World Neurosurg
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Mannitol is the most commonly used intraoperative hypertonic solution in patients undergoing craniotomy. However, its use has been reported to be associated with hyperkalemia, which can occasionally be life threatening. ⋯ Knowledge of the existence of mannitol-induced hyperkalemia is paramount for the neurosurgeon and the anesthesiologist, because early treatment with insulin and calcium can quickly restore normal cardiac rhythm and prevent intraoperative death.
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Comparative Study
Cranial Center of Mass Compared to C7 Plumb Line Alignment in Adult Spinal Deformity.
To report the cranial center of mass (CCOM) progression in surgically treated patients for adult spinal deformity (ASD). The C7 plumb line/sagittal vertical axis (SVA) has important relationships with patient-reported outcomes; however, this has not yet been defined for CCOM. ⋯ CCOM alignment restoration is an important parameter in ASD, and malalignment is consistent over time.
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Although paraclinoid aneurysms are now frequently referred for endovascular treatment, the durability of obliteration is still to be determined. Therefore, direct surgery for paraclinoid aneurysms still remains indispensable. The present study aimed to evaluate the risk factors for the visual impairments in patients with unruptured intradural paraclinoid aneurysms. ⋯ The present study showed that carotid cave location and plug-in method during dural closures were related to postoperative continued visual impairments. Neurosurgeons should carefully consider the surgical indication for unruptured carotid cave aneurysms and avoid plug-in methods.
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Vein of Galen aneurysmal malformation (VGAM) is a rare pediatric vascular malformation of the brain. Genetic backgrounds are not well elucidated. We report on a monozygotic twin with VGAM and his endovascular treatment, and the genetic analyses of the twins and their parents. ⋯ We have reported a rare combination of a monozygotic twin and VGAM and the successful endovascular treatment. Phenotypic discordance in monozygotic twins established early in embryogenesis could be attributable to environmental or epigenetic factors.
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Reducing complications from unruptured aneurysms (UAs) treatment is important. We clarify the criteria for achieving safe and complete treatment for UAs ≤10 mm by clipping or coil embolization. ⋯ The treatment for UAs within the criteria, with the most recent points of concern, can lead to safe and complete results.