World Neurosurg
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To investigate the impact of hospital teaching status on the timing of intervention and inpatient morbidity and mortality after surgery for acute spinal cord injury (SCI). ⋯ In this nationwide study, patients with vertebral column fractures with SCI who were admitted to teaching hospitals were more likely to receive early intervention compared to patients admitted to nonteaching hospitals. Future studies into the long-term implications of admission to teaching hospitals versus nonteaching hospitals for patients with SCI are encouraged.
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Endoscopic third ventriculostomy (ETV) is a safe and less-invasive treatment strategy for patients with obstructive hydrocephalus and provides excellent outcome. Nevertheless, repeat ETV in cases of ETV failure is a controversial issue. ⋯ Repeat ETV in cases of late ETV failures represents an excellent option for cerebrospinal fluid circulation restoration up to 14 years of follow-up. Repeat ETV in early ETV failure in contrast is not favored by the performing surgeons; and factors of ETV failure should be analyzed very carefully before a decision for repeat ETV is made.
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The aim of the study was to investigate the diagnostic potential of interleukin 6 (IL-6) and other soluble biomarkers in serum and cerebrospinal fluid (CSF) for early diagnosis of cerebral vasospasm (cVSSAH) and external ventricular drain-associated ventriculitis (VCSAH) and to separate these conditions from aneurysmal subarachnoid hemorrhage (aSAH) without further complication (SAHw/o/c). ⋯ CSFIL-6 is increased after aSAH in patients with cVSSAH or VCSAH. Patients with a CSFIL-6 level higher than a C-OFF of 3100 pg/mL have an increased likelihood for VCSAH; patients with CSFIL-6 levels between 530 and 3100 pg/mL have an increased posttest probability for cVSSAH.
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Case Reports
Ultrasonography detects ulnar nerve dislocation despite normal electrophysiology and magnetic resonance imaging.
Dislocation of the ulnar nerve (UN) occurs in a subset of patients with ulnar neuropathy. Electrodiagnostic and magnetic resonance imaging (MRI) studies are performed to support the clinical diagnosis. We report the case of a patient with ulnar neuropathy with normal electrodiagnostic and MRI studies but with ultrasonography (US) showing UN dislocation, which prompted successful treatment by UN submuscular transposition. ⋯ Normal findings on electrodiagnostic or MRI studies should not immediately dissuade surgeons from operating on a symptomatic patient with a clinical examination supporting ulnar neuropathy and with US evidence of UN dislocation, because such a patient may experience postoperative symptom relief. Furthermore, the dynamic capability of US imaging complements data obtained from electrodiagnostic and MRI studies, especially when these tests are normal, and it should be considered by clinicians when evaluating patients with medial elbow pain or signs of ulnar neuropathy.
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Case Reports
Bolstering the Nasoseptal Flap Using Sphenoid Sinus Fat Packing: A Technical Case Report.
Resection of extensive skull base lesions often necessitates relatively large dural openings and arachnoid, resulting in skull base defects with the potential for a postoperative cerebrospinal fluid leak. A nasoseptal flap (NSF) is a vascularized graft that has greatly diminished the incidence of cerebrospinal fluid leak. Annealing of flaps against the ventral skull base can be tenuous within the first few days after surgery. We report the use of sphenoid sinus fat packing as a buttress to support the nasoseptal flap during skull base reconstruction. ⋯ Sphenoid sinus fat packing can be an important technical adjunct in bolstering the nasoseptal flap against the ventral skull base in the tenuous early perioperative period.