World Neurosurg
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Review Meta Analysis
Postoperative Visual Loss Following Lumbar Spine Surgery: A Review of Risk Factors by Diagnosis.
Postoperative visual loss (POVL) is a potentially devastating complication of lumbar spine surgery that may lead to significant functional impairment. Although POVL is rare, a review of the literature shows that it is being reported with increasing frequency. A systematic analysis detailing the etiology and prognosis of the 3 main types of POVL has yet to be published. We reviewed potential preoperative and intraoperative risk factors for ischemic optic neuropathy (ION), central retinal artery occlusion (CRAO), and cortical blindness (CB) after lumbar spine surgery. ⋯ We reviewed the preoperative and intraoperative risk factors for each of the 3 main POVL types, using several published case reports to supplement the limited large-scale studies available. ION risks may be influenced by a longer operative time in the prone position with anemia, hypotension, and blood transfusion. The risk for CRAO is usually due to improper positioning during the surgery. Prone positioning and obesity were found to be most commonly associated with CB development. The prognosis, prevention techniques, and treatment of each POVL type can vary considerably.
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Review Meta Analysis
Epidemiology of Idiopathic Normal Pressure Hydrocephalus: A Systematic Review of the Literature.
Idiopathic normal pressure hydrocephalus (iNPH) is an important cause of gait disturbance and cognitive impairment in elderly adults. However, the epidemiology of iNPH is relatively unknown, largely as a result of the paucity of specifically designed population studies. This systematic review aims to assess the prevalence and incidence of iNPH. ⋯ iNPH appears to be extremely underdiagnosed. Properly designed and adequately powered population-based studies are required to characterize the epidemiology of this disease accurately.
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Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is an inflammatory disorder of the central nervous system; it has only recently been defined and to date has received only limited attention. Its cause is as yet unknown. The pathologic characteristics are infiltration of T lymphocytes into the perivascular spaces of the pons, responsiveness to immunotherapy, and gadolinium-enhancing punctiform lesions in the brainstem seen on magnetic resonance imaging (MRI). ⋯ CLIPPERS syndrome may become manifest with a progressive tumor-like pontine lesion. This report adds clinical and radiologic aspects to the limited number of CLIPPERS cases reported to date, and underlines the importance of considering CLIPPERS in the differential diagnosis of tumor-like pontine processes.
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We report the first case of a recurrent malignant subdural effusion that was treated with whole-brain radiation therapy. A 72-year-old man presented with headaches and de novo left central facial palsy and right upper extremity weakness. His past medical history was remarkable for a prostatic adenocarcinoma diagnosed in 1999 (T4N0M0) with no metastatic disease diagnosed to date. ⋯ Whole-brain radiation therapy was performed from day 10 to 17 after surgery at a palliative dose of 20 Gy in 5 fractions. No treatment-associated complications were reported. Thirty days after radiotherapy, the computed tomography scan of the head showed total resolution of the malignant effusion.
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Comparative Study
The Reliability of the Ultrasonic Bone Scalpel in Cervical Spondylotic Myelopathy: a Comparative study of 46 Patients.
In patients with cervical spondylotic myelopathy (CSM), laminectomy is usually performed with a Kerrison rongeur or a high speed drill (HSD).The HSD, which is most often selected for laminectomy, may cause complications such as duratomy, thermal and mechanical neural injuries. With an ultrasonic bone scalpel (UBS), a less traumatic laminectomy can be performed in a shorter time. The aim of this study was to compare the results of laminectomies using HSD and UBS. ⋯ For patients with CSM, laminectomy using the UBS provides a safe, rapid, and effective decompression with a lesser blood loss. The low rate of complications lessens the postoperative morbidity rates and shortens hospital stay.