World Neurosurg
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Splitting of the optic nerve by a pituitary adenoma is an extremely unusual condition with only 3 cases reported to date. ⋯ In aneurysm and tumor cases, awareness of the exact anatomy is particularly important to preserve function. An overlooked duplication or penetration of cranial nerves may result in inadvertent injury to important structures and loss of function.
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Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure. Cerebrospinal fluid (CSF) leaks, although uncommon, may occur and can be a potentially serious complication. Little is known regarding the fusion rate after durotomy in ACDF. This study sought to investigate the clinical outcomes and fusion rates of patients with CSF leak after ACDF. ⋯ ACDFs with CSF leak had a 100% fusion rate in this series, with generally excellent clinical outcomes, although it is difficult to conclude definitively that there is no effect on fusion rates because of the small sample size. However, given the relative rarity of this complication, this study provides important data in the clinical literature regarding outcomes after CSF leak in ACDFs.
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Preoperative Predictors of Spinal Infection within the National Surgical Quality Inpatient Database.
Surgical-site infections (SSIs) are a major cause of morbidity and mortality, increasing the length and cost of hospitalization. In patients undergoing spine surgery, there are limited large-scale data on patient-specific risk factors for SSIs. ⋯ Analysis of a large national patient database revealed many independent risk factors for SSIs after spinal surgery. Some of these risk factors can be modified preoperatively to reduce the risk of postoperative infection.
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Ineffective closure of complex skull base approaches leads to wound complications and cerebrospinal fluid (CSF) leak. This can result in protracted hospital stays, additional procedures, delayed postoperative recovery, and increased cost of care. Removal of large middle fossa-infratemporal fossa tumors are particularly problematic as they result in a large dead space with gravity-facilitated CSF leakage into the cavity. In this report we describe the use of a novel technique, the "inverted gull wing" titanium mesh reconstruction. ⋯ The inverted gull wing technique represents a simple, fast, and effective closure for complex transzygomatic infratemporal fossa approaches.
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Optic pathway gliomas (OPGs) are rare neoplasms in children with an unpredictable clinical course. There is significant controversy regarding the optimal management and outcome of these patients. ⋯ The initial role of surgery in newly developed OPG is biopsy for tissue diagnosis and relief of the hydrocephalus, if present, followed by chemotherapy. Chemotherapy decreases or stabilizes the tumor size in most cases, leading to preservation of both visual and endocrinal functions. The most significant prognostic factor confirmed in this study was the age of the patient.