World Neurosurg
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To evaluate demographics, treatment options, and outcomes of traumatic brachial plexus injuries in pediatric patients. ⋯ Pediatric traumatic brachial plexus injuries are often high-energy injuries resulting in nerve root avulsions. Most patients were able to regain antigravity elbow flexion or stronger after brachial plexus reconstruction, and more than half had similar improvement in shoulder function. Treatment should be directed with goals of elbow flexion, shoulder stability/external rotation, and rudimentary grasp.
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To determine the association of preoperative hyponatremia with short-term postoperative complications and health care utilization (length of stay, readmissions) after anterior cervical fusion and discectomy (ACDF). ⋯ Preoperative hyponatremia is an independent risk factor for pneumonia and prolonged length of stay after ACDF.
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Recent publications on minimally invasive surgery (MIS) for hematoma evacuation have suggested survival benefits in select patients. Since 2015, our center has been performing an MIS technique using continuous irrigation with aspiration through an endoscope (stereotactic intracerebral underwater blood aspiration [SCUBA]). It is unknown how these patient outcomes compare with intracerebral hemorrhage (ICH) score predictions. Our aim is to determine if SCUBA patients had better 30-day mortality than predicted by their presenting ICH score. ⋯ This study suggests that minimally invasive hematoma evacuation with the SCUBA technique for ICH may reduce predicted 30-day mortality, with a number needed to treat of 4 to prevent 1 mortality.
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Some giant intracranial aneurysms can develop serpentine morphology, secondary to a peculiar near-complete intra-aneurysmal thrombosis. The resulting complex angioarchitecture, along with atypical clinical presentations (i.e., mass effect, distal ischemia) seen, makes management of such aneurysms technically challenging. These aneurysms are not amenable to endovascular treatment, and hence the only remaining treatment option is a tailored microsurgical procedure (clipping/parent vessel occlusion or reconstruction/trapping/aneurysmorrhaphy) accompanied by a safety bypass (high-flow, low-flow, or in situ bypass, subject to dependence of distal circulation on proximal trunk with reference to aneurysm). ⋯ Intraoperative and postoperative angiography confirmed the anastomosis patency. The patient's recovery was uneventful. This treatment can save operating time, eliminate donor artery-related morbidity, and offer a surgical alternative to the conventional strategy of STA-MCA bypass.
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Case Reports
Combined petrosal approach for resection of petroclival meningioma. 2D operative video.
Petroclival meningiomas are rare skull base lesions, which originate at the upper two thirds of the clivus, medially to cranial nerves V-XI. Interposition of the cranial nerves between the tumor and surgeon and the proximity/involvement of the basilar artery and brainstem make surgical treatment challenging. Nevertheless, documented growth, brainstem compression, and neurologic symptoms argue in favor of resection. ⋯ Gross total resection (Simpson grade II) was achieved. Intraoperatively, the fourth cranial nerve was transected and treated with primary end-to-end neurorrhaphy. The patient had a good neurologic outcome, with a trochlear nerve deficit, which partially improved over 12 months.