World Neurosurg
-
Observational Study
The Association between Surgical Level and Early Postoperative Thigh Symptoms among Patients Undergoing Standalone Lateral Lumbar Interbody Fusion (LLIF).
Lateral lumbar interbody fusion (LLIF) has often been associated with postoperative lumbar plexus symptoms, including pain, paresthesia, and motor deficits in the lower extremities, especially the anterior thigh regions. Previous studies have suggested that LLIF procedures at L4-L5 will be associated with a greater motor deficit rate than other levels. However, it is unclear which level has the greatest risk of pain and paresthesia. The purpose of the present retrospective observational study was to investigate the difference in the incidence of early postoperative thigh symptoms (pain and paresthesia) stratified by procedure level among patients who had undergone standalone LLIF. ⋯ Our results have demonstrated that standalone LLIF at the L2-L3 was significantly associated with a greater incidence of postoperative anterior thigh paresthesia but that the incidence of postoperative thigh pain showed no significant association with any operative level.
-
Erythrosine (E127), a synthetic food dye containing iodine and sodium, has often been used inside packaged foods and beverages in Turkey and many other countries. We evaluated the effects of erythrosine on neural tube development in early-stage chicken embryos. ⋯ Erythrosine increased the risk of neural tube defects in early-stage chicken embryos, even at half of the approved dose.
-
Chronic subdural hematomas (cSDHs) are common neurosurgical pathological entities and typically occur after trauma in elderly patients. The 2 most commonly used strategies for treatment have included burr hole drainage and craniotomy with decompression. However, the choice of these procedures has remained controversial and has been primarily determined by surgeon preference. We designed a matched-cohort analysis to compare these 2 procedures and identify the risk factors associated with the postoperative outcomes. Thus, we compared the rates of reoperation and mortality for patients who had undergone craniotomy versus burr hole evacuation for cSDH. ⋯ Our study identified an increased need for reoperation for patients treated with burr hole evacuation compared with those undergoing craniotomy. Older age and low Glasgow coma scale scores were associated with worse outcomes in both groups. Certain methods of anticoagulation were also associated with worse outcomes, which varied between the 2 groups. We recommend that surgeons individualize the choice of procedure according to the specific patient characteristics with consideration of these findings.
-
Patient-reported outcomes measures (PROMs) are critical in evaluating the effectiveness of surgical spine interventions. The Oswestry Disability Index (ODI) is commonly used but tedious to administer routinely. The EuroQol-5 Dimensions (EQ-5D) questionnaire is easier to administer but not traditionally used to measure spine surgical results. This study aimed to investigate the correlation of commonly administered PROMs in lumbar tubular microdecompression patients, and to consider whether ODI could be predicted from remaining PROMs. ⋯ ODI can be predicted from EQ-5D, leg and low back pain VAS, and health state items with moderate accuracy. The added utility of capturing ODI routinely may not out-weigh the challenges in doing so.
-
Flow diversion has become increasingly popular for treatment of cerebral aneurysms in the past few years. In an increasing number of patients with aneurysms, flow diversion (FD) has failed, with a paucity of reported data regarding salvage treatment for these challenging cases. ⋯ Aneurysms for which FD fails present a variety of unique and challenging management situations that will likely be encountered with increased frequency, given the popularity of FD. Microsurgical salvage options require individualized care tailored to the underlying pathological features, patient characteristics, and surgical expertise.