World Neurosurg
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Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSH) is characterized by a typical pattern of localized pretruncal hemorrhage on head computed tomography. PNSH is usually associated with a benign clinical course and a lower incidence of complications. The etiology is unknown, but many explanations have been proposed, including venous injury or rupture followed by thrombosis of a ruptured microaneurysm. ⋯ Symptomatic saddle pulmonary embolism in the setting of intracranial hemorrhage creates conflicting risks of medical intervention. There are no case reports or evidence of the use of systemic thrombolysis in the setting of SAH. Owing to the benign natural history of PNSH, tPA may be a safe intervention. Neurointensivists and neurosurgeons should be aware that intravenous tPA was used safely for life-threatening pulmonary embolism in the setting of PNSH. Additionally, the use of tPA without resultant rebleeding in this case opposes the theory of the presence of a thrombosed ruptured microaneurysm.
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Demographics and Outcomes of Interhospital Neurosurgical Transfer Patients Undergoing Spine Surgery.
Interhospital patient transfer (IHT) of patients is common and accounts for a significant portion of health care costs, yet the variables driving neurosurgical IHT have not been systematically described. We analyzed variables that distinguished spine surgery patients who underwent IHT from patients who did not undergo IHT to report on the effect of frailty on IHT. ⋯ IHT patients comprise a more frail and surgically complex surgical spine population compared with n-IHT patients. IHT was also an independent risk factor for increased complications and length of stay after spine surgery. Patients' insurance status and age did not distinguish between IHT and n-IHT groups. This is the first report in any specialty to demonstrate increasing frailty is associated with IHT.
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Observational Study
COVID-19 impact on neurosurgical practice: lockdown attitude and experience of a European academic center.
The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge. Different models of reorganization have been described aiming to preserve resources and ensure optimal medical care. Limited clinical neurosurgical experience with patients with COVID-19 has been reported. We share organizational experience, attitudes, and preliminary data of patients treated at our institution. ⋯ By applying infection prevention and resource-sparing logistics measures shared by the international medical community, we were able to maintain essential neurosurgical care in a pandemic with controlled nosocomial infection risk. Special consideration should be given to medical management and surgical indications in patients infected with severe acute respiratory syndrome coronavirus 2, because they seem to show a problematic hemostatic profile that might result in an unfavorable clinical and surgical outcome.
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Case Reports
Unusual manifestation of the spinal epidural arteriovenous fistula as sudden paraplegia.
Spinal epidural arteriovenous fistulas (SEDAVFs) are a rare entity that cause gradual progression of neurological dysfunction. We present a case of SEDAVF with acute exacerbation of paraplegia that was successfully treated with emergency transarterial embolization. ⋯ SEDAVFs may result in acute exacerbation that can be treated with an endovascular intervention-a rapid and effective means of obliterating shunts.
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Our study aimed to assess whether elective posterior lumbar fusions (PLFs) performed in states with Certificate-of-Need (CON) laws versus states without CON laws had lower utilization rates, lower costs, and better quality of care. ⋯ The presence of CON laws was associated with lower utilization of elective 1- to 3-level PLFs and a greater number of high-volume facilities. However, their effect on quality of care, via reduction of 90-day readmissions and 90-day complications, is minimally significant.