Neurosurgery
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Although the value of patient-reported outcomes (PROs) regarding assessing patient and quality-of-care outcomes is increasingly recognized within spine surgery, the benefits and challenges associated with the collection and clinical use of PROs remain to be established. The aim of this review was to discuss the published evidence on the wealth of clinically relevant data provided by PRO measures within spine surgery. ⋯ Physician-reported outcomes are often unable to provide a comprehensive evaluation of clinical and quality-of-care outcomes within spine surgery. Incorporation of PROs in patient evaluation is an integral part of efforts aimed at achieving excellence in health care delivery, as PROs help gain insight into individual patients' experiences and integrate an appraisal of patients' perspectives into clinical practice.
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The benefit of middle meningeal artery embolization (MMAE) in the treatment of chronic subdural hematoma (CSDH) has been recently demonstrated in a series of clinical trials. Whether MMAE benefits "trial-ineligible" patients remains elusive. We thus sought to explore the potential benefit of MMAE in neurologically stable (modified Rankin Scale ≤3) patients with "trial-ineligible" CSDHs because of large size: Thickness >15 mm and/or midline shift ≥5 mm. ⋯ This study emphasizes the considerable prevalence of potentially "trial-ineligible" patients with CSDHs because of large size that may still benefit from standalone MMAE.
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Case Reports
Superselective Angiography of Vasa Vasorum Within Partially Thrombosed Vertebral Aneurysm: A Case Report.
Partially thrombosed vertebral artery aneurysms (PTVAs) are rare, most of which are not easy to treat. Furthermore, endovascular treatment of PTVAs may not have favorable outcomes. The relationship between PTVAs and well-developed vasa vasorum (VV), including the mechanism of aneurysm growth, has been reported, but there are no reports of imaging findings by digital subtraction angiography (DSA). In this case, we successfully performed superselective angiography of well-developed VV and evaluated its imaging characteristics. We present the first DSA report of a well-developed VV of PTVA. ⋯ We successfully identified a VV within PTVA. Superselective VV angiography showed staining of the thrombosed component and venous return draining into the suboccipital cavernous sinus. In this case, the embolization of the VV proved to be an effective endovascular treatment of PTVA, but the safety of this method is a challenge. Further case studies are required to validate this method, and we hope it will evolve into a new treatment of PTVA.
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Hydrocephalus after Gamma Knife® stereotactic radiosurgery (SRS) for vestibular schwannomas is a rare but manageable occurrence. Most series report post-SRS communicating hydrocephalus in about 1% of patients, thought to be related to a release of proteinaceous substances into the cerebrospinal fluid. While larger tumor size and older patient age have been associated with post-SRS hydrocephalus, the influence of baseline ventricular anatomy on hydrocephalus risk remains poorly defined. ⋯ Patients with vestibular schwannoma with higher baseline EI, larger tumor volumes, and fourth ventricle deformation are at increased odds of developing post-SRS hydrocephalus. These patients should be counseled regarding risk of hydrocephalus and carefully monitored after SRS.
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Surveillance studies offer sparse knowledge of predictors of future growth in sporadic vestibular schwannomas (VS).Our aim was identification of these risk factors. We propose a scoring system to estimate the risk of growth in sporadic vestibular schwannoma. ⋯ Our retrospective study revealed that younger age, cystic morphology, cisternal extent, larger volume, and growth during 1st year were strong predictors of future growth. Moreover, we propose a scoring system that accurately estimates the risks of future tumor growth.