Abstract: Clinical prediction and decision rules use evidence-based medicine to assist clinicians in diagnosing and treating illness. Although widespread in modern medical practice, there are relatively few clinical rules for neurosurgical conditions. This article reviews the background of how clinical prediction and decision rules are derived, validated, evaluated, and used in practice. It also summarizes a list of clinical rules published for neurosurgical illnesses and analyzes each rule for how it was derived and whether it was validated and/or evaluated compared with similar rules. It reports on whether the implementation of each rule was studied and grades the overall quality of each report.
Case series identifying chronic traumatic encephalopathy (CTE) in former athletes and military veterans have been, and continue to be, reported. Recently, there have also been substantial descriptions of the neuropathological similarities and differences between CTE and other neurodegenerative diseases such as Alzheimer disease (AD). Finally, there is growing evidence that neurodegenerative diseases, including Parkinson disease (PD), afflict those with a history of head trauma and blast exposure at higher rates than the general population.
Over the past century, craniotomy and resection of both the tumor resection and its dural base has become the preferred approach for the majority of symptomatic patients with skull base meningiomas.
The concept of flow diversion seems intuitive for the treatment of vascular disease. Flow diversion is stenting in a way that truly reconstructs the parent vessel, encouraging flow within the true vessel lumen and restricting it from surrounding pathology. This technique is possible because of the tightly braided nature of flow-diverting stents (30%-35% metal surface area coverage).
Residual and recurrent aneurysms are difficult quandaries for patients and clinicians because curative occlusion is not achieved and a decision about retreatment must be made, weighing the risks of rupture from a partially treated aneurysm against the risks of further intervention, which can be exponentially more challenging than an untreated aneurysm.
The clinical significance of remnants or recurrences of treated intracranial aneurysms is not a new concern for vascular neurosurgeons. However, in the endovascular era of aneurysm treatment, there has been more focus on this problem. It should be noted, first and foremost, that not all aneurysm remnants are created equally.
The anterior communicating artery (ACoA) is a common location for both ruptured and unruptured aneurysms. As with the treatment of all intracranial aneurysms, microsurgical clip occlusion has long represented the traditional and time-tested method of treatment. However, with the evolution of endovascular technology and improvements in catheter design that allowed easier access to the ACoA complex, coiling for lesions in this location became safer, with early series demonstrating good results.
OBJECT: The authors review their ventriculoperitoneal (VP) shunt revisions over a 3-year period to determine the rate of intraventricular hemorrhage (IVH) and subsequent need for re-revision.
OBJECT: Although stereotactic radiosurgery (SRS) has been accepted as a therapeutic option for arteriovenous malformations (AVMs) in children and adolescents, substantial data are still lacking regarding the outcomes of SRS for AVMs in this age group, especially long-term complications. This study aimed to clarify the long-term outcomes of SRS for the treatment of AVM in pediatric patients aged ≤ 18 years.
OBJECT: The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program.
OBJECT: More information about the association between preoperative anterior translation of the C-7 plumb line and clinical outcomes after decompression surgery in patients with lumbar spinal canal stenosis (LSS) would help resolve problems for patients with sagittal imbalance. The authors evaluated whether preoperative sagittal alignment of the spine affects low-back pain and clinical outcomes after microendoscopic laminotomy.
OBJECT: Despite extensive clinical experience with laminoplasty, the efficacy of the procedure and its advantages over laminectomy remain unclear. Specific clinical elements, such as incidence or progression of kyphosis, incidence of axial neck pain, postoperative cervical range of motion, and incidence of postoperative C-5 palsies, are of concern. The authors sought to comprehensively review the laminoplasty literature over the past 10 years while focusing on these clinical elements.
OBJECT: Acute cervical spine injuries have been extensively studied in high-level contact sports. However, the relation between the appearance of degenerative cervical spine disease and the exposure to repeated trauma in such sports as rugby is still unclear. Using clinical and MRI evaluation, we aimed to determine if former professional rugby players had more serious degenerative cervical spine symptoms than the general population.
OBJECT: A range of surgical options exists for the treatment of degenerative lumbar spondylolisthesis (DLS). The chosen technique inherently depends on the stability of the DLS. Despite a substantial body of literature dedicated to the outcome analysis of numerous DLS procedures, no consensus has been reached on defining or classifying the disorder with respect to stability or the role that instability should play in a treatment algorithm. The purpose of this study was to define grades of stability and to develop a guide for deciding on the optimal approach in surgically managing patients with DLS.
OBJECT: The authors´ objectives were to compare the rate of fusion after occipitoatlantoaxial arthrodesis using structural allograft with the fusion rate from using autograft, to evaluate correction of radiographic parameters, and to describe symptom relief with each graft technique.
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