebral artery infarction; however, concerns remain about long-term outcome.
BACKGROUND AND IMPORTANCE: A porous bioresorbable polymer scaffold has previously been tested in preclinical animal models of spinal cord contusion injury to promote appositional healing, spare white matter, decrease posttraumatic cysts, and normalize intraparenchymal tissue pressure. This is the first report of its human implantation in a spinal cord injury patient during a pilot study testing the safety and feasibility of this technique (ClinicalTrials.gov Identifier: NCT02138110).
Abstract: Osteoporosis, the most common form of metabolic bone disease, leads to alterations in bone structure and density that have been shown to compromise the strength of spinal instrumentation. In addition, osteoporosis may contribute to high rates of fracture and instrumentation failure after long posterior spinal fusions, resulting in proximal junctional kyphosis and recurrent spinal deformity.
Abstract: Surgical management of spinal deformity is elderly patients is characterized by significant variability. In a value-based health care economy, minimization of risks and maximization of benefit and durability of surgery are a priority. The choice of a surgical approach is a significant determinant of risk, cost, and outcome. Informed choice regarding a surgical approach requires participation of the patient and surgeon. Limited interventions may be appropriate for patients with radicular symptoms and focal pain.
Abstract: Spinal deformities are frequent and disabling complications of movement disorders such as Parkinson disease and multiple system atrophy. The most distinct spinal deformities include camptocormia, antecollis, Pisa syndrome, and scoliosis. Spinal surgery has become lower risk and more efficacious for complex spinal deformities, and thus more appealing to patients, particularly those for whom conservative treatment is inappropriate or ineffective. Recent innovations and advances in spinal surgery have revolutionized the management of spinal deformities in elderly patients.
Introduction: Poor leptomeningeal collateral flow is related to worse clinical outcome in acute ischemic stroke, but the factors that determine leptomeningeal collateral patency are largely unknown. We explored the determinants of leptomeningeal collateral flow and assessed their effect on the relation between leptomeningeal collateral flow and clinical outcome.
BACKGROUND AND PURPOSE: Blood-brain barrier permeability is not routinely evaluated in the clinical setting. Global cerebral edema occurs after SAH and is associated with BBB disruption. Detection of global cerebral edema using current imaging techniques is challenging. Our purpose was to apply blood-brain barrier permeability imaging in patients with global cerebral edema by using extended CT perfusion.
BACKGROUND AND PURPOSE: The Woven EndoBridge (WEB) device was recently introduced for intrasaccular treatment of wide-neck aneurysms without the need for adjunctive support. We present our first experience in using the WEB for small ruptured aneurysms.
Background and Purpose: Information about outcomes in Embolic Stroke of Undetermined Source (ESUS) patients is unavailable. This study provides a detailed analysis of outcomes of a large ESUS population.
Background and Purpose: In hemodialysis patients, previous reports have described a high prevalence of cerebral microbleeds (CMBs), but no longitudinal studies have been performed to determine the clinical significance of CMBs in these patients. In this study, we investigated whether the presence of CMBs was a predictor of future strokes in hemodialysis patients.
Background and Purpose: Hypertensive patients with electrocardiographic left ventricular hypertrophy are at increased risk of all-cause and cardiovascular death. Lowering blood pressure (BP) after stroke reduces the risk of recurrent stroke, but recent data suggest that lower systolic BP (SBP) measured 5 years after stroke is associated with increased mortality. Whether lower SBP is associated with increased short-term mortality after stroke in hypertensive patients is unclear.
Background and Purpose: Cerebral white matter lesions (WMLs), a surrogate for small-vessel disease, are common in patients with stroke and may be related to an increased intracranial bleeding risk after intravenous thrombolysis in acute ischemic stroke. We aimed to investigate the risk of symptomatic intracerebral hemorrhage (sICH) in the presence of WMLs in a large cohort of ischemic stroke patients treated with intravenous thrombolysis.
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