World Neurosurg
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Case Reports
Spontaneously resolving symptomatic subdural hygromas after cerebellopontine angle tumor surgery.
Subdural hygroma is a rare disease most commonly encountered in posttraumatic patients. Even more rarely, it has been described as a complication of cerebellopontine angle tumor requiring surgical evacuation. ⋯ These 2 cases highlight the 2 principal pathogenesis theories for the development of subdural hygromas (arachnoid tear and effusion) and suggest a theory for their sudden and spontaneous resolution: the pressure equilibrium opening the valve created by the arachnoid tear. Eventhough surgical treatment remains the recommended attitude, these cases show that conservative treatment can be an option in some cases.
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No true reference values for intracranial pressure (ICP) in humans exist; current values are estimated from measurements in adults who undergo treatment in order to correct ICP. We report ICP values in a "pseudonormal" group of children and adults to examine if age affects ICP. ⋯ We found similar differences in daytime and nighttime ICP between children and adults with no ICP-related disease. ICP seems to decrease with age across all ages. This has implications for therapeutic interventions (e.g., shunt valve selection or resistance in external ventricular drainage).
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Severe traumatic brain injury (sTBI) is a significant global health problem disproportionately affecting low- and middle-income countries (LMICs). Management of intracranial hypertension in sTBI is crucial to survival and optimal recovery. Practitioners in high-income countries routinely use intracranial pressure (ICP) monitors although their usefulness has been questioned. ICP monitors are usually unavailable in LMICs. No consensus-based/tested protocols or literature exists for sTBI treatment without ICP monitoring. ⋯ We derived consensus-based guidelines for sTBI treatment without ICP monitoring, and introduced a research method to a large multidisciplinary group of LMIC clinicians naive to such methods.
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Case Reports
Symptomatic Vasospasms as a life-threatening complication after transsphenoidal surgery.
To identify symptomatic vasospasms as a rare complication after transsphenoidal surgery, with emphasis on management and outcomes. ⋯ Although a rare complication, vasospasms after transsphenoidal surgery can lead to severe and multilocular ischemic infarctions with a wide variety of neurologic impairments. This rare complication should be considered in patients with unexpected postoperative neurologic deficits. Computed tomography (CT)/magnetic resonance imaging and (contrast-enhanced) CT/magnetic resonance angiography are appropriate diagnostic tools. Treatment of vasospasms, including the option of intra-arterial spasmolysis, should not be delayed.
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The aim of this study is to determine whether preoperative scores on a screening measure for cognitive status (the Saint Louis University mental status examination), were associated with discharge to a location other than home in older patients undergoing surgery for deformity. ⋯ In geriatric patients undergoing surgery for deformity correction, cognitive screening before surgery can identify patients with impaired cognitive status who are less likely than those with normal cognitive status to return home after surgery.