World Neurosurg
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Diversion of cerebrospinal fluid (CSF) is a common neurosurgical procedure for control of intracranial pressure (ICP) in the acute phase after traumatic brain injury (TBI), where medical management is insufficient. CSF can be drained via an external ventricular drain (EVD) or, in selected patients, via a lumbar (external lumbar drain [ELD]) drainage catheter. Considerable variability exists in neurosurgical practice on their use. ⋯ The data presented demonstrate that EVD and ELD can be successful in ICP control after TBI, with ELD limited to carefully selected patients with strict drainage protocols. The findings support prospective study to formally determine the relative risk-benefit profiles of CSF drainage modalities in TBI.
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The management of external ventricular drains (EVDs) is a critical aspect of patient care in the intensive care setting. However, nurses on the general floor are not commonly exposed to patients with EVD and therefore lack the necessary knowledge and skills to manage and troubleshoot EVDs effectively. The aim of this study was to evaluate the level of knowledge, comfort, and impact of EVD management among nurses on the floor after the implementation of a quality improvement (QI) tool. ⋯ The results of this study highlight the need for continued training and education to support the care of patients with EVDs in the ward setting. The implementation of a QI tool can significantly improve nurses' knowledge and comfort level in EVD management, leading to improved patient outcomes and overall quality of care.
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Brain tumor biopsies are essential for pathologic diagnosis. However, hemorrhagic complications after biopsies may occur, leading to suboptimal outcomes. This study aimed to evaluate the associated factors of hemorrhagic complications after brain tumor biopsies and propose countermeasures. ⋯ We recommend the following measures to prevent hemorrhagic complications: consider biopsy techniques that allow adequate hemostatic manipulation preferentially; perform more careful hemostasis in cases of suspected gliomas of WHO grade III/IV, multiple lesions, and abundant MBs in the tumors; and, if there are multiple candidate biopsy sites, select areas with lower rCBF and no MBs as a biopsy target.
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To investigate the surgical method and efficacy of the extended pterional approach in the resection of huge medial sphenoid ridge meningiomas (MSRMs). ⋯ The use of the extended pterional approach in the resection of huge MSRMs appears to be an effective surgical method. Careful dissection and preservation of vascular and neural structures, as well as meticulous microsurgical techniques in managing cavernous sinus tumors, can lead to reduced surgical complications and improved treatment outcomes.
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Case Reports
Effects of sacral slope changes on the intervertebral disc and hip joint: A finite element analysis.
Spinopelvic parameters are vital components that must be considered when treating patients with spinal disease. Several finite element (FE) studies have explored spinopelvic parameters such as sacral slope (SS) and the impact on the lumbar spine, although no study has examined the effect on the hip and sacroiliac joint (SIJ) on varying SS angles. Therefore, it is necessary to have a biomechanical understanding of the impact on the spinopelvic complex. ⋯ The results provide evidence that patients with higher SS may be more prone to increased ROM at the slip angle (L5-S1). In addition, patients with higher SS were shown to have higher contact stresses on the hip joint and SIJ, potentially leading to SIJ dysfunction. Clinically, correcting lumbar lordosis including SS is important; however, a high SS may have a negative impact on the intervertebral disc, SIJ, and hip joint.