World Neurosurg
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Surgical Strategy and Decision Making in Recurrent Atlanto-Axial Dislocations: The Role of Traction.
To analyse patients with recurrent atlanto-axial dislocation and give a criterion of an ideal patient who can benefit from redo surgery. ⋯ The best candidates who can benefit after redo surgery are the ones who exhibit either clinical and/or radiological improvement on the trial of traction, as the pathological C1-C2 joints are either not fused or have undergone pseudoarthrosis. Those patients who do not exhibit significant clinical or radiological improvement post-trial of traction should not be offered subsequent surgical intervention.
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Endothelial dysfunction, induced by high shear stress from increased nidal blood flow, may promote a cycle of inflammation, possibly leading to instability and cerebral arteriovenous malformations (AVMs) rupture. Macrophages, identified with Cluster of Differentiation 68, are key inflammatory components in AVM pathology. We aim to evaluate the relationship of inflammation with AVM flow and hemosiderin. ⋯ These findings suggest a relationship among AVM vessel wall inflammation, hemosiderin, and hemorrhage presentation. Further investigations with larger sample sizes are warranted to understand the role of altered hemodynamics, hemosiderin deposition, and inflammation in AVM vessel walls.
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Meningiomas are the most frequently diagnosed benign intracranial tumors. However, meningioma en plaque (MEP) is a rare subset accounting for 2.5% of all meningiomas and is characterized by flat, carpetlike proliferation along the dura, typically arising in the spheno-orbital region, and, therefore, causes proptosis, decreased visual acuity, and orbital pain. We present a unique case of a patient with MEP presenting with cerebrospinal fluid (CSF) rhinorrhea and conduct a systematic review of the literature. ⋯ MEP associated with spontaneous CSF rhinorrhea is extremely rare and poses diagnostic and therapeutic challenges. Conservative management for select cases of MEP can be a good choice, sparing the patient from surgical complications, especially for skull base areas that are difficult to access.
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Burnout syndrome impacts 1 of 2 neurosurgeons and negatively impacts both the individual and institution. The impact of burnout on neurosurgeons may have increased due to the SARS-CoV-2 pandemic. Characteristics of burnout may differ among neurosurgeons and non-neurosurgeon physicians, and this may better target wellness initiatives designed to alleviate burnout. ⋯ We show that although the rate of burnout does not differ for neurosurgeons, the characteristics of burnout may. This may represent the key to providing specialty-specific targeted interventions to alleviate burnout. Furthermore, there is a significant proportion of neurosurgeons at risk for subsequent burnout for which additional importance must be placed to prevent progression to burnout.