World Neurosurg
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The natural history and the outlook of patients with hydrocephalus are dramatically affected using cerebrospinal fluid shunts. The several issues related with a long-standing shunt should suffice to justify all the possible attempts to free the patient from it. This study focused on the role of secondary endoscopic third ventriculostomy (ETV) in the achievement of shunt removal in cases of shunt malfunction, and to identify patients who could benefit most from the procedure. ⋯ Many patients with shunt malfunction can benefit from secondary ETV even after decades of shunting. Age at secondary ETV, the number of previous shunt revisions, and the ETV success score can help to better identify the best candidates for the procedure.
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When it comes to autogenous nerve grafting, the sural and great auricular nerve (GAN) are the 2 nerves predominately used for trigeminal and facial nerve repair. Arising from the second and third cervical ventral rami, the GAN emerges from the posterior border of the sternocleidomastoid coursing superiorly and anteriorly toward the ear. ⋯ The GAN is an excellent option for use in nerve grafting for repair of, for example, facial dysfunction. In this study, we review our measurements, techniques for identification, and dissecting techniques for the GAN. The proximity to the operative area and minimal complications associated with GAN grafting might contribute to improved patient satisfaction and better outcomes regarding functional restoration.
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Numerous reports have described the semi-jailing technique (SJT) using a closed-cell stent for stent-assisted coil embolization, revealing issues including poor expansion and thrombotic complications in curved vessels. This paper reports preliminary experience with SJT using an open-cell stent, a novel type of stent allowing stent placement from a microcatheter. ⋯ Although the open-cell stent carries the disadvantage of an unresheathable design, coil placement with a shorter stent deployment length may be advantageous during SJT for internal carotid artery aneurysm embolization with favorable consequences for excellent vessel wall apposition.
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Surgical treatment of ruptured blood blister-like aneurysms (BBAs) arising from the internal carotid artery (ICA) is challenging. We retrospectively reviewed the results of our surgical strategies tailored for each aneurysm site. ⋯ Inadequate cerebral blood flow is a distinct possibility even with HFB, so parent artery flow should be preserved to protect against ischemia whenever possible. However, if preservation of the anterior choroidal artery or posterior communicating artery during clipping or trapping is difficult, HFB combined with occlusion of the proximal portion of the ICA in the neck is a feasible option.
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Few studies have examined the outcomes of open reduction and internal fixation of vertebral fractures. The purpose of this study was to determine patient-related and surgery-related risk factors associated with 30-day postoperative mortality after open reduction and internal fixation (ORIF) of cervical, thoracic, and lumbar vertebral fractures. ⋯ Pulmonary comorbidity and diabetes were found to be independent risk factors for 30-day mortality after ORIF of vertebral fractures. Recognizing these risk factors is important in preoperative risk stratification, perioperative care, and patient counseling.