World Neurosurg
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Case Reports
Initial Experience with High Definition Camera-On-a-Chip Flexible Endoscopy for Intraventricular Neurosurgery.
The usefulness of existing neuroendoscopes has been limited by either decreased range of motion or suboptimal image resolution. The flexible high-definition chip-camera endoscope has emerged as a potential solution to the shortcomings of available instruments by combining superior flexibility and image quality in order to better operate within spatially constrained intraventricular operations. ⋯ As demonstrated by this initial experience, the use of high-definition camera-on-a-chip flexible endoscopy may provide enhanced intraoperative visualization and application for intraventricular neurosurgery.
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Cerebral vasospasm is an important cause of morbidity after subarachnoid hemorrhage, but can also occur after resection of acoustic neuroma. This study aimed to identify factors associated with postoperative cerebral vasospasm in patients with acoustic neuroma. ⋯ Younger patient age, larger tumor size, and firmer tumor consistency were independently associated with postoperative cerebral vasospasm in patients with acoustic neuroma.
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Postoperative central nervous system infections (PCNSIs) are rare but serious complications after neurosurgery. The purpose of this study was to examine the prevalence and causative pathogens of PCNSIs at a modernized, resource-limited neurosurgical center in South Asia. ⋯ This study summarizes the prevalence, causative organism of PCNSI, and antibiotic usage for all of the neurosurgical cases over a 13-month period in a modernized yet resource-limited neurosurgical center located in South Asia. The results from this study highlight the PCNSI landscape in an area of the world that is often underreported in the neurosurgical literature because of the paucity of clinical neurosurgical research undertaken there. This study shows an increasing prevalence of gram-negative organisms in CSF cultures from PCNSIs, which supports a trend in the recent literature of increasing gram-negative bacillary meningitis.
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Aortic root dimension (ARD), an echocardiographic marker of aortopathy, has recently been associated with intracranial aneurysm eccentricity, suggesting a common underlying pathophysiology between intracranial aneurysm and aortopathy. ⋯ Fusiform aneurysms are correlated with larger ARD than saccular aneurysms, suggesting a shared pathophysiologic mechanism with aortopathy.
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Perimesencephalic subarachnoid hemorrhage (PMSAH) is a well-defined subtype of angiogram-negative SAH, characterized by a benign natural history and a virtually nonexistent risk of recurrence. Few case reports of recurrent PMSAH exist in the literature, all occurring after relatively short time intervals ranging from 5 days to 31 months, mostly in patients on antithrombotic therapy. We present a unique case of ultra-late PMSAH recurrence after 12 years, in a patient not receiving antithrombotic medications. ⋯ Although exceptional, recurrence of PMSAH is not impossible. If the 2 events are assumed to be random and independent of each other, binomial statistics yield approximately a 79 per billion chance of 2 or more episodes occurring over an 80-year lifetime. However, other possibilities should be kept in mind, including tiny and radiographically occult vascular lesions or particular venous anatomy predisposing patients to recurrent bouts of PMSAH. Patients should not be told that the risk of recurrence is zero, but that it is close to zero.