World Neurosurg
-
Work-related musculoskeletal disorders (WMSDs) among neurosurgeons can lead to consequences for themselves, the hospital, and society. In the current study, the working conditions of neurosurgeons from an ergonomic point of view is evaluated, together with WMSD. ⋯ Despite only a minority of the surgeons taking time off due to WMSD, the majority suffers from WMSD. Education of residents in ergonomics to prevent WMSD in their later careers and ergonomic furnishing of surgical instrumentation and operating rooms seem to be areas for improvement.
-
Case Reports
Hybrid surgical rescue of failed stent retrieval with acute middle cerebral artery occlusion.
Failure of stent retrieval and periprocedural embolization of plaque are rare complications of carotid artery stenting, which need emergency surgical treatment. In Video 1, we demonstrate failed stent retrieval with acute middle cerebral artery occlusion that was treated with carotid endarterectomy and stent-assisted thrombectomy in a hybrid operating room. A 65-year-old man underwent carotid artery stenting for symptomatic left internal carotid artery stenosis with severe calcification. ⋯ After carotid endarterectomy, the stent-assisted thrombectomy was performed. Postoperative digital subtraction angiography confirmed the recanalization of the middle cerebral artery. The patient's neurologic function dramatically improved after hybrid treatment.
-
After subarachnoid hemorrhage (SAH), headache management is often difficult owing to the need to use multiple analgesic drugs. Fentanyl is an opioid we can use after surgery, and it can decrease pain post SAH. The aim of this study was to investigate the effectiveness and safety of fentanyl for management of headache after SAH. ⋯ Using fentanyl after surgical clipping for ruptured intracranial aneurysms might decrease headache and produce few adverse effects. Adequate headache control showed improved dietary intake after SAH.
-
Intraoperative abnormal muscle response (AMR) is widely used as an indicator during microvascular decompression surgery for hemifacial spasm. Usually only 1 muscle is recorded, and not all patients show a response, leaving the surgery somewhat blinded. We propose an improved method to record from multiple muscles innervated by multiple branches of the facial nerve to increase the positive AMR detection rate. ⋯ This new multibranch AMR monitoring method can effectively increase the positive detection rate to as high as 98.4%. It is expected to better assist surgery.
-
Case Reports
Thoracic Intradural Extramedullary Ependymoma with anaplastic transformation: A case report and discussion.
Intradural extramedullary spinal ependymomas arising from outside the region of the conus medullaris are rare clinical entities, and anaplastic transformation of these lesions is even more exceptional. ⋯ We advocate that primary spinal ependymomas should be within the differential of intradural extramedullary lesions arising outside the region of the conus medullaris.