World Neurosurg
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Spinal subdural hematoma (SSH) is a rare and infrequently reported complication of hemilaminectomy, laminectomy, and other spinal decompression surgeries. In this review, we aim to analyze the available literature for reported cases of SSH to better identify risk factors and presenting symptoms, as well as highlight the importance in prompt investigation and management of SSH to prevent long-term morbidity and chronic neurologic deficit. ⋯ SSH is a rare, emergency condition with neurologic deficit that can present as recurrent back pain and acute cauda equina postoperatively following hemilaminectomy and laminectomy procedures. Vigilance, early investigation, and surgical evacuation is important in preventing short- and long-term morbidity. Further collation of data and analysis is required to better identify patients at high risk for developing SSH postoperatively.
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To analyze radiologic characteristics, treatment strategy, and treatment outcomes of posterior fossa giant solid hemangioblastomas (GSHBs; ≥4 cm in maximum diameter). ⋯ GSHBs are surgically challenging. The current study shows that favorable outcome can be achieved for GSHBs in the cerebellar hemispheres and vermis. For those involving the brainstem, planned near-total resection or subtotal resection in a piecemeal fashion can be attempted if en bloc resection is judged to be infeasible, and further intervention can be considered as needed.
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To describe a cohort of T3-T4 thoracic disc herniations (TDHs), their clinical and radiologic characteristics, and unique thoracoscopic transaxillary approach (TAA). ⋯ T3-T4 TDHs are infrequent but may be underdiagnosed because they tend to be small and their signs and symptoms may mimic a cervical problem involving the shoulders and even the arms. There may be a male predominance. The TAA is straightforward, safe, efficacious, and well tolerated despite the supposed vulnerability of the upper thoracic spinal cord. Dissection between large crowded subpleural veins characteristic for the upper thoracic spine and ensuring adequate dura decompression when the steep angle may partially obscure the tip of the instruments does require some extra time. Thorough knowledge of the unique anatomy of the upper thorax is mandatory and the assistance of a cardiothoracic surgeon is highly recommended.
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The surgical management of lesions within or around the brainstem is usually associated with significant morbidity. Even though several safe entry zones have been described for brainstem lesions, especially cavernous malformations (CMs), their resection remains a challenge due to the convergence of highly functional nerve tracts and nuclei in this rather small structure. Moreover, the ventral location of some of these lesions usually calls for complex surgical approaches involving extensive bone drilling and significant manipulation of neurovascular structures. ⋯ Reconstruction was carried out in a multilayered fashion. The patient presented a postoperative cerebrospinal fluid leak, which resolved with a lumbar drain. Neurologic status remained unchanged after surgery, with the patient displaying a favorable clinical outcome (Video 1).
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Clinical Trial
Alterations in Local Peri-Infarct Blood Gases in Stroke Patients Undergoing Thrombectomy.
Ischemic stroke is a prevalent, devastating disease with high morbidity and mortality. Despite extensive research using animal models, significant gaps remain in understanding the pathological processes in human stroke. We previously developed a tissue bank to analyze the blood immediately proximal and distal to an intracranial thrombus in patients undergoing mechanical thrombectomy (ClinicalTrials.gov identifier, NCT03153683). Our goal for the present project was to evaluate the blood gas changes and acid/base balance during stroke and determine how vascular collateralization affects these changes. ⋯ The arterial blood gases differed immediately proximal and distal to thrombi in large vessel occlusive stroke. Although vascular collateralization did not appear to affect the blood gas changes, some blood gas values differed between men and women. The changes in bicarbonate and pCO2 suggested a compensatory acid-base process occurring at the time of infarction.