Neurosurgery
-
We sought to determine the frequency, risk factors, and impact on functional outcome and quality of life (QOL) of global cognitive impairment 1 year after subarachnoid hemorrhage. ⋯ Global cognitive impairment affects more than 20% of subarachnoid hemorrhage survivors at 1 year, is predicted by fever, anemia treated with transfusion, and delayed cerebral ischemia, and adversely affects functional recovery and QOL.
-
Comparative Study
Radiographic and anatomic basis of endoscopic anterior craniocervical decompression: a comparison of endonasal, transoral, and transcervical approaches.
To evaluate surgical access to the craniocervical junction using 3 endoscopic approaches: endonasal, transoral, and transcervical. ⋯ The endonasal and transoral approaches allow wide exposure with large working angles to the craniocervical junction. The transcervical approach accesses the odontoid for resection from the body of C2 to the lip of the basion. The angles of attack in the transcervical approach when centered on the surgical target are limited, but this approach offers a clean, sterile operative field. Clinical investigation will be required to determine the optimal indications for each approach.
-
We describe a prospective cohort study that investigated the effectiveness of microsurgical bilateral decompression using unilateral laminotomy for lumbar spinal stenosis and assessed the factors influencing the outcome. ⋯ Microsurgical bilateral decompression using unilateral laminotomy is an effective surgical option for lumbar spinal stenosis, even in high-risk patients with multilevel stenosis.
-
Hearing loss after removal of vestibular schwannomas with preservation of the cochlear nerve can result from labyrinthine injury of the posterior semicircular canal and/or common crus during drilling of the posterior wall of the internal auditory meatus. Indeed, there are no anatomic landmarks that intraoperatively identify the position of the posterior semicircular canal or of the common crus. We investigated the usefulness of image guidance and endoscopy for exposure of the internal auditory canal (IAC) and its fundus without labyrinthine injury during a retrosigmoid approach. ⋯ Frameless navigation using high-resolution computed tomographic scans and bone-implanted reference markers can provide a "roadmap" to maximize safe surgical exposure of the IAC without violating the labyrinth and leaving a small segment of the lateral IAC unexposed. Further exposure and surgical manipulation of this segment, including the fundus without additional cerebellar retraction and labyrinthine injury, can be achieved using an endoscope. Use of image guidance and an endoscope can help in exposing the entire posterior aspect of the IAC including its fundus without violating the labyrinth through a retrosigmoid approach. This technique could improve hearing preservation in vestibular schwannoma surgery.
-
Patients undergoing surgery for degenerative cervical spine disease may require future surgery for disease progression. We investigated factors related to the rate of additional cervical spine surgery, the associated length of stay, and hospital charges. ⋯ Patients undergoing surgery for degenerative cervical spine disease undergo reoperations at the rate of 2.5% per year. An initial ventral approach and/or fusion seem to be associated with lower reoperation rates. An initial nonventral approach and fusion were more expensive.