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Sentinel headache in intracranial aneurysms: this stranger
Key point: The presence of a severe, sudden headache, often referred to as a warning leak, minor leak, or sentinel headache (SH), during the days or weeks before subarachnoid hemorrhage (SAH) has been reported in 15% to 60% of all patients admitted with an SAH. The clinical significance and pathophysiology of SH have been a Read more about Sentinel headache in intracranial aneurysms: this stranger[…]
A walk in the past
Dr. Guido Guglielmi, father of the endovascular coiling of brain aneurysms.
Dural venous sinus stenting in idiopathic intracranial hypertension: let’s try to understand something more
Key point: Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a syndrome characterized by increased intracranial pressure, with non-specific neurological symptoms and a normal neuroimaging, except for findings occurring with chronic increased intracranial pressure of any cause. Diagnostic criteria have been identified by Dandy and Smith. IIH occurs with a frequency of about 1 Read more about Dural venous sinus stenting in idiopathic intracranial hypertension: let’s try to understand something more[…]
EVT selection 6-24 hours after stroke: no thanks!
Key point: In this post, we have seen that DAWN (and DEFUSE-3) trials results opened a great debate and left us with a big question: We concluded that the development of strict selection criteria could reduce the “therapy effect” of the treatment, despite it could increase the rate of patients with a good outcome. Meanwhile Read more about EVT selection 6-24 hours after stroke: no thanks![…]
The future of neurosurgery
When the news got out that Edison was developing the first practical electric light bulb, not everyone was impressed. A British Parliament Committee noted that Edison’s light bulb was “unworthy of the attention of practical or scientific men” and a chief engineer for the British Post Office said that the “subdivision of the electric light is an Read more about The future of neurosurgery[…]
ISUIA: the old problem.
Key point: In the last post, we have concluded that when an unruptured intracranial aneurysm is identified we have to decide whether the “patient” (and not only the aneurysm) should be treated and whether it should be treated with endovascular or neurosurgical techniques. But for years our decision making has been influenced by results of Read more about ISUIA: the old problem.[…]
An “old” meta-analysis: coiling versus microsurgical clipping in the treatment of unruptured MCA aneurysms
Key point: The widespread use of neurovascular imaging has increased the amount of intracranial aneurysms eccidentally detected. Although the lifetime risk of aneurysmal rupture in many cases is relatively small (approximately 1% per year), rupture can results in permanent neurological deficits or death, the reason why often patients may desire the treatment of unruptured aneurysms Read more about An “old” meta-analysis: coiling versus microsurgical clipping in the treatment of unruptured MCA aneurysms[…]
DAWN trial: solution or problem?
Key point: The main results of the “magnificent seven” (MR-CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, REVASCAT, THRACE, THERAPY) regarding stroke therapy showed that endovascular thrombectomy had a clinical benefit when it was performed within 6 hours after the onset of stroke symptoms and that there is an inverse relation between time and the benefit of the Read more about DAWN trial: solution or problem?[…]
Anesthesia-related outcomes for endovascular stroke revascularization: A systematic review and meta-analysis
Key point: Despite recently published trials showed the sizeable treatment effect of the endovascular mechanical thrombectomy, several studies suggest that the choice of anesthetic management during the endovascular recanalization procedure may have a substantial effect on patient outcomes. Preliminary retrospective observational studies have suggested that general anesthesia (GA) is associated with poorer outcomes than conscious sedation Read more about Anesthesia-related outcomes for endovascular stroke revascularization: A systematic review and meta-analysis[…]
Sex, Smoking, and Risk for Subarachnoid Hemorrhage
Key points: According to prospective cohort studies, smoking is the most important risk factor for unruptured intracranial aneurysms, correlating with their appearance, growth and rupture. In addition, earlier studies report that women are at higher risk for SAH with adjusted hazard ratios (HRs) from 1.4 to 1.9 compared with men. In this paper, published August, 2016, Read more about Sex, Smoking, and Risk for Subarachnoid Hemorrhage[…]