World Neurosurg
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There is a paucity of clinical evidence that guides perioperative glycemia management in patients undergoing craniotomy for brain tumor resection. The purpose of this study was to better understand global perceptions and practices related to glycemia management in these patients. ⋯ Our survey results suggest that perceptions and practices related to blood glucose management in patients undergoing brain tumor resection are variable. This study highlights the need for stronger clinical evidence and guidelines to help guide decisions for when and how to manage blood glucose derangements in these patients.
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Spinal meningiomas constitute 10% of all meningiomas. They most commonly rise in the thoracic spine and are most common in middle aged women; symptoms include progressive myelopathy.1,2 Radiation induced/radiotherapy-associated cranial meningiomas are well described with aggressive behavior; however, radiation-induced spinal meningiomas are extremely rare in the literature.3-7 Our patient had a history of Hodgkin lymphoma treated with neck radiation, and thyroid cancer treated with radioactive iodine/thyroidectomy. He presented with neck pain and myelopathy from a large intradural, extramedullary tumor compressing the spinal cord (C3-C5). ⋯ Cervical spine meningiomas with spinal cord compression and myelopathy should be resected to prevent further neurological decline. Dural splitting can be utilized to achieve "radical" tumor resection to prevent recurrence, which is particularly important if the tumor is aggressive and recurrent, as is the case in radiation-induced/radiotherapy-associated meningiomas. Upon dural closure, we applied autologous fat tissue along with fibrin glue to avoid spinal fluid leak as we published earlier.8 The patient consented to the procedure and publication of his image.
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The far-lateral suboccipital approach and its variants, including the transcondylar, supracondylar, and paracondylar approaches, are essential skull base techniques for the neurosurgeon to expose and treat pathologies located at the ventral and ventrolateral craniovertebral junction. An understanding of the surgical anatomy and technical nuances of these approaches is vital for preventing catastrophic brainstem or spinal cord injury, neurovascular injury, and/or cranial nerve injury. This is achieved by carefully studying the location, the rostral-caudal and lateral extents of the lesion itself, and the anatomy of the surrounding structures on preoperative imaging. ⋯ A thorough knowledge of the anatomy of the extradural and intradural segments of the vertebral artery, and the lower cranial nerves, in relation to the lesion is also critical. For almost all lesions, the far-lateral suboccipital route with no or minimal condylar drilling is more than adequate for removing the most ventral lesions. Herein, we discuss the indications, general and preoperative considerations, and surgical anatomy and technical nuances of this approach.
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Although the Veterans RAND 12-item Physical Component Survey (VR-12 PCS) has been broadly used to evaluate patient-reported outcome measures (PROMs) in spine surgery, its feasibility for use in patients undergoing minimally invasive lumbar discectomy (MIS LD) has not been well studied. This study aimed to assess the feasibility of VR-12 PCS for use up to 2 years postoperatively for MIS LD by correlation with PROMs for physical function. ⋯ Physical function scores for VR-12, SF-12, and PROMIS PF all demonstrated significant improvements following MIS LD. Strongly statistically significant correlations of VR-12 PCS with SF-12 PCS and PROMIS PF from preoperative measures through 2 years demonstrate the feasibility of VR-12 for assessing patient-reported physical function in MIS LD patients.
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Interbody fusion at the caudal levels of long constructs for adult spinal deformity (ASD) surgery is used to promote fusion and secure a solid foundation for maintenance of deformity correction. We sought to evaluate long-term pseudarthrosis, rod fracture, and revision rates for TLIF performed at the base of a long construct for ASD. ⋯ At 3-year follow-up, the rate of pseudarthrosis after TLIF performed at the base of a long fusion for ASD was 9.8%, and the rate of revision surgery to address pseudarthrosis and/or rod fracture was 8.9%. All patients were successfully treated with revision interbody fusion or posterior augmentation of the fusion mass, without need for further revision procedures at the TLIF level.