World Neurosurg
-
Multicenter Study
Epidemiology and Characteristics of Neurosurgical Conditions at Mbarara Regional Referral Hospital.
The unmet surgical need, specifically neurosurgical need, in Uganda is significant, yet only 2 public hospitals currently perform neurosurgery in the country. This study examines the epidemiology and outcomes of neurosurgical conditions presenting to 1 of 12 regional referral hospitals in Uganda, in an effort to understand the neurosurgical needs of this population. ⋯ Traumatic brain injury represented the majority of neurosurgical admissions at MRRH, disproportionately affecting young males. Age, closed head injury, admission Glasgow Coma Scale, getting a diagnostic image, and neurosurgical procedure were all independent predictors of mortality. Resource appropriate interventions throughout the health system are needed to meet the demand and improve outcomes.
-
To assess the contribution of low-field intraoperative magnetic resonance (iMRI) to endoscopic pituitary surgery. ⋯ Low-field iMRI is a useful and safe assistance even in advanced surgical techniques such as endoscopy. Its contribution is limited by the intrinsic features of the tumor. Further randomized studies are required to confirm the cost-effectiveness of iMRI in pituitary surgery.
-
Review Meta Analysis
Comparative outcomes of cortical screw trajectory fixation and pedicle screw fixation in lumbar spinal fusion: A systematic review and meta-analysis.
We conducted a systematic review and meta-analysis to compare the postoperative outcomes of cortical screw and pedicle screw (PS) fixation techniques for posterior lumbar interbody fusion (PLIF). ⋯ PLIF with CBT screw fixation had postoperative back and leg pain, disabilities, and function score.
-
To assess outcomes after endoscopic endonasal surgery for recurrent or residual pituitary adenomas. ⋯ The endoscopic endonasal approach provides a safe and effective option for recurrent pituitary adenomas. Smaller tumor size, absence of cavernous sinus invasion, and previous microscopic approach were independent predictors of GTR. This finding might suggest that inadequate exposure or limited viewing angle may adversely affect extent of resection in primary microscopic surgeries.
-
In cases of severe traumatic brain injury, cerebrospinal fluid (CSF) diversion though an external ventricular drain (EVD) is a proven method to assist in the control of elevated intracranial pressure. Under normal circumstances, the EVD is placed in a frontal location. However, in cases of multifocal intracranial injury and swelling, collapse of the frontal horns of the lateral ventricles leads to frequent failure of frontal CSF drainage. In this series we describe the utility of the Keen's point EVD as a safe alternative to maintain continuous CSF diversion for patients in whom frontal drainage is not feasible. ⋯ In all cases, we were able to reliably maintain continuous CSF diversion for an extended period of time. There was 1 mortality due to the severity of initial injuries. In the remaining 2 patients, intracranial pressure was able to be normalized following placement of the Keen point EVD. The Keen point EVD is a viable option to maintain continuous CSF drainage in patients with diffuse intracranial injury and should be considered in patients whom a frontal EVD cannot reliably maintain continuous drainage of CSF.