World Neurosurg
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Spontaneous spinal epidural hematoma (SSEH) is a rare neurosurgical emergency. It presents as acute spinal cord compression and usually requires surgical decompression. The patients who will benefit most from decompression surgery are unknown, and the factors associated with prognosis remain controversial. The purpose of our study was to identify the clinical features, treatments, and main factors related to the prognosis of SSEH. ⋯ SSEH is a rare but serious illness. It is more likely that SSEH arises from a ruptured internal vertebral venous plexus. The initial neurologic status is the determining factor influencing the treatment method and clinical outcome. The number of involved segments cannot be used to decide the treatment method or predict prognosis. Patients with shorter operative intervals appear to have better neurologic recovery.
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The outcome associated with the treatment of poor-grade aneurysmal subarachnoid hemorrhage is rather discouraging. Even then, some patients may survive; however, the long-term outcomes and the patterns of recovery of these survivors have not received much attention in the literature. ⋯ If operated at the earliest opportunity after admission, meaningful survival may be provided to a significant number of patients with poor-grade subarachnoid hemorrhage. The recovery process in the survivors is a dynamic process and considering the late improvements in some, it is advisable be follow them beyond the conventional end points.
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Large tumors of the skull base may require multiple approaches for safe removal, as unidirectional approaches may require excessive brain retraction. ⋯ Multidirectional approaches to large tumors can be considered less invasive if the surgical corridors are combined in a way to minimize traction forces on both brain and tumor and maximize visualization and protection of critical structures. These combination approaches can be made simpler with the seamless integration of the endoscope and microscope. The choice between the principal and auxiliary corridors should alternate just as smoothly as the visual modality and must be dictated by the anatomy and minute-to-minute tactical situation during the operation.
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To show the differences of metabolomic changes in a rat model of cauda equina injury (CEI) and find potent metabolic biomarkers of CEI. ⋯ Our results may improve the cause of CEI and provide a basis for clinical diagnosis and locating biomarkers in the early stages of the pathologic process of CEI.