World Neurosurg
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Surgical trapping or endovascular deconstruction commonly is used for the treatment of giant or complex intracranial aneurysms. Preoperative balloon test occlusion and cerebral blood flow studies and intraoperative neurophysiologic monitoring can indicate whether sufficient collateralization exists or whether revascularization is needed. Hemodynamic insufficiency can occur, however, despite passing these tests, necessitating posttreatment revascularization. ⋯ Ischemic complications must always be anticipated in the treatment of giant or complex intracranial aneurysms, even if pre- and intraoperative blood flow studies indicate sufficient collateralization. Here we show that extracranial-to-intracranial bypass is an effective option to rescue unanticipated hemodynamic insufficiency after parent vessel occlusion. This study emphasizes the need for cerebrovascular surgeons to maintain proficiency in complex bypass techniques.
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Case Reports
Acute Traumatic Cervical Cord Injury in Pediatric Patients with os Odontoideum: A Series of 6 Patients.
Os odontoideum can lead to instability of the atlantoaxial joint and places the spinal cord at significant risk for acute traumatic catastrophic events or chronic neurologic change. The purpose of this study was to retrospectively review acute cervical cord injury after minor trauma in 6 pediatric patients with os odontoideum. ⋯ Pediatric patients with asymptomatic or myelopathic atlantoaxial instability secondary to os odontoideum are at risk for acute spinal cord injury even after minor traumatic injury. Sufficient fixation and fusion should be undertaken as prophylactic treatment of developing myelopathy and to improve neurologic symptoms with acute traumatic cervical cord injury in pediatric patients with os odontoideum.
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The biomechanical study was performed to investigate the effect of a novel pedicle screw anchor in increasing the pullout strength of pedicle screws. ⋯ A novel anchor for standard pedicle screws resulted in significantly less axial movement during fatigue and a greater failure force compared a screw with no anchor. The anchor may provide a stronger bone-to-screw interface, than a non-anchor screw, without the complications of cement augmentation.
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Regulatory agencies are standardizing quality metrics on the basis of which surgical procedures will be evaluated. We attempted to create a predictive model of perioperative complications in patients undergoing craniotomies for glioma resection. ⋯ The presented models can assist in the preoperative estimation of the complication risk for glioma patients and be used as an adjunct for outcome benchmarking in this population.