World Neurosurg
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To study factors influencing oro-facial herpetic eruptions (HEs) in patients undergoing retromastoid suboccipital craniectomy for vestibular schwannomas (VS). ⋯ The study highlights the relatively high incidence and factors associated with this rare but benign complication.
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Microvascular decompression (MVD) of the facial nerve monitored intraoperatively by abnormal muscle response (AMR) activity is a common treatment for hemifacial spasm. AMR frequently persists after MVD, however, for which electromyography (EMG)-guided nerve combing sometimes is recommended. Because no research regarding the success of EMG-guided nerve combing has been published, we compared the effectiveness of nerve combing after MVD with simple MVD in cases including persistent AMR. ⋯ In cases of hemifacial spasm with persistent AMR after MVD, EMG-guided nerve combing significantly improved the success rate of the operation. Although it also significantly increased the incidence of postoperative facial palsy over the short term (up to 1 week), incidences in the long term were not significantly different.
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The medical literature still lacks information about the impact of surgery and adjuvant treatment on the life of patients with meningioma. The clinical outcome, timing of tumor recurrence, and causes of death are often overlooked. This study evaluates these data taking into account tumor localization and histologic grade. ⋯ Histologic grade is the most important factor for long-term survival. Complete resection has to be pursued in GII and GIII meningioma but must be carefully weighed against morbidities in GI meningioma.
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To evaluate the association of perioperative hemoglobin A1c (HbA1c) level in patients with diabetes with the incidence of infection after anterior cervical discectomy and fusion requiring operative intervention, in addition to determining if a threshold level of HbA1c above which the risk of infection increases significantly exists. ⋯ The risk of deep postoperative infection in patients with diabetes mellitus increases as the perioperative HbA1c level increases. ROC analysis determined that a perioperative HbA1c level higher than 7.5 mg/dL could serve as a threshold for a significantly increased risk of infection.
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In cases of severe traumatic brain injury, cerebrospinal fluid (CSF) diversion though an external ventricular drain (EVD) is a proven method to assist in the control of elevated intracranial pressure. Under normal circumstances, the EVD is placed in a frontal location. However, in cases of multifocal intracranial injury and swelling, collapse of the frontal horns of the lateral ventricles leads to frequent failure of frontal CSF drainage. In this series we describe the utility of the Keen's point EVD as a safe alternative to maintain continuous CSF diversion for patients in whom frontal drainage is not feasible. ⋯ In all cases, we were able to reliably maintain continuous CSF diversion for an extended period of time. There was 1 mortality due to the severity of initial injuries. In the remaining 2 patients, intracranial pressure was able to be normalized following placement of the Keen point EVD. The Keen point EVD is a viable option to maintain continuous CSF drainage in patients with diffuse intracranial injury and should be considered in patients whom a frontal EVD cannot reliably maintain continuous drainage of CSF.