World Neurosurg
-
Multicenter Study Observational Study
Epidemiology of Mild Traumatic Brain Injury with Intracranial Hemorrhage: Focusing Predictive Models for Neurosurgical Intervention.
To outline differences in neurosurgical intervention (NI) rates between intracranial hemorrhage (ICH) types in mild traumatic brain injuries and help identify which ICH types are most likely to benefit from creation of predictive models for NI. ⋯ This study highlighted disparate NI rates among ICH types in patients with mild traumatic brain injury and identified mild, isolated subdural hematomas as most appropriate for construction of predictive NI models. Increased health care efficiency will be driven by accurate understanding of risk, which can come only from accurate predictive models.
-
Tubular microdiscectomy has become a staple technique among spine surgeons. Yet the associated learning curve, especially its later stages, has not been extensively studied. With studies reporting a higher rate of recurrent herniation using tubular microdiscectomy, surgeons' level of experience becomes of primary importance for the interpretation of such findings. We aimed to analyze possible improvements in the later stages of the learning curve and to identify factors independently associated with recurrent herniation. ⋯ Relevant improvements in clinical results were seen even after the surgeon had already accumulated extensive experience. Any future studies should unambiguously report the level of experience of the participating surgeons, possibly including the number of cases previously treated using a particular technique.
-
Case Reports
Anterior Lumbar Dural Tear: A Transthecal Route for Primary Closure after Iatrogenic Durotomy.
Durotomies are not infrequent in spine surgery and have increased complication rates. Primary repair is the gold standard and is feasible when access is not limited by the anatomy. A patient who presented 1 week after spinal fusion with cerebrospinal fluid (CSF) leak underwent a novel transthecal approach to repair an anterior dural tear. ⋯ Dorsal transthecal access to the ventral aspect of the lumbar thecal sac for inadvertent anterior dural tears is a safe, feasible, and durable surgical management strategy.
-
Intra-axial brain tumors located at anatomically eloquent areas are challenging conditions. On one hand, it is often difficult to pursue maximum extent of resection of tumor in these locations. On the other hand, neuroplasticity occurs in some patients with low-grade glioma, and the primary neural functions are known to sometimes shift from conventional "eloquent cortices." ⋯ This case highlights the importance of preoperative multimodal neurophysiologic imaging in patients with low-grade gliomas in eloquent areas.
-
Case Reports Comparative Study
Three-dimensional cortical surface reconstruction versus operative findings: their similarity and applications.
Three-dimensional cortical surface reconstruction (3DCSR) is an important tool for operations involving cerebral cortex, but data on its similarity to actual cortical architecture are lacking. In this study, the authors systematically tested the similarity between operative findings and 3DCSR built by a neuronavigation system and illustrated its applications. ⋯ Authors have systematically demonstrated that 3DCSR built by neuronavigation system in this study provides detailed anatomy of cortical surface with a high degree of similarity to operative findings even in the presence of cortical distortion, leading to various applications beyond navigation alone.