Neurosurgery
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Ocular fundus abnormalities, especially intraocular hemorrhage, may represent a clinically useful prognostic marker in patients with acute subarachnoid hemorrhage (SAH). ⋯ Although ocular fundus abnormalities are associated with disease severity in SAH, they do not add value to patients' acute management beyond other risk factors already in use.
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Multiple percutaneous vertebral cement augmentation may create sandwich vertebrae. Whether the sandwich vertebra is at higher risk of further fracture remains unknown. ⋯ The incidence of sandwich vertebral fracture is not higher than that at the adjacent levels. The factor associated with further sandwich vertebral fracture was male gender. Once sandwich vertebral fracture occurred, patients may seek more surgical intervention than those with only adjacent fractures.
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Elevated body mass index (BMI) is a well-known risk factor for surgical complications in lumbar surgery. However, its effect on surgical effectiveness independent of surgical complications is unclear. ⋯ Increasing BMI is associated with decreased effectiveness of 1- to 3-level elective lumbar fusion, despite absence of surgical complications. BMI ≥ 30 kg/m2 is, therefore, a risk factor for both surgical complication and reduced benefit from lumbar fusion.
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Ventriculoperitoneal shunt placement remains the primary treatment modality for children with hydrocephalus. However, morbidity and revision surgery secondary to infection remains high, even while using antibiotic-impregnated shunts. ⋯ These data suggest that for this select group of patients, use of intraventricular antibiotics was associated with decreased rates of re-intervention secondary to infection.
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Shunting procedures have a high failure rate when used to treat pseudotumor cerebri (PTC) patients who have failed medical therapy. This failure is believed to be attributable to the collapsibility of the ventricular system when exposed to increased differential pressure gradients in the cerebral spinal fluid compartments caused by ventriculoperitoneal shunts (VPS). ⋯ CPS is a viable alternative to VPS in PTC patients who have failed traditional shunting methods to give these patients a persistent benefit of a working shunt. The procedure provides this solution with low operative and perioperative morbidity.