World Neurosurg
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Because of a lack of markers for predicting prognosis and an underlying mechanism, patients with primary brainstem hemorrhage (PBH) are currently treated with multiple strategies, but most of them have poor outcomes in a comparison with patients with supratentorial intracranial hemorrhage. Recently, it has been reported that the neutrophil-to-lymphocyte ratio (NLR) represents a novel composite inflammatory marker to predict the prognosis of patients with intracranial hemorrhage, a majority of whom have supratentorial hemorrhage. In this report, we aim to assess the potential predictive value of NLR in patients with PBH. In addition, other available laboratory parameters, including platelet-to-lymphocyte ratio (PLR), and admission blood glucose level (ABG), will be also investigated as markers for prognosis in patients with PBH. ⋯ NLR, PLR, and ABG can be used to independently predict 90-day functional outcome in patients after PBH. When combined, they have better predictive power in identifying PBH patients with a poor prognosis. To our knowledge, this study is the first to reveal the associations between NLR, PLR, and hyperglycemia and the functional outcomes of patient with PBH. In associating with previously studies on hemorrhage site, our results provide a good opportunity to elucidate the underlying mechanisms of PBH.
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Aggressive vertebral hemangiomas are rare tumors of the spine. The treatment management strategy usually consists of vertebroplasty, radiation therapy, or, in rare cases of surgical strategy. ⋯ Here we demonstrate the usefulness of radiofrequency ablation technique as an alternative treatment, as well as robotic assistance for optimal placement of the ablation probe within the lesion.
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Brain Trauma Foundation (BTF) guidelines reflect evidence-based best practices in management of traumatic brain injury. The aim of this study was to examine self-reported physician compliance and predictors of compliance related to BTF guidelines. ⋯ Few respondents reported their institutions "always" follow BTF guidelines. General surgeons and providers at high-volume level I trauma centers were more likely to comply with guidelines. Differences in survey responses based on provider and institutional characteristics may help target educational efforts.
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Three-column spinal osteotomies were developed to address severe and stiff kyphoscoliosis. However, the optimal choice of osteotomy in these patients is still unclear. This retrospective study aims to compare the outcomes and complications between grade 4 and grade 5 osteotomies in patients with severe and stiff thoracic kyphoscoliosis. ⋯ Similar clinical outcomes can be achieved with grade 4 and grade 5 spinal osteotomies. This may enrich the basis on moving down to a lower osteotomy grade when treating patients with severe and rigid thoracic kyphoscoliosis.
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Chiari malformation type I (CM-I) is a well-known hindbrain disorder in which the cerebellar tonsils protrude through the foramen magnum. The soft tissues, including the transverse ligament and the tectorial membrane at the retro-odontoid space, can compress the cervicomedullary junction if they become hypertrophic. ⋯ The retro-odontoid soft tissue in symptomatic patients with CM-I can be hypertrophic enough to compress the cervicomedullary junction ventrally even if there are no combined osseous anomalies. Foramen magnum decompression works to reduce the hypertrophic changes significantly, suggesting that downward tonsil movement might participate in hypertrophic soft tissue formation at the retro-odontoid space.