Surg Neurol
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Modern cranial base approaches to the clivus and foramen magnum may threaten the stability of the cranio-cervical junction. This necessitates stabilization and fusion in some cases. We studied occipitocervical fusion after extreme lateral transcondylar approaches. ⋯ One third of patients will require fusion after extreme lateral transcondylar approaches. Most patients with less than 70% resection of the condyle remain stable without need for surgical intervention, whereas complete resection necessitates fusion in most cases.
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Transsphenoidal meningoencephalocele is a rare congenital anomaly, reported only in 14 adult patients. It may be subdivided into intrasphenoidal, extending into the sphenoid sinus, and true transsphenoidal, traversing the floor of the sinus and protruding into the nasal cavity or nasopharynx. ⋯ Adult patients with intrasphenoidal meningoencephalocele often present with rhinorrhea and should be considered for transsphenoidal repair, whereas patients with true transsphenoidal meningoencephalocele should not undergo surgery, in view of the complex anatomy and the slow progression of symptoms.
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Poor results after lumbar spinal surgery have been recorded in compensation cases throughout the world medical literature. It seems that psychosocial factors play an important role in the delay in returning to gainful employment but that chronic postoperative lumbar and lower extremity pain is blamed for this state of affairs. The present series of late outcomes is based on actual physical examination by independent neurosurgical and orthopedic experts appointed by the Workman's Compensation Board, providing an impartial opinion as to the discrepancy between objective findings and failure to reintegrate into the work force. ⋯ Although motivational (that is, psychosocial) factors undoubtedly play a role in failure to return to work, the role of chronic pain cannot be ignored. Increased attention must be devoted to ascertaining the etiology of this pain and ways to prevent it.
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Temporary acute agitated delirium is a frequent complication after surgery for chronic subdural hematoma (CSH) in elderly patients. To clarify the pathogenic mechanism underlying this complication, we measured cerebral blood flow before and after surgery in elderly patients with CSHs. ⋯ In elderly patients with CSH, intense and prolonged hyperperfusion after surgery induces temporary acute agitated delirium. This postoperative hyperperfusion syndrome is exacerbated by hypertension.