World Neurosurg
-
Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive and effective treatment option that can potentially treat deep-seated pathologies in cases without safe open surgical corridors. In the present report, we have described our experience using MRgLITT for brainstem pathologies. ⋯ The brainstem represents formidable territory even for minimally invasive procedures. The overall morbidity and mortality has remained high, and the probability of achieving a meaningful outcome must be carefully assessed.
-
Traumatic brachial plexus injuries are devastating lesions, and neurotization is an usually elected surgical therapy. The phrenic nerve has been harvested as a motor fibers donor in brachial plexus neurotization, showing great results in terms of motor reinnervation. Unfortunately, these interventions lack solid evidence regarding long-term safety and possible late respiratory function sequelae, raising crescent concerns after the COVID-19 pandemic onset and possibly resulting in reduced propensity to use this technique. The study of the distal anatomy of the phrenic nerves may lead to a better understanding of their branching patterns, and thus the proposition of surgical approaches that better preserve patient respiratory function. ⋯ The right phrenic nerve presented greater consistency concerning insertion site, terminal branching point distance to this muscle, and number of rami than the left phrenic nerve.
-
Observational Study
Observational Studies in Neurosurgery: Structure, Functioning, and Uses.
Although randomized interventional studies are the gold standard of clinical study designs, they are not always feasible or necessary. In such cases, observational studies can bring insights into critical questions while minimizing harm and cost. There are numerous observational study designs, each with strengths and demerits. Unfortunately, it is not uncommon for observational study designs to be poorly designed or reported. In this article, the authors discuss similarities and differences between observational study designs, their application, and tenets of good use and proper reporting focusing on neurosurgery. ⋯ This paper disambiguates widely held misconceptions on the different observational study designs. In addition, it uses case-based scenarios to facilitate comprehension and relevance to the academic neurosurgery audience.
-
Metastatic glioblastoma to the vertebral spine is rarely encountered. The decision to intervene surgically must consider the poor prognosis in these patients. ⋯ She initially underwent vertebroplasty with symptomatic improvement, but the progression of disease precluded further surgical interventions, and the patient was referred for chemotherapy and radiotherapy. The case illustrates that the choice of treatment modality varies throughout the time course of the disease-patients with spinal instability or few solitary metastases may benefit from intervention, but as the disease burden increases, palliative radiotherapy and chemotherapy may offer greater benefit.
-
Risk factors for post-traumatic syringomyelia (PTS) development after traumatic spinal cord injury (tSCI) are incompletely understood. This study aimed to investigate the influence of direct surgical decompression after tSCI, as well as demographic, clinical, and other management-related factors, on rates of PTS development. ⋯ Direct surgical decompression after tSCI was not demonstrated to significantly influence rates of PTS development. Age at injury and severity of injury should be considered as risk factors for PTS on follow-up.