World Neurosurg
-
To evaluate the cerebral and hemodynamic effects of low-dose intramuscular diclofenac sodium (DCFS) administered for fever control in patients with acute brain injury in the intensive care unit. ⋯ Low-dose intramuscular DCFS administration for fever control in patients with acute brain injury is effective but also exposes patients to potentially deleterious hypotensive episodes that must be diagnosed and treated expeditiously to prevent further damage to the injured brain.
-
The combination of anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) has been demonstrated to be effective for multilevel cervical spondylotic myelopathy (CSM); however, the combination of ACCF and cervical disc arthroplasty (CDA) for 3-level CSM has never been addressed. ⋯ For patients with multilevel CSM caused by segmental OPLL and DDD, the hybrid surgery of ACCF and CDA demonstrated satisfactory clinical and radiologic outcomes. Moreover, although located next to each other, the instrumented ACCF construct and CDA still achieved solid arthrodesis and preserved mobility, respectively. Therefore, hybrid surgery may be a reasonable option for the management of CSM with OPLL.
-
The accurate histologic diagnosis of germ cell tumors in the pineal region is a keystone for determining the best treatment strategy and prognosis. This situation poses a challenge for the neuropathologist, considering the lack of a standarized procedure to obtain biopsy samples, which results in few and small specimens, which are not suitable for diagnosis. ⋯ The supraorbital frontal endoscopic approach enables the surgeon to perform histologic mapping of pineal region tumors, allowing standarization of the procedure used to obtain the specimens. This approach could result in a more accurate diagnosis, especially in mixed germ cell neoplasms.
-
Pituitary apoplexy is a rare complication of the initial administration of leuprolide acetate. ⋯ Clinicians should be aware of this rare but known complication of leuprolide injection so that prompt diagnosis and treatment initiation are performed in patients with leuprolide-associated pituitary apoplexy.
-
Therapeutic decompressive craniectomy (TDC) controls increased intracranial pressure (ICP). Its role was controversial until its successful introduction to treat malignant middle cerebral artery ischemia. However, standardization of size and site of TDC remains controversial. This study was designed to evaluate whether size and site matter in TDC. ⋯ The size of a TDC is very important in reducing increased ICP. The size should be tailored to the level of increased ICP and the likelihood of further brain swelling postoperatively. A smaller TDC should be located more anteriorly to control increased ICP. Although location is not as important when increased ICP is >30 mm Hg and TDC size ≥8.3 cm is required.