World Neurosurg
-
To evaluate whether increasing the volume drained from chronic subdural hematomas (SDHs) via either twist drill drainage (TDD) or burr hole drainage (BHD) followed by instillation of tissue plasminogen activator (tPA) is more efficacious than simple drainage alone. ⋯ This study adds another therapeutic option for patients with chronic SDH requiring treatment. In this retrospective study, the addition of tPA increased the volume of hematoma drained and significantly reduced the incidence of recurrence requiring further intervention regardless of cranial access route. No complications occurred related directly or indirectly to the administration of tPA. Further study of this technique is warranted.
-
Radiosurgery has emerged as an important primary treatment means of typical trigeminal neuralgia. Despite its high safety and efficacy, the likelihood of recurrence is significant, potentially requiring salvage treatment. Posterior fossa exploration and microvascular decompression is an option for salvage treatment. Results are presented regarding a single-surgeon experience, and a grading scale is proposed for postirradiation surgical findings. ⋯ Microvascular decompression can be performed in the postradiosurgery setting safely with high efficacy. Dissection typically was not significantly more difficult in comparison to procedures performed without prior history of radiosurgery intervention.
-
Dialysis-associated destructive spondyloarthropathy (DSA) is the major bony complication of end-stage renal disease, most commonly found in the lower cervical region. The risk factors for developing dialysis-associated DSA include duration of hemodialysis and patient age. Patients with DSA have a higher incidence of osteoporosis and poor bone mineral density, which may place them at greater risk of atraumatic fractures, instrumentation failure, and neurologic compromise. ⋯ Patients with renal osteodystrophy present a challenge for the spine surgeon due to compromised bone density. Hardware failure at the bone-construct interface is common in these patients, with revision surgery needed in 22% of published cases. Longer constructs with circumferential instrumentation and halo immobilization may minimize the risk of pseudoarthrosis and construct pull-out.