World Neurosurg
-
Increasing experience with intraventricular neuroendoscopic procedures shows good results in the combination of endoscopic third ventriculostomy (ETV) and tumor biopsy. Other possible combinations are mainly presented in subgroups in the literature. Here, we present our experience with combined intraventricular procedures within 1 setting over the last 2 decades. ⋯ A combination of different intraventricular endoscopic procedures is safe and reliable, bearing similar risks of morbidities and mortality to single neuroendoscopic procedures. This study is one of the largest series in the literature and has similar low complication rates to others. Fornix contusion is the most frequent intraoperative complication in these patients. However, obvious clinical correlation is rare.
-
Spinal cord transection is a radical but effective treatment for highly selective cases of symptomatic spinal retethering in paraplegic spina bifida patients. Autonomic dysreflexia (AD) is a potentially life-threatening syndrome involving a dysregulated sympathetic discharge reflex commonly seen following cervical and high thoracic spinal cord injury, leading to a disconnect between autonomic pathways above and below the lesion that can lead to severe complications including uncontrolled hypertension, bradycardia, stroke, and potentially death. Herein we present a case in which a paraplegic spina bifida patient presenting with symptomatic spinal retethering experienced autonomic dysreflexia following an elective spinal cord transection. ⋯ This case highlights a potential major side effect from elective transection of the spinal cord. If unrecognized and untreated, AD can cause significant distress and morbidity. We hope this first case report serves to supplement existing data and aid in future surgical and medical decision-making.
-
The authors describe a modified technique for placement of the C1 lateral mass screw using a Steinmann pin as a guide. This technique minimizes dissection and provides atlantoaxial stabilization during arthrodesis. ⋯ The use of Steinmann pins to guide the placement of C1 lateral mass screws is safe and effective in C1-2 arthrodesis. Limiting dissection minimizes blood loss and injury, maintains efficient operative time, and assists in accurate placement of the screws. Furthermore, with less manipulation and retraction of the C2 nerve root, postoperative occipital neuralgia and the need for C2 root transection are avoided.
-
There is a significant burden of unmet surgical need in many low- and middle-income countries (>80% in parts of Africa). This need is even larger for specialties such as neurosurgery. Surgical capacity tools have been developed and used to assess needs and plan for resource allocation. This study piloted a new tool to assess neurosurgical capacity and describes its use. ⋯ NeuroPIPES survey scores were in keeping with the number of neurosurgeons and respective caseloads of each hospital. However, the variation in scores between respondents at the same hospital suggests that adaptations could be made to the tool that may improve reliability and validity. The methodology used to create NeuroPIPES may be successfully applied to a variety of other surgical subspecialties for similar assessments.
-
Glioblastoma is the most frequent primary brain tumor and despite of complete treatment survival is still poor. The aim of this study is to define the utility of reoperation for improving survival in patients with recurrent glioblastoma, and determine other prognostic factors associated with longer survival. ⋯ Reoperation and the extent of resection (EOR) are the only surgical variables that neurosurgeons can modify to improve survival in our patients. Higher EOR and reoperation rates in patients who can be candidates for second surgery, will increase OS and PFS.