World Neurosurg
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Limited information is available about the hospital types to which patients with intracerebral hemorrhage (ICH) are admitted and treated. This could be important because some effective therapeutic measures can only be administered at comprehensive stroke centers (CSCs). ⋯ Despite a considerable proportion of ICH patients remaining at a non-CSC for their entire hospitalization, the short- and long-term mortality were comparable between the 2 hospital types. More studies are required to determine whether outcomes other than mortality might be related to the admitting hospital type and whether the routing protocols for ICH patients should be modified.
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The world currently faces the novel COVID-19 pandemic, with cutbacks in patient care. Little is known about the effects of a pandemic on the presentation and admission to an outpatient clinic. Our aim was to gain a better understanding of the effects of reduced neurosurgical care access from the patient perspective, especially in terms of anxiety and urgency of treatment, and to improve outpatient management in case of a potential second wave and potential restrictions on health care. ⋯ Despite COVID-19, patients in need of neurosurgical service were hardly afraid to visit doctors and/or hospitals. Nonetheless, because legal requirements, access has been restricted, causing potential collateral damage in a small subset of neurosurgical patients.
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Case Reports
Beware the wandering needle: inadvertent intramedullary injection during an attempted cervical medial branch block.
A 27-year-old man developed sudden neck pain, severe quadriparesis, and right shoulder allodynia during an outpatient cervical medial branch block procedure. Cervical spine imaging revealed evidence of an interlaminar needle trajectory with abnormal signal in the right hemicord at the level of C4, consistent with intramedullary injection and contusion. Following a 48-hour stay in the intensive care unit, during which hemodynamic vasopressor support was administered to optimize spinal cord perfusion, the patient exhibited almost complete neurologic recovery with resolution of the neuropathic pain. He was eventually discharged home and underwent outpatient physical therapy for a mild residual right hemiparesis.
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Management of sphenoid lateral recess (SLR) cerebrospinal fluid (CSF) leaks present a challenge because of the location and requiring complete visualization of the defect for a successful repair. The endoscopic endonasal transpterygoid approach (EETPA) is considered the gold standard in addressing these defects. We lay out our experience in implementing this approach with plasma ablation. ⋯ Plasma ablation-assisted EETPA allows for a uninostril approach to the SLR, easy accessibility, and better visualization with a bloodless field, which allows appropriate repair, thus minimizing complications and preventing recurrence.
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Giant middle cerebral artery (MCA) aneurysms are rare complex cerebrovascular lesions to treat.1 The management of those aneurysms may be very challenging, despite the introduction of refined microsurgical techniques and the rapid progress in endovascular methods, which often require bypass surgery as part of the strategy.2-4 This approach is particularly relevant to giant, dolichoectatic, and thrombotic aneurysms.5,6 This video shows the surgical strategy and stepwise depiction of the surgical treatment of a complex giant thrombosed aneurysm using a double-barrel superficial temporal artery (STA) to MCA bypass (Video 1). Informed written consent was obtained from the patient and his family. The patient was a 50-year-old man, previously healthy, who presented with headache, memory difficulty, and left-sided involuntary movements for 2 months. ⋯ The complete clipping and patency of the anastomosis was validated during surgery by indocyanine green angiography. Postoperative cerebral computed tomography angiography revealed good patency from the STA to the MCA. The patient was neurologically intact without complains.