World Neurosurg
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Case Reports
Delayed brainstem hemorrhage secondary to mild traumatic head injury: report of a case with good recovery.
In clinical practice, secondary traumatic brainstem hemorrhage often develops during descending transtentorial herniation due to raised intracranial pressure, which is known as Duret hemorrhage. Although usually considered a fatal and irreversible event, in rare circumstances, victims of Duret hemorrhage could gain favorable outcomes. To our knowledge, secondary brainstem hemorrhage due to mild traumatic head injury without descending transtentorial herniation has never been reported. In this report, we present a case of delayed brainstem hemorrhage secondary to a relatively mild traumatic brain injury that experienced a rapid and favorable recovery. ⋯ We present a rare case of secondary traumatic brainstem hemorrhage that experienced a rapid and good recovery process. The mechanism is still obscure to us and needs to be further studied. Although traumatic brainstem hemorrhage usually means a fatal event to most of the patients, some patients may experience a favorable recovery. This rare circumstance should be stressed in prognosis consultation and clinical management of these kinds of patients.
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Although a significant amount of experience has accumulated for awake procedures for brain tumor, epilepsy, and carotid surgery, its utility for intracranial neurovascular indications remains largely undefined. Awake surgery for select neurovascular cases offers the advantage of precise brain mapping and robust neurologic monitoring during surgery for lesions in eloquent areas, avoidance of potential hemodynamic instability, and possible faster recovery. It also opens the window for perilesional epileptogenic tissue resection with potentially less risk for iatrogenic injury. ⋯ Awake surgery appears to be safe for select patients with intracranial neurovascular pathologies. Potential advantages include greater safety, shorter length of stay, and reduced cost.
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Previous studies have suggested that postoperative hypopituitarism in patients with nonsellar intracranial tumors is caused by traumatic surgery. However, with development of minimally invasive and precise neurosurgical techniques, the degree of injury to brain tissue has been reduced significantly, especially for parenchymal tumors. Therefore, understanding preexisting hypopituitarism and related risk factors can improve perioperative management for patients with nonsellar intracranial tumors. ⋯ Prevalence of hypopituitarism is high in patients with nonsellar intracranial tumors. The occurrence of hypopituitarism is correlated with factors including an acute or subacute course (≤3 months), intracranial hypertension (ICP >200 mm H2O), and mass effect (P < 0.05). Mass effect is an independent risk factor for hypopituitarism.
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Prefabricated customized cranioplasty implants are anatomically more accurate than manually shaped acrylic implants but remain costly. The authors describe a new cost-effective technique of producing customized polymethylmethacrylate (PMMA) cranioplasty implants with the use of prefabricated 3-dimensional (3D) printed molds. ⋯ Making customized PMMA cranioplasty implants via 3D printed polylactic acid molds is a cost-effective technique for delayed reconstruction of various cranial defects.
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To investigate the effects of surgeon volume on inpatient morbidity after 1- and 2-level anterior cervical discectomy and fusion (ACDF). ⋯ In this study, increasing surgeon volume was independently associated with significantly lower odds of perioperative complications following 1- and 2-level ACDF. Performing 4 or more procedures per month was associated with the lowest complication rate.