Notes

Percutaneous Management of Concomitant Significant Aortic Stenosis and also Thoracoabdominal Aortic Aneurysm.
Although the bifrontal approach used to be recommended for large olfactory groove meningioma (OGM), recent studies showed that large OGMs can also be resected safely via unilateral approaches. The present study aimed to discuss reasons for preferring a unilateral frontotemporal approach (UFTA), and the technical nuances and results of the UFTA, based on 18 cases.

The clinical and surgical data of patients who had been operated on for large (4-6cm) or giant (>6cm) OGM via a UFTA between 2011 and 2018 were retrospectively collected.

In all, 18 patients were included. All tumors were compatible with a diagnosis of OGM in the light of peri-operative examinations. 11 cases (61%) were large and 7 (39%) giant OGM; mean diameter was 6.1cm (range, 4-10cm). selleck inhibitor Resection extent was Simpson grade II in 14 cases (78%), grade III in 1 (5%), and grade IV in 3 (17%). Sixteen cases (89%) had no peri-operative complications, while 2 patients (11%) showed cerebrospinal fluid leakage and hemorrhagic deposition in the surgical area. There were no new neurological deficits nor deaths.

The UFTA for OGM is a relatively safe and effective approach, ensuring a high total removal rate with low mortality and morbidity. This study, with a reasonable number of patients, is one of the few in the literature on the outcome of this approach.
The UFTA for OGM is a relatively safe and effective approach, ensuring a high total removal rate with low mortality and morbidity. This study, with a reasonable number of patients, is one of the few in the literature on the outcome of this approach.
Lumbosacral transitional vertebrae (LSTV) is a common anatomic variant of the spine, characterized by the formation of a pseudoarticulation between the transverse process of the lumbar vertebrae and sacrum or ilium. LSTVs have been implicated as a potential source of low back pain-dubbed Bertolotti syndrome. Traditionally, LSTVs have only been subdivided into types I-IV based on the Castellvi radiographic classification system.

Solely identifying the type of LSTV radiographically provides no clinical relevance to the treatment of Bertolotti syndrome. Here, we seek to analyze such patients and identify a clinical grading scale and diagnostic-therapeutic algorithm to optimize care for patients with this congenital anomaly.

Patients presenting with back pain between 2011 and 2018 attributable to a lumbosacral transitional vertebra were identified retrospectively. Data was collected from these patients' charts regarding demographic information, clinical presentation, diagnostic imaging, treatment and outcomes. Based on evaluation of these cases and review of the literature, a diagnostic-therapeutic algorithm is proposed.

Based on our experiences evaluating and treating these patients and review of the existing literature, we propose a clinical classification system for Bertolotti syndrome we proposed a 4-grade scale for patients with Bertolotti syndrome based upon location, severity, and characteristics of pain experienced due to LSTVs.

Based on our experience with the cases illustrated here, we recommend managing patients with LSTV based on our diagnostic-therapeutic algorithm. Moving forward, a larger prospective study with a larger patient cohort is needed to further validate the treatment paradigm.
Based on our experience with the cases illustrated here, we recommend managing patients with LSTV based on our diagnostic-therapeutic algorithm. Moving forward, a larger prospective study with a larger patient cohort is needed to further validate the treatment paradigm.
Sphenoid wing meningiomas are a challenging surgical disease with relatively high perioperative morbidity. Most studies to date have focused on resection strategies as it relates to disease recurrence. Few have examined the optimal strategy as it relates to overall patient survival. We retrospectively reviewed our case series and evaluated extent of resection and perioperative stroke as it relates to all cause and disease-specific survival.

Ninety-four patients were included in the study. Demographics, clinical features, operative features and clinical course, and time to mortality evaluation were collected. Extent of resection (EOR) was defined as gross total (GTR, 100%, near total (NTR, ≥ 95%), and subtotal (STR, < 95%).

The overall mean EOR was 94.5% with 70.2% of cases achieving GTR, 12.8% achieved NTR, and 17% achieved STR. Postoperative stroke only occurred with GTR or NTR (p = .041). Age alone was significant on Cox regression analysis for all cause mortality (p = .042, HR 1.054 [95% CI 1.002 .We report a review of medical aspects of the consciousness. The behavioral dimension, phenotypic descriptors, relative consciousness and neural correlates of consciousness and related disorders were addressed successively in a holistic and chronological approach. Consciousness is relative, specific to each individual across time and space. Historically defined as the perception of the self and the environment, it cannot be separated from behaviors, entailing an idea of conscious behavior with metapractic and metagnostic aspects. Observation of spontaneous and evoked overt behavior distinguishes three main types of disorder of consciousness (DoC) coma, vegetative state or unresponsive wakefulness, and minimally conscious or relationally impoverished state. Modern functional exploration techniques, such as imaging, increase the understanding of DoCs and consciousness. Whether consciousness is a superior function and/or an instrumental function is discussed. Neural correlates can be subdivided into two wakefulne during attentional tasks. Thanks to recent advances in DoC pathophysiology, further significative therapeutic progress is expected, taking into account the societal context. This depends notably on the dissemination of medical knowledge and its transfer to a wider public.
The Brain Trauma Foundation (BTF) published evidence-based guidelines with a detailed approach to the management of intracranial hypertension (ICH) in traumatic brain injury (TBI) patients. However, management with cerebrospinal fluid (CSF) drainage in TBI patients remains a controversial topic and is a recent addition to the 4
Edition of the BTF guidelines. External lumbar drainage (ELD) has been proposed for the management of patients with refractory ICH despite aggressive measures. ELD has been described in the literature with possible benefits in outcomes; still, many questions remain unanswered.

A systematic search on MEDLINE was conducted for articles that studied lumbar CSF drainage in adult TBI patients with ICH.

Eleven studies met the inclusion criteria, which included 5 prospective and 6 retrospective studies. Several studies showed that CSF drainage via lumbar drain resulted in significant reduction of ICP compared to before ELD placement and had a low complication rate. However, the data reporting mortality and functional outcomes are varied across studies.
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