Download e-book for iPad: Advances and Technical Standards in Neurosurgery: Volume 42 by Johannes Schramm

By Johannes Schramm

This quantity of Advances and Technical criteria in Neurosurgery covers a few very important new advancements in useful neurosurgery and endovascular treatment. within the Technical criteria part quite a few themes are thought of, together with optic pathway gliomas, pineal lesions, cavernous sinus meningiomas and the everlasting challenge of stripling and repetitive head damage. Endovascular therapy of quite a few lesions is now universal perform and the state-of-the-art in endovascular remedy for acute ischemic stroke is reviewed. An appraisal of the proof on no matter if there's a position for microsurgical vascular decompression for crucial high blood pressure increases attention-grabbing questions. the amount is done by way of contributions on neurosurgical therapy of cluster complications and occipital nerve stimulation.

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02) and survival (57 % vs. 01) [41]. Mechanical Thrombectomy Protocols Mechanical thrombectomy was designed for application when failed IAT follows failed IVT [21] or when thrombolysis is contraindicated by bleeding diathesis, warfarin use, elevated international normalized ratio (INR), major surgery within the prior 14 days, thrombocytopenia, genitourinary or gastrointestinal bleeding, and associated trauma such as a fall at onset of stroke symptoms. Following the IMS trials, several studies found that a mechanical approach, used alone or in combination with IV and IA tPA, could improve the recanalization rate and, thereby, patient outcome [77, 78].

The enigma of the high revascularization rate on the one hand and lower-thanexpected good-outcome rate on the other. Analysis of the pretreatment CT scans revealed that an ASPECTS score of >7 (small infarct) at baseline was associated with a higher likelihood of achieving functional independence after revascularization than a score of ≤7 (50 % vs. 0001), and a total of 64 % of patients in the trial presented with large infarcts. This finding, along with other emerging data [95], supports the use of advanced imaging selection to guide the use of IA therapy.

If no treatable thrombus was demonstrated, therapy was terminated. If angiography identified the thrombus, treatment was continued with a mechanical device followed by infusion of tPA and delivery of low-intensity ultrasound at the site of occlusion using the EKOS microinfusion or a standard microcatheter. The choice of IA strategy was 40 G. Raphaeli et al. made by the treating neurointerventionalist. IA treatment had to begin within 5 h and be completed within 7 h of stroke onset [3, 40]. An interim analysis was conducted in May 2012 by the independent Data and Safety Monitoring Board based on the 3-month mRS results of 587 participants at over 50 sites in the USA and Canada.

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