World Neurosurg
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Review
Presentation, management and outcome of primary leiomyosarcoma of the spine: A systematic review.
Primary spinal leiomyosarcoma (PSL) is extremely rare. A case is presented, followed by a systematic review establishing the consensus on presentation, diagnosis, management, and outcomes. Comparison is made with metastatic spinal leiomyosarcoma (MSL). ⋯ PSL diagnosis is challenging, with positron emission tomography-computed tomography and histopathologic sampling playing an important role. There is a limited evidence base for the treatment strategies used but surgical management is key, with generally good outcomes. Prognosis for PSL seems to be better than for MSL. There is scope for more dedicated research in PSL and MSL.
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Cerebral revascularization surgery has been advanced by the refinement of several adjunctive tools. These tools include perioperative blood thinners, intraoperative spasmolytic agents, electrophysiological monitoring, and methods for assessing bypass patency or marking arteriotomies. ⋯ Understanding these adjuncts can help surgeons ensure that they receive reliable intraoperative information about bypass function and minimize the risk of serious complications. Overall, this review provides a succinct reference for neurosurgeons on various cerebrovascular bypass adjuncts.
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Dystonia in pantothenate kinase-associated neurodegeneration (PKAN) is progressive despite medication. Deep brain stimulation (DBS) was reported to effectively provide symptom relief. No consensus exists in candidate and target selection for DBS. We aimed to demonstrate effectiveness of subthalamic DBS (STN-DBS) placement in pediatric patients with PKAN. ⋯ This case series demonstrated that STN-DBS is an effective symptom-based treatment for pediatric patients with PKAN.
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On the morning of July 11, 1804, Major General Alexander Hamilton, an American statesman and one of the Founding Fathers of the United States, boarded a barge from Manhattan to the New Jersey shore. There, he met his personal and political opponent, Aaron Burr, for a duel during which Burr shot a bullet that entered Hamilton's torso, fractured a false rib, passed through internal organs, and lodged itself in one of his upper lumbar vertebrae. In this unique historical analysis of a pivotal event in American history, we provide a comprehensive discussion of the spinal injuries sustained by Alexander Hamilton, with special consideration of anatomic details and the ballistics of the time. To the authors' knowledge, this is the first thorough examination of the spinal injuries sustained by the prolific Founding Father and great mind behind the American financial system, Alexander Hamilton.
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Intrathecal baclofen (ITB) is a treatment modality used to improve the quality of life of patients with intractable spasticity and dystonia. Although it is an effective solution in patients failing oral interventions, it is associated with potential infectious complications. It is known that pediatric patients with ITB have significantly higher infection rates compared with adult patients. The cause of these higher rates in pediatric patients remains unclear. In the present study, we performed a meta-analysis focusing on the incidence of infection, and clarification of potential risk factors for infection in pediatric patients with ITB. ⋯ Surgeons and clinicians should use these data to better assess patient risk-benefit when considering ITB pump implantation.