World Neurosurg
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The role of isoprostanes in cerebral vasospasm (CVS) following aneurysmal subarachnoid hemorrhage (aSAH) is controversial. Recent studies have suggested that the level of isoprostanes in cerebrospinal fluid could play a role in outcomes of patients with aSAH. We measured concentration of urinary F2-isoprostanes (F2-IsoPs), which is simple and noninvasive. ⋯ Urinary F2-IsoPs may be used as a noninvasive prognostic biochemical marker in patients with aSAH. F2-IsoP levels in urine may have significant implications in pathogenesis of CVS.
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The aim of this international survey was to investigate the current management of patients undergoing surgery for chronic subdural hematoma (cSDH) treated with low-dose acetylsalicylic acid (ASA). ⋯ Most neurosurgeons discontinue ASA treatment for at least 7 days in the perioperative period of surgical evacuation of cSDH, even though recent studies show that early ASA resumption might be safe. Thrombosis prophylaxis is administered by only 60%, even though patients with cSDH are at high risk of developing thromboembolic complications. Better evidence and guidelines are warranted because the incidence of patients with cSDH under the treatment of ASA is increasing.
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Deep bypass surgery remains a challenging operative procedure. For novice trainees, there is a high barrier to improving the microsurgical skills needed for this procedure because of the relatively low number of cases and the high cost of microsurgical instruments. Here, the authors introduce a training model that includes highly accessible devices and does not require a microscope. ⋯ Our training system will be helpful, especially for deep bypass surgery, since training with similar muscle effort and fatigue can improve surgical skills. This system is economic, highly accessible, and available even for portable training.
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Opinions vary regarding optimal treatment of unstable hangman's fractures, including rigid orthosis and internal fixation. The anatomy of upper cervical spine is complex. The advent of intraoperative 3-dimensional navigation systems facilitates safe and accurate instrumentation. ⋯ Intraoperative O-arm-based navigation is a safe, accurate, and effective tool for screw placement in patients with unstable hangman fracture and achieves good anatomical reduction.
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Subependymomas are infrequent, low-grade gliomas associated with the ventricular system and the spinal cord. Little is known about the origin and natural history of these slow-growing lesions. ⋯ Subependymomas demonstrate mixed populations of cells expressing glial lineage markers as well as putative stem cell markers, suggesting these tumors may arise from multipotent glial progenitors that reside in the subventricular zone. Definitive diagnosis requires surgical sampling. Although the clinical course of subependymomas appears benign, the inability to radiographically diagnose these lesions, and the possibility of an alternative malignant lesion support a low threshold for early and safe maximal resection.