Neurosurgery
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Anecdotal cases of rapidly progressing dementia in patients with dural arteriovenous fistulas (dAVFs) have been reported in small series. However, large series have not characterized these dAVFs. We conducted an analysis of the largest cohort of dAVFs presenting with cognitive impairment (dAVFs-CI), aiming to provide a detailed characterization of this subset of dAVFs. ⋯ Venous hypertension is a key angiographic feature of dAVFs-CI. Moreover, these fistulas present at a mean age of 58 years-old, and exhibit a complex angioarchitecture characterized by an increased number of arteriovenous connections and stenosed sinuses. The presence of venous ectasia further exacerbates the impaired drainage and contributes to the development of dAVFs-CI. Notably, in certain cases, closure of the dAVF has the potential to reverse symptoms.
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Although an increased intracranial pressure (ICP) is a known problem in children with syndromic craniosynostosis, it remains unclear whether elevated ICP and impaired cerebral perfusion exist in nonsyndromic synostosis and should be defined as targets of primary treatment. This study aimed to investigate ICP, cerebral autoregulation (CAR), and brain perfusion in infants with nonsyndromic craniosynostosis at first surgical intervention. ⋯ Contrary to common belief, an elevated ICP and significantly impaired CAR can exist early in single suture synostosis, particularly sagittal synostosis. Because an influence of raised ICP on long-term cognitive development is known in other diseases, we suggest that preventing increased ICP during the phase of maximal brain development may be a goal for decompressive surgery, at least for sagittal synostosis cases.
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Carotid artery stenting (CAS) has become a viable alternative to carotid endarterectomy for the management of carotid stenosis. Our aim was to determine the rate of radiographic restenosis after CAS and clinical, radiographic, and procedural predictors of in-stent restenosis. ⋯ In this large, single-center study of carotid artery stenosis treated with CAS, residual in-stent carotid stenosis of approximately 30% and smoking status were independent predictors for restenosis. Maximizing treatment of initial stenosis and smoking cessation education are important steps in preventing future carotid restenosis.
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Postoperative dysphagia is a common complication of anterior cervical diskectomy and fusion (ACDF), although its pathophysiology remains poorly understood. Patients with severe dysphagia may suffer from serious complications such as aspiration pneumonia, in addition to difficulty with oral intake or malnutrition; therefore, a prompt indicator for postoperative management would be helpful. We quantitatively evaluated the retropharyngeal space (RS) after ACDF and investigated its association with postoperative dysphagia. ⋯ Our data demonstrate that a value of 6.1 mm for the APD of the RS is an effective indicator for dysphagia after ACDF, which contributes to optimizing the patient management in the acute postoperative period.
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As the global neurosurgical workforce expands, so do the contributions of women neurosurgeons. Recent studies highlighted pioneering women leaders in neurosurgery and provided invaluable perspectives into the proportion of women neurosurgeons in regions across the world. To provide a broad perspective of global trends, this study aims to characterize the global female neurosurgical workforce and evaluate its association with countries' economic status, broader physician workforce, and global gender gap index (GGGI). ⋯ Much progress has been made in expanding the neurosurgical workforce and the proportion of women within it, but disparities remain. As we address the global neurosurgeon deficit, improving recruitment and retention of women neurosurgeons through mentorship, collaboration, and structural support is essential.