World Neurosurg
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The use of an external ventricular drain is required for the treatment of many diseases, such as traumatic brain injury and subarachnoid hemorrhage (SAH). Meningitis and ventriculitis are frequent complications arising from the use of external ventricular drain therapy. This study aimed to determine the sensitivity, specificity, and cutoff point for cell index (CI) in patients with traumatic brain injury, SAH, and hemorrhagic stroke. ⋯ Therefore, CI is valuable for the diagnosis of infection, but was inadequate for monitoring treatment. We hope to use the new cutoff point proposed by this study in our institution to improve patient clinical outcome.
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Observational Study
Patient expectations and preferences in the spinal surgery clinic.
Managing patient expectations is essential in the treatment of patients undergoing spinal surgery. Patient satisfaction is associated with improved clinical outcomes and can be improved when patient and surgeon expectations are aligned and patient preferences are met. ⋯ Because spine surgery is largely elective, patients often seek treatment to improve quality of life and alleviate subjective symptoms. Understanding patient expectations is critical to ensure that patients and physicians are working toward similar goals.
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Case Reports
Clival defect with primary CSF rhinorrhea: a very rare presentation with challenging management.
Primary spontaneous cerebrospinal fluid (CSF) rhinorrhea due to clival defect is an extremely rare presentation, and only 6 cases have been reported in the literature so far17. ⋯ Timely endoscopic transnasal, transsphenoidal repair of CSF leaks is the gold standard practice and could prevent devastating complications including repeated episodes of meningitis.
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Case Reports
Microvascular decompression for trigeminal neuralgia using a novel fenestrated clip and tentorial flap technique.
Microvascular decompression (MVD) for neurovascular compression syndromes, such as trigeminal neuralgia and hemifacial spasm, has been traditionally described as an interposing technique using Teflon. Some alternative interposing materials have been proposed. In addition, transposing techniques have been increasingly reported as an alternative with a potentially lower recurrence rate and fewer complications. ⋯ We propose a novel technique for the treatment of trigeminal neuralgia, eliminating the need for padding the vessel with a foreign body. This technique can be applied successfully in selected cases of neurovascular compression syndromes.
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Traumatic brain injury (TBI) in older patients is becoming an increasing problem, and methods that help predict outcomes in this population are needed. The objective of this study was to evaluate skeletal muscle mass as a predictive marker for TBI outcome in older patients. ⋯ Reduced skeletal muscle mass was associated with poorer outcome after TBI in our cohort of older patients. Our results suggest that identifying patients with low muscularity may contribute to better stratification in this population.