World Neurosurg
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Surgery for syringomyelia generally aims to treat the underlying cause, if it is known. Optimal management is unclear for idiopathic syringomyelia, or when treatment of the putative cause has failed or is high risk. Syrinx to subarachnoid shunting is an option for these cases; a series is reported to assess the outcomes of this approach. ⋯ Syrinx to subarachnoid shunting is a safe and effective treatment for idiopathic syringomyelia and for patients who are not suitable for, or have not responded to, other treatment.
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Cavernous hemangioma (CH) of the bone is a rare, benign neoplasm found usually in the vertebral body. This tumor rarely develops in the calvaria, with predilection to occur in the frontal and temporoparietal bones. ⋯ This is the second reported case of calvarial CH with complete erosion of the dural plane and extension into subdural space. Although surgical resection is generally safe and easy, the possibility of dural invasion should be kept in mind for safe resection of calvarial CH, especially overlying the eloquent brain area.
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Observational Study
Adult patients with pneumococcal meningitis at a neurosurgical neurological center. Different predisposing conditions?
In previous studies of pneumococcal meningitis in adults within general hospitals or national cohorts, the most common predisposing conditions were otitis media, sinusitis, pneumonia, immunosuppression, alcoholism, and diabetes. The epidemiology of pneumococcal meningitis is changing because of the use of vaccines in childhood, and antibiotic resistance has increased. ⋯ We conclude that patients with pneumococcal meningitis treated at neurosurgical neurologic centers have different predisposing conditions with severe disease and high mortality, thus prompting us to recommend aggressive pneumococcal vaccination in patients with CSF leaks and severe head trauma. Prospective studies to identify which neurosurgical patients may benefit in the long term from a pneumococcal vaccine are urgently needed.
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Perhaps the most disabling condition seen in patients with spinal cord injury (SCI) is spasticity. Spasticity is characterized as hyperreflexia and hypertonicity as a result of damage to the supraspinal tracts in the aftermath of SCI. Intrathecal baclofen (ITB) is the mainstay therapy for spasticity unresponsive to oral baclofen. One of the problems associated with post-SCI spasticity unresponsive to ITB is the development of scar tissue that prevents the diffusion of baclofen in the desired spinal cord area. This case offers a unique strategy to deal with multilevel scar tissue. ⋯ After undergoing multilevel thoracic and lumbar laminectomies with subarachnoid-to-subarachnoid spinal shunt, the patient's spasticity was finally brought under control with adequate daily baclofen infusion. This case demonstrates a creative way to address ITB catheter failure before considering other measures, such as neuroablative procedures (e.g., rhizotomy, myelotomy). This case reinforces the recommendation that ablative procedures, which have far greater complications, should be reserved for patients who have failed medical or other nonablative therapies.
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Ossification of the posterior longitudinal ligament (OPLL) has a reported incidence of 1.9%-4.3%. Disease progression is associated with surgery, with most studies focusing on OPLL progression after laminoplasty. The continued range of motion following surgery is believed to place strain on adjacent levels, driving calcification of the ligament. We present a case of marked progression of OPLL at levels adjacent to a previous anterior cervical discectomy and fusion. ⋯ Our report demonstrates that OPLL progression, which is largely reported following laminoplasty, may similarly occur following anterior cervical discectomy and fusion and supports the concept of motion-related OPLL progression.