World Neurosurg
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Venous thromboembolism (VTE) is an important complication after spine surgery with an incidence of 31%. To our knowledge, no study has reported a time-dependent examination of factors influencing VTE. We report factors influencing first and multiple VTE events and perform a time-dependent analysis. ⋯ Sex, VTE history, IVC filter type, chemoprophylaxis, and hospital stay influenced development of VTE. Time to VTE correlated with DVT history and IVC filter type, whereas VTE history and hospital stay influenced multiple VTE events.
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Shunt-related procedures in the treatment of hydrocephalus are often associated with malfunction and revision resulting in significant patient morbidity and financial impact on the health care system. The increased utilization of endoscopic third ventriculostomy (ETV) as an alternative treatment paradigm for obstructive hydrocephalus carries the theoretical expectation of concomitant decreased numbers of shunt procedures. The objective of the present study was to determine the impact of ETV on shunt-related procedures within a 14-year interval (1998-2011), during which ETV has gained wider acceptance and greater utilization. ⋯ Based on prior cost-effectiveness analyses, the observed trend of the inverse correlation between ETVs and shunt-related procedures may contribute to financial savings and improvement in patient outcomes. Further study is required to define the impact on morbidity and associated success rates.
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Case Reports
Delayed Diagnosis of Enhancing Posterior Fossa Tumors Mimicking the Tela Choroidea of the Fourth Ventricle.
Posterior fossa brain tumors are common in children. Symptoms typically develop when the tumors have reached sufficient size to cause compression of adjacent neural structures or cause obstructive hydrocephalus. Many tumors in this region originate from the tela choroidea and choroid plexus of the fourth ventricle. Enhancement of the fourth ventricular tela choroidea and choroid plexus is uncommon in children, and when such enhancement is present, it may represent early tumor growth. ⋯ Pediatric patients who have enhancing tela choroidea or choroid plexus without an obvious mass lesion of the fourth ventricle may harbor early tumors. Surveillance imaging in these patients may be warranted given the aggressive nature of certain posterior fossa tumors in children. Failure to recognize abnormal enhancement patterns in this region may lead to delayed diagnosis.
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Case Reports
Validity of the Lateral Supraorbital Approach as a Minimally Invasive Corridor for Orbital Lesions.
Many approaches were recommended for surgical treatment of orbital lesions via either transorbital or transcranial routes. The frontolateral craniotomy through eyebrow skin incision (lateral supraorbital approach) is a combined cranio-orbital approach that could be used in different orbital lesions. ⋯ The lateral supraorbital approach is a minimally invasive approach that provides excellent exposure of the superior, lateral, and medial orbit, as well as the orbital apex.
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Cerebral arteriovenous malformations (AVM) are infrequently diagnosed and treated in elderly patients (age, >60 years). We hypothesize that, in contrast to AVM surgical outcomes, radiosurgery outcomes are not adversely affected by increased age. The goals of this case-control study are to analyze the radiosurgery outcomes for elderly patients with AVMs and determine the effect of elderly age on AVM radiosurgery outcomes. ⋯ Advanced age does not appear to confer appreciably worse AVM radiosurgery outcomes, unlike its negative effect on AVM surgical outcomes. Thus, when an AVM warrants treatment, radiosurgery may be the preferred treatment for elderly patients.