World Neurosurg
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The role of patient-reported outcomes (PROs) in elective cranial neurosurgery has been poorly studied, and their significance in reflecting complication rates is unclear. ⋯ In elective craniotomy patients, PROs seem promising patient-centered tools for outcomes reporting. Furthermore, neurosurgery-specific patient-reported outcome measures (PROMs) can perhaps be implemented to clinical use to improve patient safety and outcome comparisons in elective cranial neurosurgery.
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Labeled the "obesity paradox," obesity has been shown to provide a survival advantage in coronary artery disease, stroke, and intracerebral hemorrhage. Studies on body mass index (BMI) in aneurysmal subarachnoid hemorrhage (SAH) show conflicting results and none examined a North American population with long-term follow-up. ⋯ In our SAH population, higher BMI resulted in less short-term and long-term mortality, but no difference in functional outcome.
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Pneumocephalus is a commonly encountered finding in neurosurgery in which air displaces intracranial cerebrospinal fluid after cranial surgery or a cerebrospinal fluid leak into paranasal or mastoid sinuses. When an intracranial air collection becomes chronically established in a fixed loculation causing mass effect, pneumatocele is a more appropriate term. We present an unusual case of a spontaneous giant frontotemporal epidural pneumatocele that persisted for more than 1 year before the patient presented for neurological treatment. ⋯ This unique case represents the first reported case in the neurosurgical literature of a giant spontaneous epidural pneumatocele occurring in an adult treated with a middle fossa approach with resolution on follow-up imaging.
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Immunosuppression and immunomodulatory therapy-induced lymphoproliferative disorders (ILPD) represent a heterogeneous group of lymphoid cell disorders that occur secondary to iatrogenic immune dysfunction, best described in the post-transplant setting. ⋯ ILPD should be considered in the differential diagnosis in patients with iatrogenic immunodeficiency presenting with neurologic symptoms and intra-axial mass lesions on neuroimaging investigations. A standard treatment regimen for ILPD remains to be determined, however withholding the immunomodulatory agents and trial of corticosteroids may be tried as a first-line option before the use of more aggressive chemotherapy and/or radiotherapy.