World Neurosurg
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Ehlers-Danlos syndrome can be associated with cerebrospinal fluid (CSF) disturbances including recurrent CSF leak and Chiari I malformations. Persistent pseudomeningoceles are known to be associated with raised intracranial pressure. We present an unusual case of a compressive epidural CSF collection occurring after a computed tomography-guided L5 nerve root block and describe an effective management strategy.
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To determine postoperative long-term changes of hippocampal volume (HV) correlating with cognitive functions in patients who underwent surgery for hippocampal sclerosis with postoperative freedom from seizures. ⋯ In seizure-free patients after hippocampal sclerosis resection , unresected contralateral HV significantly declined with older age at surgery. Visual memory was preserved regardless of side and volume loss. Despite significantly reduced HVs, verbal memory was preserved with the unresected contralateral dominant hippocampus. Earlier surgical intervention may have lower potential risk for memory decline secondary to postoperative HV loss.
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Cerebrospinal fluid (CSF) leaks usually happen in the early postoperative period. However, delayed CSF leak can happen several years after treatment. The purpose of this study was to review the characteristics and clinical course of delayed CSF leak after treating skull base tumors. ⋯ Patients with delayed CSF leak are more likely to have a history of radiation and to present with meningitis at diagnosis. Therefore, CSF rhinorrhea should always be suspected, even several years after treatment, if early symptoms of CSF leak develop in patients with a history of skull base tumor.
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Despite improved medical management, the incidence of spinal pathology remains high in patients with Parkinson disease (PD). Several studies have investigated lumbar spine surgery in this population, but data regarding costs and perioperative complications for patients undergoing cervical decompression/fusion on a nationwide scale are lacking. ⋯ Although patients with PD experience greater complication rates and non-home discharges following cervical spine surgery compared with NPD patients, the overall clinical impact of these results may be minimal relative to surgery at other spinal levels in this population.
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Burnout among physicians has been a topic of growing interest in both the scientific and the lay press. It has been well established that burnout and perceived inequity in work-life balance can contribute to poor physician work satisfaction and poorer patient outcomes. To better understand burnout among neurosurgery residents at our institution, we systematically surveyed residents for symptoms of burnout and enacted responsive protocols to try to combat its deleterious effects. ⋯ Making a significant change in burnout rates in neurosurgery will require a number of key factors, including targeted initiatives that focus on specific local needs, honest buy-in by departmental leaders, and recognition by the physicians themselves that a problem exists.