World Neurosurg
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Comparative Study
The modified iliac screw-An anatomical comparison and technical guide.
Iliac screws are a widely used sacropelvic fixation technique, which is often criticized for its impaired wound healing owing to hardware prominence. The aim of this study was to present a modified iliac screw (MIS) fixation technique that uses a different entry point more medially and caudally to the posterior superior iliac spine next to the rudimentary S1-S2 joint. Soft tissue coverage and midline distance in an MIS and a traditional iliac screw were compared. ⋯ The MIS avoids the use of connectors and provides less prominent pelvic fixation. Clinically, this might help prevent prominent hardware and related wound healing impairment.
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Intramedullary spinal cord dermoid tumors are rare. Early diagnosis with appropriate imaging is of utmost importance for a good outcome. Gross total resection is the treatment of choice for optimal results. Neurosurgical intervention for any intramedullary lesion is fraught with problems because of the nature of the lesion and handling of the spinal cord, which is already compromised because of the intramedullary lesion. Recurrence of the intramedullary dermoid tumor is frequent because of incomplete resection of the tumor. Most commonly, patients present with worsening of neurologic deficits. Inadequate resection because of the fear of worsening the neurologic deficits is associated with significant complications. ⋯ This report highlights the spectrum of complications that can develop in a patient varying from worsening of the deficits to meningitis and subsequent development of hydrocephalus.
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Review Case Reports
Infiltration of Benign Meningioma into Sagittal Sinus and Subsequent Metastasis to Lung: A Case Report and Literature Review.
Meningioma is an intracranial tumor frequently encountered in the neurosurgical setting. Extracranial disease is a rare occurrence, with a reported incidence in 0.1% of cases. Metastasis is associated with previous craniotomy, venous sinus invasion, local recurrence, and World Health Organization (WHO) grade III tumor. Metastasis of a benign, grade I meningioma is extraordinarily rare. ⋯ This a rare case of a WHO grade I meningioma involving the sagittal sinus with direct seeding of the pulmonary vascular bed leading to multiple meningioma metastases. The report highlights an increased risk of distant metastases for a benign meningioma with invasion of dural sinuses.
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The letter of recommendation (LOR) represents a nonstandardized way to evaluate residency candidates. The goal of this project was to assess the current components of the Electronic Residency Application Service application and to determine and develop support for a standardized letter of evaluation (SLOE) in the resident selection process. ⋯ Most neurosurgical program directors agree that increasing the objectivity of the application would be beneficial, including the addition of standardized questions. However, there is only moderate interest in implementing an SLOE.
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Chiari malformation comprises a spectrum of congenital malformations characterized by a herniation of the cerebellar tonsils below the foramen magnum. Chiari malformation type I (CM-I) is the most prevalent subtype seen in clinical practice. ⋯ The effects of CM-I on cognitive functioning, however, and their impact on neuropsychological performance are poorly understood, despite having long been recognized. This article reviews neuropsychological deficits demonstrated by individuals with CM-I, and explores cerebellocortical neuroanatomic pathways to provide possible rationale for the neurocognitive impairments present in affected individuals.