World Neurosurg
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Cervical cord syndrome (CCS) is the most common type of incomplete spinal cord injury. Prompt surgical decompression within 24 hours increases neurologic function and rates of home discharge. Racial disparities exist in spinal cord injury, with Black patients experiencing longer lengths of stay and higher rates of complications than in White patients. This study aims to investigate potential racial disparities in time to surgical decompression in patients with CCS. ⋯ Though the advantages of early surgical decompression in the setting of CCS have been detailed in medical literature, Black, and female patients experience lower rates of prompt surgery following hospital admission and higher rates of adverse outcomes. This disproportionately increased time to intervention exemplifies demographic disparities in the timely provision of treatment to patients with spinal cord injuries.
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Normal pressure hydrocephalus and comorbidities: A quality study of the university hospital Münster.
Idiopathic normal pressure hydrocephalus (NPH) is commonly accompanied by diverse comorbidities that impact the postoperative course and result in a distinction between shunt responders and shunt non-responders. This study aimed to enhance diagnostics by identifying prognostic differences between NPH patients, individuals with comorbidities, and those with other complications. ⋯ The evaluation of comorbidities accompanied by NPH holds significant importance and necessitates meticulous observation, expertise, and multidisciplinary care.
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Systemic lupus erythematosus (SLE) is a common clinical condition, and one of its more common complications is bleeding. Intramedullary and posterior pharynx hemorrhage in SLE is rare and disastrous. We present a patient with a predominantly neurological clinical presentation, which on examination was thought to be the result of active SLE complicated by intramedullary and pharynx hemorrhage. ⋯ The patient's neurological deficits improved gradually. She could walk independently when she was discharged. Early magnetic resonance imaging detection and early glucocorticoid treatment can halt the progression of neuropsychiatric SLE.
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Spinal anesthesia is an effective modality for lumbar surgery. Patient eligibility with respect to medical comorbidities remains a topic of debate. Obesity (body mass index ≥30 kg/m2), anxiety, obstructive sleep apnea, reoperation at the same level, and multilevel operations have variously been reported as relative contraindications. We hypothesize that patients undergoing common lumbar surgeries with these comorbidities do not experience greater rates of complications compared with controls. ⋯ Spinal anesthesia is a safe option for patients with significant comorbidities and can be considered for most patients undergoing routine lumbar surgeries.
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The indication for performing biopsies in patients with diffuse lesions in the brain stem is controversial. The possible risks associated with the technically challenging interventions must be balanced against clarifying the diagnosis and the possible therapeutic options. We reviewed the feasibility, risk profile, and diagnostic yield of different biopsy techniques in a pediatric cohort. ⋯ Biopsies of the caudal brainstem in children were feasible and safe in the presented setup. The amount of tumor material acquired allowing for an integrated diagnosis and was obtained at reasonable risk. The selection of the surgical technique depends on the tumor location and growth pattern. We recommend the performance of brainstem tumor biopsies in children at specialized centers to better understand the biology and enable possible novel therapeutic options.