World Neurosurg
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Case Reports
Acute Compartment Syndrome as a Complication of the Use of Intraoperative Neuromonitoring Needle Electrodes.
The use of intraoperative neurophysiologic monitoring (IOM) has become commonplace in many neurosurgical procedures as a tool to reduce the risk of complications through the early identification of reversible neurologic compromise. Although complications related to IOM itself are exceedingly rare, recognizing their clinical presentation in the postoperative neurosurgical patient is essential for the early identification and implementation of appropriate treatment. ⋯ This case represents the first report of post-procedural compartment syndrome resulting from placement of neuromonitoring needles for routine IOM. Although it is a particularly rare complication of IOM, compartment syndrome represents a surgical emergency that carries significant morbidity if not immediately recognized and treated.
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Measures of health care use such as length of hospital stay (LOS) are used as proxies for quality of care after spine surgery. Accordingly, hospitals and health systems are investing considerable resources into the preoperative identification of patients at risk for prolonged LOS. This study aims to investigate the impact of preoperative level on outcomes and LOS after spinal fusion. ⋯ Our study shows that elderly male patients with lower preoperative Hgb levels have increased LOS and postoperative delirium after spinal fusion. Moreover, preoperative Hgb levels negatively correlate with LOS.
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Case Reports
Neuroendoscopic Fenestration for Entrapped Temporal Horn After Surgery: Report of 3 Cases.
The postoperative ventricular adhesion after resection of central nervous system tumors can obstruct physiologic cerebrospinal fluid (CSF) circulation and cause temporal horn entrapment. The surgical goal is to restore physiologic flow of CSF. The authors reviewed their database to report their experience with endoscopic fenestration for treating entrapped temporal horn caused by atrial adhesions. All endoscopic operations performed from February 2015 to December 2016 were reviewed. ⋯ Endoscopic fenestration is an option in the treatment of entrapped temporal horns. However, more experience is required to recommend it as the treatment of choice.
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Case Reports
Successful Use of Covered Stent for Carotid Artery Injury with Active Medial Projecting Extravasation.
Nontraumatic carotid artery injury with active extravasation, or carotid blowout syndrome (CBS), is relatively rare and highly difficult to treat because it is difficult to approach the lesions owing to anatomic factors. It also involves quick progression and a risk of cerebral embolization caused by thrombi and carotid artery occlusion. Recently, covered stents were revealed to be effective for CBS. However, they have several disadvantages, such as their costs, rebleeding complications, or cerebral embolic risks. A firm selection method of CBS types that are appropriate for covered-stent therapy is expected. ⋯ CBS cases having rupture points around the clavicle and having medial projection extravasation should be treated by covered stent placement under tentative hemostasis using manual finger pressure rather than conventional open surgical treatment.
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Case Reports
Full Endoscopic Interlaminar Approach for Nerve Root Decompression of Sacral Metastatic Tumor.
Endoscopic surgery has been successfully applied in treatment of degenerative spinal disease, but few studies have assessed its use in treating sacral metastasis. We report a successful full endoscopic interlaminar approach for sacral nerve root decompression of a sacral metastatic tumor. ⋯ For patients with sacral metastasis without spinal instability or difficulty lying in prone position under local anesthesia, the full endoscopic interlaminar approach for nerve root decompression of sacral metastasis may be a suitable method.