World Neurosurg
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This report describes a technique for an immediate mechanical intervention using a familiar tool for emergency physicians and trauma surgeons to temporize acute epidural bleeding with mass effect. The Monro-Kellie Doctrine suggests that immediate removal of some blood will reduce intracranial pressure and mitigate some of the deleterious effects until the neurosurgeon can respond. ⋯ Bedside craniosotmy with an intraosseous drill can allow for immediate temporizing of a large epidural hemorrhage and be applied by emergency physicians and/or trauma specialists when neurosurgical consultation is delayed. Serial aspirations should be performed when hemorrhage is ongoing and until definitive evacuation is performed.
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For the surgical treatment of spinal malignant tumor, spinal reconstruction with bone graft and instrumentation is necessary after tumor resection, but postoperative complications, including grafted bone resorption, may arise. ⋯ Anteriorly grafted bone resorption due to stress shielding may occur after reconstructive cervical spine surgery with robust posterior spinal instrumentation. Bisphosphonates and denosumab may be considered to inhibit grafted bone resorption.
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This study analyzes the incidence of microembolic infarctions (MIs) in the cerebellum after carotid artery stenting (CAS) to determine the risk factors. ⋯ Catheter maneuvering in the aortic arch or the brachiocephalic trunk could be the main cause of thromboemboli in cerebellar MIs. Careful attention should be paid to catheter maneuvering, especially in older patients with right-sided carotid lesions. In addition, cerebellar hypoperfusion caused by vertebral artery narrowing with IHD might reduce washout of debris, a cause of cerebellar MIs.
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Inappropriate intervertebral height restoration caused by nonoptimal choice of cage size is common in anterior cervical discectomy and fusion. The purpose of this study was to evaluate the radiological and clinical outcomes of cervical intervertebral distraction performed in prediscectomy under the strain limitation of the intact disc in a procedure defined as disc-limited intervertebral distraction. ⋯ Disc-limited intervertebral distraction is beneficial in avoiding overestimation of the cage size when performing anterior cervical discectomy and fusion and physiologically restoring intervertebral space height.
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Case Reports
Case Report of Acquired Stuttering Following Soccer Related Concussion: Functional MRI as a Prognostic Tool.
Acquired stuttering has been reported resulting from various forms of traumatic brain injury. In stuttering patients, there has been an association with higher activity of right frontal operculum activity on functional magnetic resonance imaging (MRI). This report looked to identify any structural lesions in a patient with postconcussive stuttering after a head injury playing soccer. ⋯ Stuttering can occur after mild to moderate head trauma. Patients with permanent stuttering have been found to have increased activity in the right frontal operculum. If no identifiable lesion can be seen, the stuttering may resolve spontaneously. Functional MRI maybe helpful in differentiating between permanent versus transient stuttering after head trauma.