Neurosurgery
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Gait and balance impairment are typical symptoms of idiopathic normal pressure hydrocephalus (INPH), implicating that falls may afflict these patients. ⋯ Falls, FOF, and low confidence in avoiding falls are considerable problems in INPH that may be reduced by shunt surgery. We suggest that remaining risk of falling and preventative measures are routinely considered in postoperative follow-ups and rehabilitation planning.
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Myelopathy is thought to be associated with higher morbidity and mortality after anterior cervical discectomy and fusion (ACDF); however, the literature investigating this association has limitations. ⋯ Patients with myelopathy who undergo elective single-level ACDF have higher risks of several perioperative events including longer operative time, longer hospital stay, higher return to operating room, and unplanned readmission rates, when compared to nonmyelopathic patients. On the other hand, myelopathic patients did not exhibit higher mortality rate.
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Although recurrence and de novo formation of arteriovenous malformations (AVMs) have been reported following complete resection, the occurrence of hemorrhage in the same location of an AVM with no detectable lesion (lesion-negative hemorrhage) has not been described after microsurgery. ⋯ A lesion-negative hemorrhage can occur following complete microsurgical resection in up to 2.4% of patients. Exploration of possible underlying causes is warranted.
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Ruptured intracranial aneurysms cause 50% of spontaneous subarachnoid hemorrhages in children, resulting in up to 65% mortality when left untreated. Although flow-diverting stents are especially suited to treat the fusiform and giant aneurysms more commonly found in children, the US Food and Drug Administration (FDA) has only approved their use in patients ≥22 years of age. Our objective was to assess the safety of flow-diverting stents in the treatment of pediatric patients with aneurysms through a systematic literature review using the PRISMA criteria. ⋯ This resulted in an incidence rate of 0.018 complications per patient at-risk month (95% CI 0.008-0.035). These data suggest that the use of flow-diverting stents for treatment of aneurysms in children may be safe and that FDA approval for this use should be evaluated. Although this analysis is comprised of case reports and case series, it represents the best attempt thus far to quantify the risk of using flow-diverting stents in children.