World Neurosurg
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Review Comparative Study
C2 nerve root sectioning in posterior atlantoaxial instrumented fusions: a structured review of literature.
To review published series describing C1-2 posterolateral instrumentation, comparing outcomes in patients who had and did not have C2 nerve sacrifice. ⋯ Sacrifice of the C2 nerve root to aid in the insertion of C1 lateral mass screws when performing posterior atlantoaxial instrumented fusions is a treatment option (class III). It may decrease blood loss and operative duration, potentially advantageous in elderly or frail patients. Numbness occurred in roughly 12% of patients, an outcome that may be unacceptable to certain patient populations, but neuropathic pain was nearly absent in reported studies with nerve section. C2 nerve preservation and retraction for C1 screw placement may have higher incidence of neuropathic pain (~5%). Rates of fusion are universally high independent of C2 nerve technique.
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Review Case Reports
Early multimodality treatment of intracranial abscesses.
The treatment of brain abscesses remains one of the success stories of contemporary neurosurgery; what began as a nearly uniformly fatal disease at the turn of the 20th century has become a largely curable ailment through the use of operative and pharmaceutical intervention. ⋯ Cushing employed a variety of operative drainage techniques for intracranial abscesses and implemented an early antibacterial agent to provide adjuvant treatment in one patient. Although these cases demonstrate a 50% mortality rate, they provide insight into the challenges faced by neurosurgeons treating intracranial abscesses at the turn of the 20th century.
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Review Case Reports
Granulomatous amoebic encephalitis caused by Balamuthia mandrillaris in an immunocompetent girl.
Balamuthia mandrillaris is a recently recognized cause of a rare, devastating infection, granulomatous amoebic encephalitis (GAE). Presenting symptoms of GAE are nonspecific and can last for months before becoming clinically significant. Once the infection involves the central nervous system, death often results within days to weeks. A high degree of clinical suspicion is needed to correctly diagnose this infection because definitive diagnostic tests are presently limited, and even then there are only sparse data concerning effective treatment. The importance of early diagnosis is emphasized because delay likely contributes to the extremely high mortality with this infection. ⋯ GAE should be considered for a patient with atypical encephalitis and single or multiple lesions with surrounding edema evident on neurodiagnostic imaging.
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Comparative Study
A population-based study of inpatient outcomes after operative management of nontraumatic intracerebral hemorrhage in the United States.
In the United States, data on patient outcomes after operative management of nontraumatic intracerebral hemorrhage (ICH) have been largely derived from tertiary care academic institutions. Given that outcomes of patients treated at these specialized centers may differ from those treated at community hospitals, our aim was to report patient outcomes on a population-based, national level. ⋯ Patients with intracerebral hemorrhage who undergo craniotomy or craniectomy have a high morbidity and mortality. Male gender, preoperative comorbidities, complications, and low hospital volume were associated with an increased risk of in-hospital mortality.
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Review Case Reports
Transcervical double mandibular osteotomy approach to the infratemporal fossa.
In this study, we propose an alternative to the traditional transmandibular lower lip and chin splitting approach for exposing high infratemporal fossa and parapharyngeal space lesions involving the carotid canal and jugular foramen. ⋯ This novel technique is useful for providing excellent access to high infratemporal fossa or parapharyngeal space tumors. It avoids the traditional chin or lip incision and preserves the mental and facial nerves and is a useful procedure in the armamentarium of skull base/cerebrovascular neurosurgeons.