Neurosurgery
-
The traditional management of pregnant patients with Chiari I malformation (CM-I) heavily favors cesarean section and general anesthesia to limit the perceived risk of maternal neurological complications attributed to vaginal delivery and neuraxial anesthesia. The aim of this study was to compare reported neurological symptoms and radiographic presentations before and after childbirth performed by patients with CM-I, with and without associated syrinx. ⋯ Our findings suggest that patients with CM-I may deliver vaginally and receive neuraxial anesthesia with low risk of neurological complications or radiographic worsening. As these patients were not prospectively selected, limitations exist, and it remains important to consider the severity of the patient's clinical and radiographic presentation when selecting anesthetic and delivery modality.
-
Identifying patients with basal ganglia intracranial hemorrhage (ICH) at risk of hematoma expansion (HE) may better define selection criteria for early surgical evacuation. The aim of this study was to use automated radiographic feature extraction to improve risk stratification for basal ganglia ICH expansion. ⋯ nv-CTD is a measure of bgICH acuity and can augment spot-sign bgICH expansion risk stratification.
-
Aggressive resection for primary tumors of the spine are associated with a high rate of adverse events (AEs), but the impact of AEs on patient-reported outcomes (PROs) remains unknown and is critical to the shared decision-making. Our primary objective was to assess the impact of surgical AEs on PROs using an international registry. Assessing the impact on clinical outcomes and identifying risk factors for AEs were our secondary objectives. ⋯ The rate of surgical AEs is considerable in this population. Surgical AEs seem to be associated with a higher number of readmissions, but do not seem to result in significant differences in PROs or in a higher risk of reoperation, mortality, and failure to achieve preplanned margins.
-
Compared with the modified Frailty Index-11 (mFI-11) frailty tool, reflective of patient comorbidities, the Fried phenotype weighs functional patient variables. This study examined using the Fried phenotype in predicting postoperative outcomes in craniotomy for patients with tumor. ⋯ The Fried phenotype more accurately correlates with postoperative outcomes including LOS, discharge disposition location, and complications than does the mFI-11 score. These findings can be used to guide preoperative planning, inform consent, and potentially identify patients who may benefit from functional optimization in the preoperative period to improve postoperative outcomes.