World Neurosurg
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Resection of epidural thoracic spine tumors is uniquely challenging owing to the dangers posed by the surrounding anatomy and the unforgiving nature of the thoracic spinal cord. We assessed the preoperative and postoperative risk factors for 30-day morbidity and mortality in patients undergoing resection of these tumors. ⋯ Excision of epidural thoracic spinal tumors carries a high complication rate. The present series has revealed distinct preoperative and postoperative factors that contribute to 30-day morbidity and mortality for tumors in this region, many of which are amenable to careful preoperative management.
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Sex has been known to significantly affect postoperative complications and length of stay after elective anterior cervical fusions. Current evidence on lumbar spine surgery is limited. ⋯ Contrary to literature on cervical fusions, we found that female sex was independently tied to an increased risk of adverse outcomes after elective posterior lumbar fusion. The results from the study suggest that women may benefit from close surveillance during the postoperative period to minimize risk of complications and subsequent resource utilization in this group.
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Epidermoid cysts within the sylvian fissure are extremely rare. Expressive aphasia and neurocognitive dysfunction because of mass effect have never been reported previously. ⋯ Although rare, epidermoid cysts of the dominant sylvian fissure can present with progressive aphasia due to mass effect on the arcuate fasciculus. Despite the long-standing symptoms, surgical resection can lead to their complete resolution.
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Meningiomas frequently occur in elderly patients, and surgical treatment is hazardous owing to multiple comorbidities. We report a series of elderly patients who were treated with surgical removal of meningiomas and compare them with a group of younger patients with similar tumors. ⋯ Elderly patients with symptomatic skull base meningiomas should be considered for surgical treatment owing to acceptable morbidity and mortality compared with younger patients. Previous comorbidities and involvement of neurovascular structures are important factors in the decision regarding extent of surgical resection.
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Case Reports
Refracture of Kummell's disease combined with huge epidural hematoma after minor trauma: A Case Report.
Kummell disease is defined as avascular necrosis of vertebra, occurs after the delayed posttraumatic osteoporotic vertebral collapse, and mainly occurs in adults older than 50 years of age. We report the first case of refracture of Kummell disease and epidural hematoma followed by paraparesis. ⋯ Although rare, the possibility of refracture of Kummell disease and spinal epidural hematoma should be kept in mind in patients with osteoporotic fractures. Periodic follow-up and treatment are essential for preventing tragic neurologic impairment.