World Neurosurg
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To examine the literature on risk factors for cerebral vasospasm (CV), one of the most serious complications following aneurysmal subarachnoid hemorrhage (SAH), with special reference to the definition of CV. ⋯ Severe SAH evident on computed tomography scan appears to be a definite risk factor for CV after SAH, followed by cigarette smoking, hypertension, and left ventricular hypertrophy on electrocardiogram. To understand the pathogenesis of CV, further studies on the relationships between risk factors, especially factors not related to the severity of SAH, and angiographic vasospasm grade are necessary.
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To refine the surgical indications of surgery for life-threatening cerebral hematomas caused by aneurysm rupture, through the analysis of possible outcome predictors. ⋯ The bleeding severity was strongly determinant for early mortality. However, if patients can survive the initial crucial phase, their chances of a favorable outcome are not negligible. Further improvement may be possible through better patient selection and the identification of nonsalvageable subjects.
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Studies have yet to investigate long-term radiologic changes in lumbar spinal stenosis patients treated with interspinous device (Coflex). This study aimed to evaluate which radiologic parameters change significantly after surgery with Coflex and identify which parameter most affects the radiologic outcome. ⋯ The preoperative state including relatively higher ADH, PDH, and larger ROM could induce erosion. The long-term preservation of disc height and ROM may also induce erosion. That reduction of most radiologic parameters seems to be natural after surgery, and insufficient reduction of disc height and ROM may induce adverse effects, which can increase the possibility of spinous process fracture or device malposition.
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Meningiomas of the foramen magnum are among the most challenging of all skull base lesions. Controversies continue regarding the most appropriate approach to this critical anatomic region. The authors report a first case in English literature about twin meningiomas arising from both sides of the ventrolateral dura at the foramen magnum. ⋯ We suggest that resection can be safely achieved via the unilateral far lateral transcondylar approach followed by Gamma Knife radiosurgery (GKRS) or a staged bilateral approach.