World Neurosurg
-
Comparative Study
Long term results and efficacy of laminectomy with fusion vs. Young laminoplasty for the treatment of degenerative spinal stenosis.
In the treatment of degenerative lumbar stenosis, facet-sparing laminectomy with instrumented fusion (FSL) was recently almost totally replaced by less invasive, allegedly equally effective surgical techniques. We performed a long-term comparison between outcomes after Young laminoplasty (YL) as a representative of the less invasive technique and FSL. ⋯ FSL is a more invasive and more expensive surgical technique than YL. In a short-term and long-term follow-up comparison, FSL is a more successful operative technique, and the difference increases over time in favor of FSL.
-
To investigate the frequency and risk factors of contralateral epidural hematoma (CEDH) following decompressive craniectomy (DC) in patients with calvarial skull fracture contralateral to the craniectomy site. ⋯ Age and number of fracture-involved bone plate are significant risk factors for CEDH development following DC. Involvement of 2 or more bone plates of contralateral calvarial skull fracture in young adult may prompt an immediate postoperative computed tomography scan to detect the occurrence of CEDH, irrespective of the operative findings and neurologic status. This may prevent devastating neurologic consequences of CEDH and improve therapeutic outcome.
-
Comparative Study
Assessment of the Endoscopic Endonasal Transclival Approach for Surgical Clipping of Anterior Pontine AICA Aneurysms.
Aneurysms of the anterior pontine segment of the anterior-inferior cerebellar artery (AICA) are uncommon. Their treatment is challenging because critical neurovascular structures are adjacent to it and the available surgical corridors are narrow and deep. Although endoscopic endonasal approaches are accepted for treating midline skull base lesions, their role in the treatment vascular lesions remains undefined. The present study is aimed to assess the anatomic feasibility of the endoscopic endonasal transclival (EET) approach for treating anterior pontine AICA aneurysms and compare it with the subtemporal anterior transpetrosal (SAT) approach. ⋯ Clipping anterior pontine AICA aneurysms using the EET approach is feasible. Compared with SAT, the EET approach provides advantages in surgical window area, ensuring proximal control before aneurysm dissection, visualization of perforating branches, and better proximal control.
-
In elderly patients with severe traumatic brain injury, the use of aggressive versus conservative management remains controversial. The aim of this study was to assess the outcome of surgical alternatives for treatment of severe traumatic intracranial hematoma in patients ≥65 years old and identify factors that may contribute to the outcome. ⋯ This study showed that Glasgow Coma Scale score (≤5) was a major determinant of outcome in elderly patients with severe traumatic brain injury. However, surgical treatment reduced mortality and improved outcome in the elderly patients in this study.
-
Venous thromboembolism (VTE) is a major preventable cause of morbidity and mortality in hospitalized patients and is a widely accepted measure for quality of care. Prolonged corticosteroid therapy, which is common in neurosurgical patients, has been associated with VTE. Using a national database, we sought to determine whether corticosteroid use for >10 days was an independent risk factor for deep venous thrombosis (DVT) and pulmonary embolism (PE). ⋯ In the neurosurgical population, prolonged courses of corticosteroids are associated with an increased risk of developing postoperative DVT and PE, even when controlling for potential confounders.