Neurosurgery
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Endoscopic third ventriculostomy (ETV) has been used predominantly in the pediatric population in the past. Application in the adult population has been less extensive, even in large neurosurgical centers. To our knowledge, this report is one of the largest adult ETV series reported and has the consistency of being performed at 1 center. ⋯ Use of ETV in adult hydrocephalus has broad application with a low complication rate and reasonably good efficacy in selected patients.
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Proximal junctional kyphosis (PJK) is a known complication after spinal deformity surgery. One potential cause is disruption of posterior muscular tension band during pedicle screw placement. ⋯ Overall rates of radiographic PJK and reoperation for PJK were not significantly decreased with MIS pedicle screw placement. However, a larger comparative study is needed to confirm that MIS pedicle screw placement does not affect PJK.
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Haptoglobin (Hp) genotype has been shown to be a predictor of clinical outcomes in subarachnoid hemorrhage. Cerebral salt wasting (CSW) has been suggested to precede the development of symptomatic vasospasm. ⋯ Hp 2-2 genotype was an independent predictor of CSW after subarachnoid hemorrhage. Because CSW is strongly associated with delayed cerebral infarction, the use of Hp genotype testing requires more investigation, and larger prospective confirmation is warranted. Additionally, a more objective definition of CSW needs to be delineated.
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The management of arteriovenous malformations (AVMs) in the basal ganglia, insula, and thalamus is demanding for all treatment modalities. ⋯ Embolization therapy appears to be safe and potentially curative for certain deep AVMs. Our results demonstrate a high percentage of anatomic obliteration with rates of complications that may approach radiosurgery profile. In particular, embolization as stand-alone therapy is most suitable to deep AVMs with small nidus size (≤3 cm) and/or associated with single venous drainage in which microsurgery might not be indicated.
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Obesity rates continue to rise along with the number of obese patients undergoing elective spinal fusion. ⋯ Increased BMI is associated with longer operative times, increased complication rates, and increased cost independent of comorbidities. These effects are more pronounced with morbidly obese patients, further supporting a role for preoperative weight loss.