World Neurosurg
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Case Reports
Cord splitting access to ventral intradural cysts of the cervico-thoracic junction and thoracic spine.
Surgical treatment of ventrally located intradural cysts is difficult and controversial. Laminectomy with division of the denticulate ligaments and gentle cord mobilization remains the standard approach but risks further neurologic deterioration secondary to cord manipulation. Our purpose is to evaluate the safety and effectiveness of a midline cord-splitting approach as an alternative for treating ventral thoracic intradural cysts. ⋯ We have been able to drain 2 ventral intradural cysts using a cord-splitting technique. This has allowed safe access to purely ventrally located lesions, which were inaccessible dorsally or dorsolaterally. By using this method we have been able to avoid a more invasive ventral transthoracic approach necessitating vertebrectomy and reconstruction and risking serious complications.
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Internal carotid artery (ICA) injury is 1 of the most feared complications in endoscopic pituitary surgery. Different endovascular techniques are available for the management of early and delayed ICA injuries. ⋯ Despite the presence of acute hemorrhage and the need for antiplatelet therapy, a flow diverter stent can be used as emergency treatment of ICA injury in selected circumstances.
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Spinal surgery is taught and practiced within 2 different surgical disciplines: neurological surgery and orthopedic surgery. We have provided a unified analysis of spine-focused faculty at U.S. residency programs. ⋯ Neurological and orthopedic spine surgery showed similar patterns for the spread of faculty across academic ranks and trends in academic productivity. Marked gender disparity was seen in both neurosurgical and orthopedic surgery, with fewer female spine surgeons seen at every academic rank. Orthopedic spine surgeons had a greater mean fellowship number than did their neurosurgical counterparts, and a lack of fellowship correlated with lower academic productivity in orthopedic, but not neurological, spine surgery.
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Pituitary adenomas account for 10%-20% of intracranial brain tumors but have greater incidence in elderly patients. We assessed microsurgical treatment for pituitary adenomas in this population. ⋯ In this series of microsurgical resection of pituitary adenomas in elderly patients, good efficacy and safety of treatment were observed. Preclusion of surgical treatment, including open resection, simply because of age is not warranted and instead a comprehensive evaluation of a patient's risk profile and surgical goals should be undertaken.
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Colloid transfusion during surgical decompressive hemicraniectomy (DHC) to treat space-occupying cerebral infarction induced by middle cerebral artery (MCA) is controversial. A multicenter retrospective study was conducted to determine whether an increased colloid transfusion during surgery is associated with a lower incidence of postoperative pneumonia and better long-term outcomes after space-occupying cerebral infarction. ⋯ Our retrospective study demonstrated that there is a robust association between increased perioperative colloid transfusion and lower incidence of postoperative pneumonia and better outcomes among the patients older than 60 years after space-occupying cerebral infarction.