World Neurosurg
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Comparative Study
Racial Differences in the Anatomy of the Posterior Fossa: Neurosurgical Considerations.
Racial differences in anatomy of the cranium exist but have not been specifically considered in neurosurgical access planning. We sought to find differences in the anatomy of the posterior fossa in a cohort study consisting of Asian, African American, and Caucasian patients. ⋯ Significant differences in anatomy have practical implications in the retrosigmoid approach to the cerebellopontine angle. Based on our findings, the junction of the transverse sinus with the sigmoid sinus can differ up to 0.5 cm in the craniocaudal axis depending on race. As neuronavigation is not standard to the approach to the cerebellopontine angle, the study aimed to provide the neurosurgeon operating in the retrosigmoid area additional knowledge to avoid sinus injury with subsequent complications, such as blood loss, sinus occlusion, or air embolism.
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Case Reports
Positioning-Related Neuromonitoring Change During Anterior Cervical Discectomy and Fusion.
Intraoperative neuromonitoring (ION) signal changes during spine surgery may portend a potentially catastrophic neurologic injury that, if identified and addressed expediently, may allow the surgeon to take correction actively and prevent permanent neurologic injury. ⋯ The use of multimodality ION is recommended for ACDF with shoulder traction to prevent postoperative neurologic deficit associated with a position-related injury. Baseline ION should be established before positioning.
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Prior studies have shown that most patients with mild traumatic brain injury or negative computed tomography (CT) scans of the head rarely decline or require neurosurgical interventions. One common reason for a delayed decline is an intracranial hemorrhage that presents within 24-48 hours. This is typically seen in elderly patients and/or patients on antiplatelet or anticoagulation agents. We describe a case of a delayed subdural hemorrhage presenting in a young adult not on any antiplatelet or anticoagulation therapy. ⋯ In rare cases, patients with negative initial head CT scans neurologically deteriorate as a result of a delayed acute subdural hematoma. We present an unusual case of a young patient on no medications with no CT findings of an intracranial injury who neurologically declined due to a delayed acute subdural hematoma.
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Observational Study
Cognitive Impairments After Clipping of Ruptured Anterior Circulation Aneurysms.
The cognitive impairments after treatment of ruptured aneurysms have often been underestimated. This study sought to assess their prevalence and analyze various associated factors. ⋯ Cognitive impairments are frequent after treatment of ruptured anterior circulation aneurysms. Impairments in recent memory, remote memory, and phonemic fluency are significantly greater after treatment of ACA-related aneurysms, compared with others, independent of other factors.
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Craniovertebral junction diseases, although considered rare, are common in northern parts of India. This study was conducted to evaluate the clinico-radiologic and surgical outcome of patients with a minimum follow-up of 1 year. Our study also compared bony fusion among various techniques of posterior fusion. ⋯ The key to successful management of craniovertebral junction disease is individualized selection of judicious surgical intervention from various available techniques.