World Neurosurg
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Endovascular techniques have gained importance in recent years in the treatment of acutely ruptured aneurysms. Sometimes artificial anticoagulation or antiplatelet agents are indicated after endovascular aneurysm occlusion to prevent thromboembolic complications. Because many patients require ventriculostomy secondary to hydrocephalus, we analyzed ventriculostomy-related hemorrhage in patients with and without anticoagulant therapy. ⋯ Patients receiving endovascular treatment were at higher risk for ventriculostomy-related hemorrhage, especially when anticoagulation was administered after aneurysm occlusion. Although no clinically relevant external ventricular drain-related hemorrhage occurred, ventriculostomy should be performed before anticoagulation whenever possible.
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Case Reports
Atypical Teratoid Rhabdoid Tumor in a Teenager with Unusual Infiltration Into the Jugular Foramen.
Atypical teratoid rhabdoid tumor is a rare malignant neoplasm that represents 1%-2% of all pediatric central nervous system tumors. Immunohistochemistry plays an important role in establishing the diagnosis with a loss of INI-1 staining in tumor cells. In this case report, we describe a teenager with an unusual presentation and pattern of infiltration of the tumor. ⋯ This case highlights the diverse clinical presentation and infiltrative potential of atypical teratoid rhabdoid tumors, thus expanding the differential diagnosis of extra-axial tumors invading the jugular foramen.
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Case Reports
Magnetic Resonance Imaging to Evaluate Cervical Spinal Cord Injury from Gunshot Wounds from Handguns.
Patients presenting with gunshot wounds (GSWs) to the neck are difficult to assess because of their injuries are often severe and they are incompletely evaluated by computed tomography (CT) alone. Our institution treats hundreds of patients with GSWs each year and we present our experience using magnetic resonance imaging (MRI) in the evaluation of cervical GSWs. ⋯ For carefully selected patients, MRI can be an effective tool in assessing GSWs to the neck and it can significantly improve the evaluation and management of this cohort. No patient in our series experienced a complication related to MRI.
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The role of patient-reported outcomes (PROs) in elective cranial neurosurgery has been poorly studied, and their significance in reflecting complication rates is unclear. ⋯ In elective craniotomy patients, PROs seem promising patient-centered tools for outcomes reporting. Furthermore, neurosurgery-specific patient-reported outcome measures (PROMs) can perhaps be implemented to clinical use to improve patient safety and outcome comparisons in elective cranial neurosurgery.
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Case Reports
Initial Experience with High Definition Camera-On-a-Chip Flexible Endoscopy for Intraventricular Neurosurgery.
The usefulness of existing neuroendoscopes has been limited by either decreased range of motion or suboptimal image resolution. The flexible high-definition chip-camera endoscope has emerged as a potential solution to the shortcomings of available instruments by combining superior flexibility and image quality in order to better operate within spatially constrained intraventricular operations. ⋯ As demonstrated by this initial experience, the use of high-definition camera-on-a-chip flexible endoscopy may provide enhanced intraoperative visualization and application for intraventricular neurosurgery.