World Neurosurg
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This study investigated the retroperitoneal oblique corridor and trajectory of L1-L5 as the lateral surgical access to the intervertebral disks in the Chinese population and detected the potential relationship between the corridor or trajectory and vertebral parameters, including disk axis, psoas muscle, and retroperitoneal vessel. ⋯ Compared with previous studies, the safe surgical area of the Chinese is generally smaller than that of Caucasian. The position of the retroperitoneal vessel is the vital potential to limit the corridor and trajectory. Preoperative assessment of vertebral parameters, especially vascular structure, is essential for planning surgical process.
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Subarachnoid hemorrhage resulting from spontaneous perforation of a small intracranial vessel, with resultant pseudoaneurysm formation, has not been widely reported in the literature. ⋯ This case illustrates an unusual sequela of subarachnoid hemorrhage presenting a unique challenge in surgical management.
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Review Case Reports
Intraspinal Canal Schwannoma with Extensive Calcification: Case Report and Literature Review.
Schwannomas are the most common benign tumors in the intraspinal location, with slow-growing and nonaggressive features. Calcification is not a common histopathological and radiological feature in schwannoma. ⋯ Although intraspinal schwannoma with extensive calcification is rare, which increases the difficulty of an accurate diagnosis preoperatively, the tumor can be completely removed with or without excision of the nonfunctional nerve roots.
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Randomized Controlled Trial
Effect of Sevoflurane Postconditioning on the Incidence of Symptomatic Cerebral Hyperperfusion after Revascularization Surgery in Adult Patients with Moyamoya Disease.
Various experimental studies have reported neuroprotective effects of sevoflurane postconditioning against cerebral ischemia-reperfusion injury. We therefore investigated its neuroprotective effects on hyperperfusion-related transient neurologic deterioration, called symptomatic cerebral hyperperfusion (SCH), and also identified predictive factors for SCH in patients with moyamoya disease after revascularization surgery. ⋯ Sevoflurane postconditioning did not reduce the incidence of SCH after revascularization surgery in patients with moyamoya disease. Rather, a decreased vascular reserve, operation on the dominant hemisphere, increased temporal occlusion time, and decreased intraoperative minimum PaCO2 were associated with SCH in these patients.
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Review Historical Article
The Story of the Development and Adoption of the Glasgow Coma Scale: Part I, The Early years.
The Glasgow Coma Scale and its derived Score have been adopted worldwide for assessing the degree of impaired responsiveness in traumatic brain injury and other kinds of acute brain damage. In this historical vignette, we describe how the foundations for their enduring success were laid during their initial development. To provide a unique additio nal background and context, the material from interviews with one of the originators of the scale was brought together with information from key publications in the early years after the first description of the scale in 1974. ⋯ These collaborations were accompanied by the creation of the total Glasgow Coma Score with a 6-point motor subdivision. The observation that outcomes after severe head injury were similar in the different countries, despite marked variations in management, stimulated controversy that promoted further interest in traumatic brain injury research and a recommendation for the worldwide use of the scale as a common severity marker. Inclusion of the scale in major developments such as the Advanced Trauma Life Support (ATLS) and the National Traumatic Coma Databank cemented its influential position in clinical care and research for the succeeding decades.