World Neurosurg
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Stimulating electrodes for lower extremity motor-evoked potential (LE-MEP) monitoring with transcortical stimulation are usually placed on the medial side of motor cortex convexity, which is not lower extremity but lumbar motor area. Lumbar MEP may be elicited with lower stimulation intensity than LE-MEP through this location, and it is useful to monitor lower extremity motor function intraoperatively. ⋯ Lumbar MEP was stimulated with lower stimulation intensity than the LE-MEP with the same intraoperative pattern of waveform changes in 12 patients. Lumbar MEP monitoring may be useful for preserving the corticospinal tract of lower extremities intraoperatively.
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Stroke is a potentially life-threatening condition that can lead to disability and prolonged hospital stay. Perioperative stroke is a rare complication of spine surgery, especially in elective procedures. The prevalence of this complication varies in the literature, and the physiopathology is uncertain in many cases. Our objective was to describe 5 cases of patients who underwent spine surgery complicated by perioperative stroke and to analyze their characteristics and clinical outcomes. ⋯ Despite the rarity of this complication, perioperative stroke in spine surgery can lead to considerable morbidity. Precocious diagnosis and treatment may improve patient outcomes.
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In the era of value-based payment models, it is imperative for neurosurgeons to eliminate inefficiencies and provide high-quality care. Discharge disposition is a relevant consideration with clinical and economic ramifications in brain tumor patients. We developed a predictive model and online calculator for postoperative non-home discharge disposition in brain tumor patients that can be incorporated into preoperative workflows. ⋯ A strongly performing predictive model and online calculator for non-home discharge disposition in brain tumor patients was developed. With further validation, this tool may facilitate more efficient discharge planning, with consequent improvements in quality and value of care for brain tumor patients.
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Neurocysticercosis (NCC) is the commonest parasitic infection of the central nervous system. There is significant difference in incidence of NCC depending on geographic location, and incidence as high as 4% is reported in the endemic areas. It results from human affliction by the larval stage of Taenia solium. Spinal NCC is quite rare as compared with cranial NCC and accounts for 1.5%-3% of all cases. Both spine and cranium can be rarely involved in NCC, and cranial involvement usually precedes the spinal involvement. ⋯ NCC can sometimes follow a very aggressive course and can involve both cranial and spinal compartments. Management of such patients is not standardized given the rarity of such cases.
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Conventional coiling is standard for treatment of ruptured intracranial aneurysms. We compared clinical and angiographic outcomes between intrasaccular flow disruption with the Woven EndoBridge (WEB) and conventional coiling in patients with aneurysmal subarachnoid hemorrhage (aSAH) using a propensity score-matched analysis. ⋯ Compared with conventional coiling, aSAH patients treated with the WEB have a similar clinical and potentially improved angiographic outcome at midterm follow-up. The WEB might be considered as an alternative to conventional coiling for the treatment of RIAs, in particular for those with wide-necked and thus challenging anatomy.