World Neurosurg
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To objectively correlate distortions of optic apparatus morphology in patients with pituitary adenomas undergoing trans-sphenoidal surgery. ⋯ Anatomic realignment of the optic apparatus 3 months following trans-sphenoidal surgery predicts VF scores, but not VA or TV scores at 1-year follow-up. Patients with preoperative ONKA values of more than 139.3° have a 76% chance of achieving normal TV scores 1 year after surgery. Postoperative chiasm sag appears to be clinically irrelevant at short-term follow-up.
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The aim of this study was to assess the diagnostic yield of follow-up investigations in aneurysm-negative subarachnoid hemorrhage (SAH) patients. ⋯ The results of this study support the use of repeat DSA in patients with NPM-SAH; however, routine repeat DSA may not be indicated in PM-SAH patients. The routine use of MRI remains controversial.
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Anterior cervical discectomy and fusion (ACDF) is the gold standard approach for surgical management of many manifestations of cervical spine pathology. In recent years, total disc replacement (TDR) has emerged as a motion preserving modality that is proposed to decrease the rate of adjacent segment disease (ASD). In patients with multi-level disease, hybrid constructs with ACDF at 1 level and TDR at an adjacent level have been performed with success. ⋯ Multiple surgical options were discussed with the patient including multi-level anterior fusion, posterior laminoplasty, and posterior decompression and fusion.4-6 Following discussion of risks, benefits, and alternatives, the patient consented to the anterior hybrid approach. The patient underwent an uncomplicated hybrid anterior fusion and disc arthroplasty and was discharged home on postoperative day 1. The present video serves as technique guide and case study of a non-contiguous construct with satisfactory motion preservation and clinical outcome (Video 1).
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Endoscopic management of pediatric hydrocephalus is always challenging because of the different anatomical structure of the ventricles. The aim of this study is to document the endoscopic anatomy of the ventricular system and to show the variations and deformations. ⋯ The compliance of the brain deteriorates with increasing intracranial pressure in pediatric hydrocephalus and the intraventricular anatomical structures differ from the normal anatomy. Developmental anomalies of the ventricle are also significant and since all these variations are often unpredictable on preoperative imaging, awareness of endoscopic anatomy, variations, and deformations will improve operative safety in children.
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Patients with moderate traumatic brain injury (mTBI) are under the threat of intracranial hypertension (IHT). However, it is unclear which mTBI patient will develop IHT and should receive intracranial pressure (ICP)-lowering treatment or invasive ICP monitoring after admission. The purpose of the present study was to develop and validate a prediction model that estimates the risk of IHT in mTBI patients. ⋯ A prediction model based on baseline parameters was found to be highly sensitive in distinguishing mTBI patients with GCS score of 9-11 who would suffer IHT. The high discriminative ability of the prediction model supports its use in identifying mTBI patients with GCS score of 9-11 who need ICP-lowering therapy or invasive ICP monitoring.