World Neurosurg
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Case Reports
Distinctive Surgical Strategy for Removal of String of Beadlike Schwannomas of Cauda Equina.
Spinal schwannomas are the most common intradural extramedullary tumors. However, a string of beadlike schwannomas is rare. In some cases, the beadlike tumors might present a multiple segmental growing pattern, often located in the lumbar spinal canal and on 1 nerve fiber. Despite its benign nature, the resection of this string of beadlike tumors could be a challenge to neurosurgeons, especially when the tumors extend to a long distance. ⋯ In this case, we first reported a new surgical approach for the removal of a string of beadlike cauda equina schwannomas. We hypothesize that this procedure would be a potential addition to the present surgical methods under some circumstances.
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Spinal stabilization surgery is an integral part of the treatment of spinal metastatic disease. Bony fusion is the hallmark of spinal stabilization in non-oncology patients. Spinal oncology patients are unlikely to achieve bony fusion because of their overall prognosis and concurrent therapies. Stabilization surgery without fusion may be a reasonable approach for these patients. Literature evaluating the effectiveness of this approach is limited. The object of this study was to investigate the rate of instrumentation failure in patients undergoing posterior spinal instrumented stabilization without fusion for spinal metastatic disease. ⋯ Our experience suggests that instrumented spinal stabilization without fusion is an acceptable approach for patients with spinal metastatic disease.
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To evaluate whether subdural hematoma (SDH) volume and other radiologic factors predict deterioration of mental status in patients with acute traumatic SDH. ⋯ Among younger patients, an overall tendency for more rapid midline shift progression was observed in patients with relatively low SDH volumes compared with older patients. Older patients seem to tolerate larger hematoma volumes owing to brain atrophy compared with younger patients. When there is a midline shift, older patients seem to be more vulnerable to mental deterioration than younger patients.
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In the past, women in neurosurgery were deemed "less than a minority." Pioneering women entered neurosurgical residency programs alone, facing large obstacles to become surgical experts. Recent data suggest a stark increase in the number of women neurosurgical residents. As the field of neurosurgery attempts to increase numbers of women surgeons, it must also adjust workplace culture to embrace a new group of trainees. Here, we share an account of historical numbers, as well as evidence of a changing landscape within neurosurgery and suggestions of ways to modify workplace culture based on examples set in other career paths.
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Case Reports
Intractable Hiccups After Coil Embolization of Partially Thrombosed Posterior Inferior Cerebellar Artery Aneurysm.
Hiccups are defined as sudden-onset involuntary contractions of the diaphragm followed by immediate inspiration and laryngeal closure, and they are considered intractable if prolonged beyond 1 month. A reflux arc involving phrenic, vagal, and central midbrain modulation is likely responsible for hiccups. We herein report a case of intractable hiccups caused by compression of the dorsal aspect of the medulla oblongata after treatment of a partially thrombosed distal posterior inferior cerebellar artery (PICA) aneurysm. ⋯ In this case, the precise location of the culprit lesion causing the patient's hiccups was the dorsal medulla oblongata. Clinicians should be aware of the possibility of structural or functional disorders of the reflux arc in patients with intractable hiccups.