World Neurosurg
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The purpose of the present study was to provide a new classification of the lateral region of the lumbar spinal canal (LLSC) and evaluate the clinical outcomes of surgical treatment of LLSC stenosis guided by the classification. ⋯ The new classification of LLSC can provide objective criteria for full-endoscopic surgery that could lead to better clinical outcomes.
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To study the effect of a staphylococcal decolonization regimen (SDR) and change in antibiotic prophylaxis regimen on postoperative meningitis (bacterial and aseptic) rates in patients undergoing elective cranial surgery. ⋯ Our data showed that the incidence of AM can be reduced with an SDR and appropriate antibiotic prophylaxis. These findings lend support to the suspicion that AM might be a form of low-grade BM possibly due to a staphylococcal infection.
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Case Reports
Rupture of a Giant Anterior Sacral Meningocele in a Patient with Marfan Syndrome: Diagnosis and Management.
Marfan syndrome is a genetic disorder that results in the weakening of connective tissues. Dural ectasia has been defined as a feature of Marfan syndrome and is present in up to 92% of patients. Rarely, dural ectasia can erode through the sacrum expanding into an anterior sacral meningocele. ⋯ The progression of dural ectasia in Marfan syndrome to an anterior sacral meningocele is uncommon. It is important to identify the characteristics associated with an expanding dural ectasia as this patient's symptoms progressed over time and the meningocele grew large. Given its rarity, there are no guidelines in place regarding size at which repair of an anterior sacral meningocele should occur prophylactically. It is important to review these cases in order continue to learn about progression, management, and outcomes of patients with an anterior sacral meningocele.
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Tumor-treating fields (TTFs) have become an important, evidence-based modality in the treatment of glioblastoma (GBM). In patients requiring cardiac pacemakers, TTF therapy is complicated by theoretical concerns regarding possible electrical interaction between the devices. ⋯ The first reported case of successful TTF administration in a GBM patient with a previously implanted cardiac pacemaker may allay the concerns of neuro-oncologists, cardiologists, radiation oncologists, and all certified TTF prescribers regarding the applicability of TTF in suitable candidates with preexisting cardiac pacemakers. This case indicates that TTF therapy may be efficacious in patients with indwelling magnetic resonance image-conditional cardiac pacemakers turned to the off position and that physical removal of the pacemaker is not necessary before starting TTF.
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Case Reports
Transforaminal endoscopic excision of intradural lumbar disc herniation and dural repair: A case report.
Intradural disk herniation is a rare entity with <0.3%-1% of all disk herniations and at an L2-L3 level even rarer. The dural defects repairs on ventral aspect are technically challenging and may not be possible after durotomy, so many authors have placed fascia, muscle, or plugging by the hemostatic material. The surgical treatment of intradural disk herniation is usually posterior open surgery with formal durotomy to remove the disk fragments with good to fair results. Poorer outcome occurs in late-presenting cases. ⋯ To our knowledge, this is the first case of transforaminal endoscopic treatment of intradural disk herniation at an L2-L3 level in which good clinical outcomes were obtained and maintained until recent follow-up of 8 months.