World Neurosurg
-
Gram-negative surgical site infections (SSI) following spine surgery are becoming increasingly more common owing to a broad perioperative antibiotic usage targeting gram-positive organisms. Enterobacter species have been reported to be the most common gram-negative bacteria following spine surgery. ⋯ Enterobacter SSI cases were associated with higher BMI, earlier wound breakdown, polymicrobial infection and longer length of stay. Nevertheless, with vigilant surveillance and timely I&Ds, these challenging infections can be treated successfully with original implant retention in almost all cases.
-
Case Reports
Distal Thrombectomy for Acute Anterior Circulation Stroke with Chronic Large Vessel Occlusion.
Endovascular therapy has been increasingly recommended for the treatment of acute ischemic stroke with large vessel occlusion of the anterior circulation. However, occlusions of the distal cerebral artery are not uncommon and may cause clinical deficits, especially when combined with ipsilateral chronic large vessel occlusion. Therefore in this patient population, the recognition of chronic occlusion and recanalization of the distal occlusive artery might be of great value for flow compensation. ⋯ The recognition of chronic occlusion is crucial during acute mechanical thrombectomy, and distal thrombectomy may be beneficial after a careful full-scale assessment.
-
To evaluate differences between thicknesses of the ligamentum flavum (LF) and diameter of the spinal canal in different neck positions in patients with ossification of the posterior longitudinal ligament (OPLL) and patients with cervical degenerative spondylosis (CDS) using cervical dynamic magnetic resonance imaging (MRI). ⋯ Dynamic morphometric changes were found to be significantly greater in the CDS group than in the OPLL group. The study shows dynamic MRI may provide additional information in CDS patients.
-
Posterior atlantoaxial fusion is an important armamentarium for neurosurgeons to treat several pathologies involving the craniovertebral junction. Although the potential advantages of recombinant human bone morphogenetic protein-2 (rhBMP-2) are well documented in the lumbar spine, its indication for C1-C2 fusion has not been well characterized. In our institution, we apply rhBMP-2 to the C1-C2 joint either alone or with hydroxyapatite, locally harvested autograft chips, and/or morselized allogenic bone graft for selected cases-without conventional posterior structural bone graft. We report the clinical outcomes of the surgical technique to elucidate its feasibility. ⋯ Although retrospective and from a single center, our study has shown that rhBMP-2 usage at the C1-C2 joint without posterior structural bone grafting is a safe and reasonable surgical option.
-
Bean syndrome (BS) is a rare congenital low-flow angiomatosis affecting multiple organ systems. About 200 cases with heterogeneous clinical presentation have been reported worldwide. The exact etiopathology is still not known. Most reported cases have occurred sporadically, although autosomal dominant inheritance has been suggested. BS predominantly presents with characteristic multifocal mucocutaneous lesions and often leads to refractory anemia caused by occult blood loss from the alimentary tract. Apart from the mucocutaneous and gastrointestinal tract involvement, this syndrome may rarely affect the central nervous system in the form of multiple venous anomalies. Patients often approach a dermatologist or gastroenterologist for treatment and this entity is usually less known among neurosurgeons. To the best of our knowledge, only 3 cases of sinus pericranii and 12 cases with orbital hemangioma as a presenting feature in BS have been reported. ⋯ Blue rubber bleb nevus syndrome is a lesser known entity among neurosurgeons that requires a high index of clinical suspicion for diagnosis. Red herrings, such as in our case, must prompt a search for characteristic mucocutaneous lesions and other associated lesions of blue rubber bleb nevus syndrome. A timely diagnosis may improve the quality of life and help avoid life-threatening complications.