World Neurosurg
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The pros and cons of semisitting positioning (SSP) versus lateral, horizontal positioning (LP) during retrosigmoid vestibular schwannoma (VS) surgery, especially concerning postoperative cranial nerve and brain stem preservation, are under continuous discussion. ⋯ SSP compared with LP surgery was associated with significantly shorter operation time and better facial and cochlear nerve function in VS surgery postoperatively, without differences in complication rates.
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The transsylvian approach is a standard method of approach for anterior circulation aneurysms or paraclinoid tumors. Care must be taken, however, to avoid inadvertent obliteration of sylvian veins to prevent postoperative brain swelling and venous infarction. Sometimes, the superficial sylvian veins have complex connections or are not visible because of the thickness of the arachnoid membrane, especially in the case of subarachnoid hemorrhage (SAH). The present report describes a simple method to dynamically visualize the sylvian vein via indocyanine green (ICG) angiography for the purposes of appropriately wide dissection of the sylvian fissure. ⋯ ICG videoangiography is an easy and useful method for identifying the connections and tributaries of the superficial sylvian veins from a transsylvian approach. This method allows wide opening of the sylvian fissure while preserving the sylvian veins.
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Case Reports
Missed or Delayed Cervical Spine or Spinal Cord Injuries Treated at a Tertiary Referral Hospital in Rwanda.
This study was aimed at 1) reporting cases of missed cervical spine injuries treated at a tertiary-level hospital, King Faisal Hospital, Rwanda (KFH-R), and 2) identifying the causes of delaying the diagnosis. ⋯ This study found that the cervical spine injuries were missed in 9.5% of the cervical spine trauma patients and resulted in a longer hospital stay for all 4 patients and severe disability in 1 patient (25%). The reasons for missed diagnoses in this study were 1) lack of cervical spine radiographic evaluation, 2) inadequate cervical spine radiographs to show the level of injury, 3) poor sensitivity of cervical spine plain radiography, 4) poor physical examination, 5) the presence of a distracting injury, and 6) poor sensitivity of radiographs and computed tomography scans for soft tissue injuries.
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Traumatic brain injury is a major general health concern. This study aims to evaluate a possible relationship between the serum level of glucose during admission and the outcome of patients with severe traumatic brain injury. ⋯ Admission serum glucose is not a significant indicator of outcome in patients with severe head trauma.
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Case Reports
Recurrent atypical meningiomas: combining surgery and radiosurgery in one effective multimodal treatment.
Owing to their rarity and proteiform pathologic features, the clinical behavior of atypical meningiomas is not yet well characterized. Though the extent of resection is believed to be a key determinant of prognosis, limited data exist regarding optimal management of patients with recurrent disease. ⋯ The disease-free interval was substantially similar after surgery and radiosurgery for treating recurrent disease in patients with atypical meningiomas. Surgery is the mainstay for prolonging survival, while radiosurgery can be an adjuvant strategy to gain time for clinical observation and planning aggressive surgical treatment.