World Neurosurg
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Review Case Reports
Central Neurocytoma: A Rare Presentation in the Fourth Ventricle and Review of the Literature.
Central neurocytomas are rare tumors, typically found in the third ventricle. We present the unusual case of a fourth ventricular central neurocytoma in a 70-year-old female presenting with imbalance and headaches, with an enhancing fourth ventricular mass on imaging. We examine the details of her clinical presentation, imaging characteristics, histopathologic analysis, and postoperative course. ⋯ In contrast to our patient, the majority of these cases were in young males. The 2 females with fourth ventricular neurocytoma developed it at a much later age (mean 63.5 years) than their male counterparts (mean 22.8 years; P = 0.005). Despite being a rare cause for a fourth ventricular lesion, given the appropriate clinical context and radiographic findings, this should remain part of the differential diagnosis.
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Review
Bundle payment model in spine surgery: Current challenges and opportunities, a systematic review.
Bundled payments offer a lump sum for management of particular conditions over a specified period that has the potential to reduce health care payments. In addition, bundled payments represent a shift toward patient-centered reimbursement, which has the upside of improved care coordination among providers and may lead to improved outcomes. ⋯ The implementation of spine surgery in bundled payment models offers opportunity for health care cost reduction. Patient heterogeneity, complications, and index hospitalization pricing are among factors that contribute to the challenge of payment variation. Development of standard care pathways, multidisciplinary coordination between inpatient and outpatient postoperative care, and empowerment of patients are also key elements of progress in the evolution of bundled payments in spine surgery. We anticipate more individualized risk-adjusted prediction models of payment for spine surgery, contributing to more manageable variation in payment and favorable models of bundled payments for payers and providers.
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Multicenter Study Comparative Study
Two-Nation Comparison of Classification and Treatment of Subaxial Cervical Spine Fractures: An Internet-Based Multicenter Study Among Spine Surgeons.
To date, no evidence-based treatment algorithm is available for fractures of the subaxial spine. The aim of the present study was to assess and compare the management strategy for traumatic subaxial fractures among German and Dutch spine surgeons. ⋯ We found a consensus for the stabilization of AO type B and C fractures but country-specific differences in the treatment of type A fractures, especially for A2 and A3 fractures. Further evidence is necessary to ensure more consistent international treatment strategies.
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Review Historical Article
The history of and controversy over Kambin's Triangle: A historical analysis of the lumbar transforaminal corridor for endoscopic and surgical approaches.
The transforaminal corridor in the lumbar spine allows access to the traversing and exiting nerve roots, the thecal sac, and the intervertebral disc space. Surgeons performing midline and minimally invasive approaches for lumbar interbody fusion access the disc space within the boundaries created by the exiting root of a segment and the traversing root after a complete facetectomy and removal of the pars interarticularis and lamina. Endoscopic surgeons and interventional pain management physicians approach the lumbar segment through a similar corridor, but with the bony anatomy intact. ⋯ The objective of the current work is to add clarity to the various lumbar transforaminal corridors. The term Kambin's triangle should be limited to percutaneous access to the disc space for endoscopic procedures in the intact spine and should not be applied to transforaminal lumbar interbody fusion after laminectomy and facetectomy. Instead, the term expanded transforaminal corridor should be applied.
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Review Case Reports
Post-Exercise Death due to a Hemorrhagic Colloid Cyst of the Third Ventricle: A Case Report and Literature Review.
Colloid cysts of the third ventricle are rare, slow-growing lesions of neuroepithelial origin. Although histopathologically benign, third ventricular colloid cysts are a well-known cause of sudden, unexpected coma and death. Several theories have been proposed to describe the rare, sudden onset of severe symptomatology and rapid clinical decline due to colloid cysts. Moreover, there is currently no clear consensus regarding the most suitable neurosurgical technique or the most effective approach for resection, nor do guidelines or standardized clinical indications exist to recommend observation versus intervention and/or resection in the asymptomatic patient. To highlight this conundrum, we present a clinical case of a hemorrhagic colloid cyst that resulted in fatality and discuss the relevant literature. ⋯ To our knowledge, this is the only case report to describe sudden-onset coma and death due to a hemorrhagic third ventricular colloid cyst occurring after exercising. We review the literature on fatal colloid cysts emphasizing the proposed mechanisms of sudden death and current neurosurgical management in both asymptomatic and symptomatic patients.