World Neurosurg
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Noniatrogenic pituitary abscess remains a rare clinical entity, and is the indication for surgery in <1% of transsphenoidal approaches. Correct diagnosis of this rare entity is often delayed. Without timely treatment, morbidity and mortality are high. Of the 200 cases reported to date, less than one-half have identified a causative organism. We report the second case of a pituitary abscess caused by Candida species, and also provide an intraoperative video showing the endoscopic management of this pathology. ⋯ With timely management, including a combination of surgical drainage and appropriate antimicrobial therapy, neurologic outcomes are good in most cases of pituitary abscess; however, endocrinopathy often does not improve. Although most reported cases with identified causative organisms speciate bacteria, some cases are of fungal etiology and require different antimicrobial agents. This further underscores the importance of identifying the causative agent.
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To investigate the ability of transforaminal lumbar interbody fusion (TLIF) to improve lumbar lordosis (LL). ⋯ For patients with neurogenic leg symptoms owing to single-level lumbar degenerative disease, whole LL was improved after TLIF as a result of spontaneous restoration of lordosis at the unfused lumbar levels.
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Case Reports
Emergency Optic Canal Decompression for Vision Salvage in Fibrous Dysplasia: A Case Report.
The most common neurologic manifestations of fibrous dysplasia (FD) are vision and hearing loss. Optic decompression for progressive vision loss has been shown to yield positive results in terms of visual outcomes; however, emergency optic decompression surgery for sudden loss of vision in FD has not to date been reported in the pediatric population. We report the first case of FD presenting with sudden vision loss and successfully managed with emergency optic decompression. ⋯ There is no consensus on the benefit and safety of prophylactic optic decompression, yet therapeutic decompression has been shown to prevent vision deterioration. Our findings suggest that therapeutic decompression even when done in the emergency setting yields positive results, while prophylactic decompression carries an inherent risk for loss of vision in a seeing eye.
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To present an algorithm based on clinical and radiologic factors, including magnetic resonance imaging (MRI) perfusion/diffusion mismatch (PDM), for the indication of urgent cerebral bypass in patients with acute ischemic stroke. ⋯ Based on an algorithm indicating salvageable brain tissue, cerebral revascularization can be safely performed in an emergency setting in a highly selected group of patients with acute ischemic stroke with favorable clinical outcome.
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To research the early acute response events of facial nerve injury. ⋯ Nissl body dissolution, typical polygonal shape disappearing, cell swelling, facial neuron mortality and apoptosis, and up-regulated expression of caspase-3, LC3, and Beclin1 are the early events of cell death after facial nerve injury, which are the important precursors to facial nerve injury.