World Neurosurg
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Racial disparities exist in health care, frequently resulting in unfavorable outcomes for minority patients. Here, we use guided machine learning (ML) ensembles to model the impact of race on discharge disposition and length of stay (LOS) after brain tumor surgery from the Healthcare Cost and Utilization Project National Inpatient Sample. ⋯ Minority race independently increases the risk of extended LOS and black race increases the risk of non-home discharge in patients undergoing brain tumor resection, a finding not mimicked in the general inpatient or operative population. Recognition of the influence of race on discharge and LOS could generate interventions that may improve outcomes in this population.
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To assess the clinical and radiographic outcomes of posterior vertebral column resection (PVCR) without anterior support in treatment of Yang type A severe rigid thoracic kyphoscoliosis. ⋯ In this study, we found that posterior vertebral column resection (PVCR) without any anterior support with a mean 3.7 cm shortening of the spinal column is safe, if close and unyielding contact of end plates can be obtained. A comprehensive understanding of the technique and intensive intraoperative neuromonitoring is mandatory to perform these challenging and complex spine deformity correction procedures safely.
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Orbital lesions are challenging to access due to their location amid critical anatomic structures. Here, we demonstrate direct transorbital cannulation of an orbital venous varix using image guidance. A 36-year-old male was diagnosed with a left orbital venous varix approximately 5 years ago at an outside institution. ⋯ The needle trajectory was determined and also visualized in real-time using image guidance (Needle Guidance, Siemens Healthineers). Once the needle reached the desired target, n-butyl cyanoacrylate glue (Codman Neuro, San Jose, California) was injected until nearly the entire venous varix was occluded. There were no complications, and at his postoperative visit the patient reported resolution of all symptoms.
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Fluorescein sodium salt is widely used in medicine as fluorescein isothiocyanate and commonly named fluorescein (FL). This fluorophore has been used as a fluorescent tracer for many applications, especially in ophthalmic surgery. It was initially used in neuro-oncology in 1948 to control tumor resection margins. After a transient disuse, it has recently had a second spring with the development of dedicated filters for operating microscopes, although it is still under evaluation in clinical use. The aim of this study is to contribute to the investigation according to which FL-guided surgery for high-grade glioma (HGG) is related to better rates of gross total resection (GTR) and so to a better outcome. ⋯ Intraoperative fluorescein-guided surgery showed safety and feasibility. Our and other studies suggest an improvement of GTR rate in HGG than nonuse.
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Intracranial meningiomas are typically benign extracerebral tumors derived from dural arachnoid cells. Predominantly, these tumors are effectively managed surgically, but the prognosis is heavily dependent on a tumor's histologic heterogeneity and its location. It is known that reproductive and hormonal factors increase the risk for meningioma in adult females, but their prognostic value still remains controversial. This study's aim was to examine possible correlation between tumor location and outcome, as well as to evaluate the prognostic value of the proposed simple tumor localization scale in predicting the management outcome of intracranial meningioma. ⋯ When estimating the management outcome of intracranial meningiomas, we propose a simple localization scale dividing the tumors into central and peripheral positions. Central tumor location might be prognostically unfavorable due to involvement of major neurovascular structures. Among the independent factors predicting favorable tumor response to surgery, more effective outcomes associated with peripheral tumor location and younger age were observed.