World Neurosurg
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Patient counseling and selection for surgical therapy in adult Chiari malformation type I (CM-1) remain debatable. We aimed to develop a clinical calculator predicting the risk of nonhome discharge and reoperation using the American College of Surgeons-National Surgical Quality Improvement Program database. ⋯ We have used a large international database to develop a simple risk calculator based on readily available preoperative variables. Following subsequent validation, this tool can help optimize patient counseling and decision making in adult CM-1.
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Comparative Study
Outcome comparison between surgically treated brain arteriovenous malformation hemorrhage and spontaneous intracerebral hemorrhage.
Case fatality and poor outcome rates are different between brain arteriovenous malformation-associated intracerebral hemorrhage (bAVM-ICH) and spontaneous intracerebral hemorrhage (SICH). These outcome rates, however, have never been compared in patients who need neurosurgical evacuation of the intracerebral hemorrhage (ICH). ⋯ patients with a bAVM who need surgical evacuation of an ICH have a more favorable outcome than surgically treated patients with spontaneous ICH, even after correction for confounding factors, such as younger age and less premorbid hypertension.
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Review Case Reports
Metal hypersensitivity after spinal instrumentation: when to suspect and how to treat.
Metal hypersensitivity is a rare complication after spinal implant placement but is related to significant clinical challenges including implant failure and poor wound healing. The incidence is likely underreported secondary to challenges with diagnosis and retreatment options. ⋯ Metal hypersensitivity is likely an underreported complication in spine literature that is associated with poor outcomes. Further research to create evidence-based guidelines on diagnosis and retreatment options will facilitate diagnosis, reduce time to revision surgery, and ultimately decrease patient suffering.
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Case Reports
Curative Removal of Small Vestibular Schwannoma with Functional Preservation: Operative Video.
This video case presents techniques of retrosigmoid curative removal of small vestibular schwannoma (VS) with functional preservation. A 49-year-old woman with right intrameatal VS presented with sudden hearing loss. Preoperative hearing was American Academy of Otolaryngology-Head and Neck Surgery (AAO) class A (pure tone audiometry: 18 dB). ⋯ No facial palsy occurred, and AAO class A (pure tone audiometry: 26 dB) hearing was preserved postoperatively. Techniques for curative tumor removal with functional preservation are as follows: 1) wide and deep IAC exposure with preservation of the meatal dura: though covered by the preserved meatal dura, meatal tumor bulges out after appropriate canal exposure, which also comprises petrous dura flap preparation and canal skeletonization; 2) sharp tumor debulking and dissection: tumor debulking is always mandatory to avoid damage to nerve function; 3) IAC reconstruction: after completion of tumor removal, the IAC roof is reconstructed using the petrous dura flap and muscle graft to restore the cerebrospinal fluid space in the canal and preserve long-term nerve function. Magnetic resonance imaging with gadolinium administration at 1 year and 5 years after surgery showed total tumor removal with no recurrence (i.e., curative tumor removal) and restored cerebrospinal fluid space in the canal by IAC reconstruction.
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The prognosis for patients with glioblastoma depends particularly on the degree of tumor resection. Patients with tumor remnants in postsurgical magnetic resonance imaging (<72 hours) may benefit from early reoperation. We present our results concerning the impact on overall survival (OS) and progression-free survival (PFS) of reoperation in patients who have already undergone surgery for glioblastoma. ⋯ Early reoperation in patients with residual tumor improved OS and PFS without increasing the number of complications compared with the patients who did not undergo reoperation.