World Neurosurg
-
Pituitary apoplexy is an acute clinical syndrome caused by pituitary gland hemorrhage or infarction. Rarely, this clinical syndrome is associated with cerebral infarction secondary to compression of an internal carotid artery. We report an unusual case of pituitary apoplexy associated with a cerebral infarct with a large ischemic penumbra. ⋯ Cerebral perfusion imaging is a useful diagnostic tool for identifying the subset of pituitary apoplexy patients that may benefit from emergent surgical intervention.
-
Case Reports
Failed Ventriculoperitoneal Shunt: is Retrograde Ventriculosinus Shunt A Reliable Option?
Currently, the treatment of hydrocephalus is mainly carried out through a ventriculoperitoneal shunt (VPS) insertion. However, in some cases, there may be surgical revisions and requirement of an alternative distal site for shunting. There are several described distal sites, and secondary options after VPS include ventriculopleural and ventriculoatrial shunt, which have technical difficulties and harmful complications. ⋯ We propose that in cases where VPS is not feasible, RVSS may be a safe and applicable second option. Nevertheless, the long-term follow-up of patients and further learning curve must bring stronger evidence.
-
Case Reports
Successful Treatment of Complex Regional Pain Syndrome with Pseudoaneurysm Excision and Median Nerve Neurolysis.
Complex regional pain syndrome (CRPS), formerly referred to as reflex sympathetic dystrophy, is a pain syndrome characterized by severe pain, altered autonomic and motor function, and trophic changes. CRPS is usually associated with soft tissue injury or trauma. It has also been described as a rare complication of arterial access for angiography secondary to pseudoaneurysm formation. ⋯ This case involves a unique presentation of CRPS caused by brachial artery angiography and pseudoaneurysm formation. In addition, the case demonstrates the efficacy of pseudoaneurysm excision and median nerve neurolysis in the treatment of CRPS as a rare complication of arterial angiography.
-
Endoscopic endonasal skull base surgery has become widely accepted in neurosurgery and otolaryngology over the last 15 years. However, there has yet to be a formal curation of the most impactful articles for an introductory curriculum to its technical evolution. ⋯ Identification of the most cited works within endoscopic endonasal skull base surgery shows greater anatomic access and safety over the last 2 decades. These articles can serve as an educational tool for novices or midlevel practitioners wishing to obtain a greater understanding of the field.
-
Nontraumatic subdural hematoma (NTSDH) is a common neurosurgical disease process, with mortality reported as high as 13%. Seizure has a known association with NTSDH, although patient outcomes have not previously been well studied in this population. The purpose of this study was to examine the relationship between in-hospital seizure and inpatient outcomes in NTSDH. ⋯ Seizure in patients with NTSDH correlates with significantly increased total LOS and increased mortality. Direct costs are similarly increased. Further studies accounting for effects of illness severity are necessary to validate these results.