World Neurosurg
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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.
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As the population ages, the proportion of elderly patients with glioblastomas has increased. Recently, many researchers have focused on the treatments available to and prognoses in elderly patients with glioblastomas. ⋯ Maximal safe surgical resection followed by radiotherapy with concurrent and adjuvant temozolomide significantly prolonged overall survival times and was well tolerated in elderly patients with glioblastomas. In addition, low p53 protein expression was a significant favorable prognostic indicator in this population.
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Postoperative surgical-site infections (SSIs) are a common complication after deep brain stimulation (DBS) surgery, occurring at a quoted rate of approximately 1%-9%. Intraoperative vancomycin powder has demonstrated efficacy in reducing SSIs after cranial and spinal surgery; however, its use during DBS surgery has yet to be established. In this study, we describe the senior author's experience with the use of intraoperative vancomycin powder to prevent SSIs after DBS surgery. ⋯ In our experience, vancomycin powder has demonstrated safety and efficacy as an adjunct medication for infection prophylaxis after DBS surgery. Further prospective studies with larger patient cohorts are warranted.
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To evaluate the obliteration rate and clinical outcome following linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) for intracranial arteriovenous malformation (AVM) in pediatric patients (age ≤18 years). ⋯ A modest median marginal dose of 15 Gy (16 Gy in the obliterated AVM group vs. 12 Gy in the nonobliterated group) resulted in an obliteration rate of 66.7% after LINAC-based SRS for intracranial AVM, with low rate.
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Meningiomas are common intracranial tumors that can have a complex arterial supply. In a patient with a recurrent large left clinoid aypical grade 2 meningioma, diagnostic angiography revealed left proximal middle cerebral artery (MCA) occlusion and reconstitution of the MCA circulation from the left middle meningeal artery. Consequently, the planned surgical approach was adjusted to preserve the left external carotid artery circulation in a difficult meningioma resection. This case illustrates a role for preoperative angiography in surgical planning of patients with complex skull base tumors involving intracranial vascular structures and highlights the unique neovascularization that often occurs as meningiomas parasitize the exracranial blood supply.