Neurosurgery
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Serum brain natriuretic peptide (BNP) is elevated after subarachnoid hemorrhage (SAH), causes diuresis and natriuresis (cerebral salt wasting), and may exacerbate delayed ischemic neurological deficits. We examined the temporal relationship between serum BNP elevation, hyponatremia, and the onset of delayed ischemic neurological deficits and determined whether serum BNP levels correlated with the 2-week outcome after SAH. ⋯ Increasing serum BNP levels independently were associated with hyponatremia, significantly increased the first 24 hours after onset of delayed ischemic neurological deficits, and predicted the 2-week Glasgow Coma Scale score.
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Clinical Trial
Back pain and disability after lumbar laminectomy: is there a relationship to muscle retraction?
Preliminary studies have suggested that prolonged retraction of the paraspinal muscle during spinal surgery may produce ischemic damage. We report the continuous measurement of intramuscular pressure (IMP) during decompressive lumbar laminectomy and its relationship to subsequent back pain and disability. ⋯ The McCulloch retractor generates a higher IMP than the Norfolk and Norwich retractor. However, postoperative improvement in VAS, ODI, and SF-36 scores in these patients was associated with a shorter duration of muscle retraction and not the degree of IMP or IPP generated. In this respect, periodic relaxation of the paraspinal muscle retractors during surgery to allow muscle perfusion may help to reduce postoperative back pain and disability.
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Case Reports
Extensive spinal cord infarction after posterior fossa surgery in the sitting position: case report.
Spinal cord injury is a rare complication of neurosurgery performed with the patient in the sitting position. Previous reports showed that the level of injury is usually located at or near the C5 segmental spinal level, and the term midcervical quadriplegia has been proposed. Extensive spinal cord and lower brainstem infarction also can occur after posterior fossa surgery performed with the patient in the sitting position. ⋯ We speculate that alteration of spinal cord blood flow by stretching of the cervical spinal cord and spinal epidural venous engorgement might have caused this devastating complication.
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We review our 8-year experience with gamma knife radiosurgery (GKRS) for the treatment of patients with benign cavernous sinus tumors and present a quantitative analysis of factors relevant to treatment outcomes. ⋯ GKRS is a safe and effective treatment for selected patients with benign cavernous sinus tumors and is an important adjunct for treating postoperative tumor residual and/or recurrent tumor. Continued analysis of treated patients over an extended time is needed to evaluate long-term disease control and potential late GKRS complications.