Neurosurgery
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Subdural hematoma (SDH) in patients with cancer is poorly described, and its frequency and causes may have changed with recent oncologic advances. ⋯ Leukemia and prostate cancer are the most common systemic cancers associated with SDH, and gliomas may predispose to SDH more often than previously recognized. Coagulopathy is common and associated with the worst outcome, but many patients experience good functional outcome and survival.
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In Asian populations, moyamoya disease has a well-defined phenotype including a bimodal age of presentation with children typically presenting with ischemic phenomena and adults presenting with hemorrhage. Studies have provided evidence that moyamoya disease in the United States may exhibit a different phenotype. ⋯ Patients admitted to US hospitals diagnosed with moyamoya disorder were more commonly female and white, and both adults and children were more likely to be diagnosed with ischemic vs hemorrhagic stroke. Over time, there was an increase in diagnosis, associated ischemic stroke, and treatment with extracranial-intracranial bypass.
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Mechanisms underlying the development of noncommunicating syringomyelia are poorly understood. ⋯ Multiple sites of CCO created a model of noncommunicating syringomyelia in adult rats. Increased astrocytic AQP4 expression was proportional to the degree of CC expansion. Modulation of aquaporin expression may be a novel target for therapeutic interventions to prevent syringomyelia.
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Changes in neurosurgical practice and graduate medical education impose new challenges for training programs. ⋯ A structured, competency-based neurosurgical education program supported with digital and mobile resources improved reading habits among residents and performance on the Congress of Neurological Surgeons-Self-Assessment in Neurological Surgery examination.
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Autoregulation is impaired by traumatic brain injury. Cerebral blood flow disturbances are spatially heterogeneous, but autoregulation is often reported as a global metric. ⋯ LLA was not increased by controlled cortical impact, nor did SRoR measurements demonstrate ineffective autoregulation when cerebral perfusion pressure was greater than and within 10 mm Hg of the LLA. Cerebral perfusion pressure optimization, indicated by autoregulation measurements, was significantly similar in the 2 hemispheres despite severe unilateral injury.