World Neurosurg
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Comparative Study
Comparative study of the spinopelvic alignment in the patients with idiopathic lumbar scoliosis between adulthood and adolescence.
Understanding the natural history of the spinopelvic alignment in adolescent idiopathic scoliosis (AIS) is important in developing surgical strategies for patients with adult idiopathic lumbar scoliosis (AdLS). Because it is challenging to follow individuals without any treatments, we sought to estimate its natural history by comparing radiographic characteristics of patients with AIS and AdLS. ⋯ Our results may predict the following natural course of Lenke 5 AIS: (1) progression of scoliotic deformity of thoracolumbar/lumbar curve with increased thoracolumbar kyphosis; (2) subsequent lumbar hypolordosis followed by pelvic retroversion; and (3) sagittal imbalance after failure of compensation.
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A mainstay of treatment for symptomatic adjacent segment disease (ASD) has consisted of revision with posterior decompression and fusion. This carries significant morbidity and can be technically difficult. An alternative is stand-alone lateral lumbar interbody fusion (LLIF), which may avoid complications associated with revision surgery. We describe the largest cohort of patients treated with LLIF for ASD to our knowledge. ⋯ To our knowledge, this is the largest cohort study of patients to date evaluating stand-alone LLIF for ASD. Our patient outcomes show it is safe and effective with low risk of morbidity.
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Case Reports
Limited Intradural Anterior Petrosectomy for Upper Basilar Aneurysms: A Technical Note.
The extradural anterior petrosectomy is a widely used skull base approach to the upper petroclival region, basilar trunk, and ventral pons. However, there is significant procedure-related morbidity and a complete petrosectomy is required, as the intradural structures are not in view at the time of drilling. We describe an intradural anterior petrosectomy for aneurysms of the basilar trunk and anterior inferior cerebellar artery with intraoperative photographs and artwork to illustrate the approach. ⋯ The intradural anterior petrosectomy allows limited drilling of the petrous apex and provides sufficient exposure of upper basilar artery aneurysms.
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Evaluation of trainee performance remains a challenge in resident education, particularly for systems-based practice (SysBP) metrics including care coordination and interdisciplinary teamwork. Time to intervention is an important modifiable outcome variable in severe traumatic brain injury (TBI) and may serve as a trackable metric for SysBP evaluation. ⋯ CTH-INC is an objective and trackable proxy measure for evaluating SysBP during neurosurgical training. Use of CTH-INC or other time metrics in resident evaluations should not supersede the safe and effective delivery of patient care.
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Intracerebral hemorrhage (ICH) is the most devastating form of stroke, with thalamic hemorrhages carrying the worst outcomes. Minimally invasive (MIS) endoscopic ICH evacuation is a promising new therapy for the condition. However, it remains unclear whether therapy success is location dependent. Here we present long-term functional outcomes after MIS evacuation of spontaneous thalamic hemorrhages. ⋯ Among patients with ICH undergoing medical management, those with thalamic hemorrhages have especially poor outcomes. This study suggests that MIS evacuation can be safely performed in a thalamic population. It also presents long-term functional outcomes that can aid in planning randomization schemes or subgroup analyses in future MIS evacuation clinical trials.