Corrigendum to "Predictors of Recovery from Traumatic Brain Injury-Induced Prolonged Consciousness Disorder".

[This corrects the article DOI: 10.1155/2017/9358092.].

Multidisciplinary attentive treatment for patients with chronic disorders of consciousness following severe traumatic brain injury in the NASVA of Japan.

Primary Objective: The aim of this study was to demonstrate the clinical outcomes of long-term multidisciplinary attentive treatment (MAT) in patients with chronic disorders of consciousness (DOC) due to severe traumatic brain injury (TBI) following automotive accidents.Research Design: Five hundred and ten patients (mean age: 40.4 years) were enrolled in this retrospective study.Methods and Procedures: Patients were provided MAT for one to several years in the eight medical facilities of the National Agency for Automotive Safety and Victims' Aid (NASVA) in Japan. Clinical status for consciousness, communication, and activities of daily living were evaluated using the NASVA grading system.Outcomes and results: Following MAT, NASVA scores at discharge were significantly improved compared to those at admission in every patient subgroup including sex, age, NASVA score, and association with/without hypoxic encephalopathy at admission. Younger age, shorter interval between injury and admission, and better neurocognitive function at admission were found to be significant and independent factors for a good prognosis.Conclusions: MAT can partially improve the cognitive and physical abilities of patients with chronic DOC. From the perspective of not only restoring a patient's daily life, but also reducing the caregiver's burden, this type of treatment program warrants more public attention.

Predictors of Recovery from Traumatic Brain Injury-Induced Prolonged Consciousness Disorder.

We investigated the clinical predictors of the degree of recovery in patients with prolonged disorders of consciousness (PDC) caused by traumatic brain injury. Fourteen patients with PDC underwent two diffusion tensor imaging (DTI) studies; the first and second scans were performed at 345.6 ± 192.6 and 689.1 ± 272.2 days after the injury, respectively. In addition to the temporal changes in each of these diffusion parameters, fractional anisotropy (FA), mean diffusivity, axial diffusivity (AD), and radial diffusivity were assessed over a 1-year period. Relationship of clinical and DTI parameters with recovery from PDC (RPDC) was evaluated using Spearman's rank-correlation and stepwise multiple linear regression analysis. The mean FA and number of voxels with FA values > 0.4 (VsFA0.4) were significantly decreased at the second scan. A significant positive correlation was observed between the degree of RPDC and mean FA (r = 0.60) and VsFA0.4 (r = 0.68) as well as between the difference in VsFA0.4 (r = 0.63) and AD (r = 0.54) between the first and second scans. On multiple linear regression analysis, initial severity of PDC and the difference in AD remained significantly associated with the degree of RPDC. The microstructural white matter changes observed in this study indicate their potential relation with the degree of RPDC over the longer term.

[Natural history and management of asymptomatic unruptured cerebral aneurysms].

Natural history of asymptomatic unruptured cerebral aneurysms (AUCAs) still remains unclear. The concern on the natural history is incidence of rupture that was thrown into confusion with the report by International Study of Unruptured Intracranial Aneurysm Investigators (ISUIA) published on the New England Journal of Medicine in 1998. The annual rupture rate of AUCAs of our series was 1.1%. The study of Unruptured Cerebral Aneurysm Study of Japan (UCAS Japan) is now on going. Management modalities for AUCA includes surgery, intravascular treatment, and conservative treatment. Optimal treatment still remains under discussion. We first consider surgery for AUCAs, second intravascular treatment, and third conservative treatment. Our surgical indications are as follows: 1) patient's age is under 75 years old, 2) aneurysm locates in the anterior circulation, and 3) aneurysm size is over 5 mm. For patients with conservative treatment, periodic observation with magnetic resonance angiography is required. When aneurysm size increases with or without bleb, surgical or intravascular treatment should be considered. Our management strategy provides satisfactory results in patients with AUCAs. It is important to select the best treatment among those three modalities. In management of AUCAs, good surgical result (no mortality and low morbidity) are required for neurosurgeon.

Anterior paraclinoid aneurysms.

OBJECT: The characteristics of a previously unclassified paraclinoid aneurysm arising from the anterolateral (dorsal) wall of the proximal internal carotid artery were retrospectively analyzed in seven patients (five women and two men) who were treated surgically for an aneurysm in this unusual location. METHODS: One patient presented with subarachnoid hemorrhage (SAH) caused by rupture of this aneurysm. The lesions were found incidentally (five cases) or during investigation of SAH due to another aneurysm (one case). There was a female predominance in this series; all female patients harbored multiple aneurysms. All patients underwent surgery. Removal of the anterior clinoid process was necessary because the proximal neck of the aneurysm was closely adjacent to the dural ring. CONCLUSIONS: This special group of aneurysms is very rare, is located exclusively in the intradural space, and carries the risk of SAH. The results of surgical treatment for this aneurysm are quite satisfactory.