1. Heller RS, Lawlor CM, Hedges TR, et al. Neuro-ophthalmic effects of stenting across the ophthalmic artery origin in the treatment of intracranial aneurysms. J Neurosurg 2014;121:18–23, 10.3171/2014.3.JNS131493
The authors evaluated 104 patients with 106 aneurysms to define the frequency and types of ophthalmic complications that occur after placement of non-flow diverting stents across the ophthalmic artery origin. Visual field defects occurred in 7.7% of 104 patients, with 3 cases of immediate postoperative visual field defect. They conclude that deploying stents across the ophthalmic artery is relatively safe relative to visual outcome. They also state that in patients presenting with mass effect, that stent-assist coiling is less effective than surgery.
2. Seners P, Turc G, Tisserand M, et al. Unexplained early neurological deterioration after intravenous thrombolysis: incidence, predictors, and associated factors. Stroke 2014;45:2004–09, 10.1161/STROKEAHA.114.005426
I’m not really sure what this paper says, because I am to distracted by the odd abbreviation that is used extensively in the paper: “ENDunexplained” which stands for “early neurologic deterioration without clear mechanism”. Eight times in the abstract, and some 39 times in the body of the manuscript. Yes, I counted them. Ok, I did read it: prior antiplatelet use is good, high admission glucose bad, low admission NIHSS score bad, and proximal occlusion bad.
3. Bydon M, De la Garza-Ramos R, Macki M, et al. Lumbar fusion versus nonoperative management for treatment of discogenic low back pain: a systematic review and meta-analysis of randomized controlled trials. J Spinal Disord Tech 2014;27:297–304, 10.1097/BSD.0000000000000072
In this systematic review, the authors evaluated the 5 available RCT’s which compare lumbar fusion to nonoperative management for treatment of adults with chronic discogenic back pain (707 patients). The pooled data showed no significant difference between lumbar fusion and the nonoperative group. Nonoperative therapy or surgery both remain acceptable treatment methods.
4. Nael K, Khan R, Choudhary G, et al. Six-minute magnetic resonance imaging protocol for evaluation of acute ischemic stroke: pushing the boundaries. Stroke 2014;45:1985–91, 10.1161/STROKEAHA.114.005305
The investigators evaluated 62 acute stroke patients, and demonstrated that a 6-minute MR stroke protocol is feasible, and maintains diagnostic image quality. They obtained diagnostic image quality in ≥90% of studies. The protocol consistened of a 58s DWI series, 52s EPI-FLAIR, 56s EPI-GRE, 20s CE-MRA and 90s DSC perfusion study. Separate (diluted) contrast injections preformed for both the MRA and perfusion studies.
5. Thomas LE, Czuczman AD, Boulanger AB, et al. Low risk for subsequent subarachnoid hemorrhage for emergency department patients with headache, bloody cerebrospinal fluid, and negative findings on cerebrovascular imaging. J Neurosurg 2014;121:24–31, 10.3171/2014.3.JNS132239.
181 patients were evaluated with the inclusion criteria: headache, > 5 RBCs/mm3 in CSF, noncontrast head CT with no evidence of hemorrhage, and CTA or MRA without aneurysm or vascular lesion within 2 weeks of the ED visit. Median follow up was 53 months. Patients with bloody CSF but negative CTA/MRA have a good prognosis, do not require further emergent diagnostic evaluation, and can be safely discharged. Patient disposition and prognosis seems most strongly determined by the results of the noncontrast head CT and CTA, and not the LP results.
6. Cheung JP-Y, Samartzis D, Shigematsu H, et al. Defining clinically relevant values for developmental spinal stenosis: a large-scale magnetic resonance imaging study. Spine 2014;39:1067–76, 10.1097/BRS.0000000000000335.
The world awaits an easy and reproducible way to define lumbar canal stenosis. Maybe this is it. The authors measured axial and sagittal MR images in 100 patients who were operated upon for canal stenosis, and 100 nonoperative controls. When all is said and done, the measurements for critical stenosis requiring decompression were AP diameters at L4 <14 mm, L5 <14 mm, and S1 <12 mm.
