World Neurosurg
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Pneumocephalus is commonly associated with cranial trauma including surgical interventions. Spontaneous pneumocephalus on the other hand is a rare diagnosis. Reported cases were predominantly unilateral. We report a unique case of a bilateral spontaneous pneumocephalus probably related to a bilateral tegmen defect related to repeated Politzer maneuvers. ⋯ Spontaneous pneumocephalus represents a rare condition often associated with increased middle ear pressure, which can be caused by autoinflation (e.g., Valsalva or Politzer maneuver), sneezing, or coughing. The described case represents a unique presentation of the bilateral spontaneous pneumocephalus associated with bilateral tegmen and dura mater defects managed surgically. Despite its rarity, spontaneous pneumocephalus originating from the temporal bone should be considered as a possible diagnosis in patients with suggestive otologic presentation (e.g., tinnitus, instability, hearing loss) and associated nonspecific neurologic symptomatology.
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Traumatic brain injuries (TBIs) are largely underdiagnosed and may have persistent refractory consequences. Current assessments for acute TBI are limited to physical examination and imaging. Biomarkers such as glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1), and S100 calcium-binding protein B (S100B) have shown predictive value as indicators of TBI and potential screening tools. ⋯ GFAP, UCH-L1, and S100B demonstrated utility for rapid prediction of a CT-positive TBI within 0-8 hours of injury. GFAP exhibited the greatest predictive power at 12-32 hours. Furthermore, these results suggest that GFAP alone has greater utility for predicting a positive CT of the head than UCH-L1, S100B, or any combination of the 3.
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Previous studies of percutaneous endoscopic lumbar discectomy (PELD) to treat lumbar disc herniation (LDH) have shown good clinical results. However, limited information has been reported regarding postoperative improvement in back muscle function. We aimed to determine whether changes in neuromuscular patterns, assessed using the flexion-relaxation phenomenon (FRP), could be observed after PELD. ⋯ PELD for individuals with LDH appears to normalize paraspinal muscle activation during lumbar flexion-extension movement. The gross range of motion and disability-related limitations of physical activity also improved.
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Observational Study
Feasibility of Staged Bilateral Radiofrequency Vim Thalamotomy for Bilateral Essential Tremor.
Patients with bilateral and/or midline/axial tremor have significant diminution in quality of life (QOL). Various studies report high complication rates with bilateral thalamotomy. However, use of primitive methods in these studies confers questionable validity. We conducted a retrospective observational cohort study in patients with medication-refractory bilateral essential tremor treated with staged bilateral radiofrequency ventral intermediate nucleus thalamotomy to subjectively examine the impact of any adverse effects on QOL and patient satisfaction. ⋯ Adverse effects that are nondisabling and hence acceptable to the patient can be considered acceptable adverse effects. Staged bilateral radiofrequency ventral intermediate nucleus thalamotomy definitely improves QOL in patients with medication-refractory bilateral essential tremor despite occurrence of acceptable adverse effects.
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To evaluate the risk factors of tumor-related epilepsy (TRE) and the relationship between TRE and functional/survival outcomes in patients with high-grade glioma (HGG). ⋯ In patients with HGG, preoperative epilepsy is significantly associated with tumor involvement of the frontal lobe, whereas postoperative epilepsy is associated with preoperative epilepsy and dominant hemispheric location. Also, patients with HGG with preoperative epilepsy have better PFS and OS.