World Neurosurg
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Because of a lack of markers for predicting prognosis and an underlying mechanism, patients with primary brainstem hemorrhage (PBH) are currently treated with multiple strategies, but most of them have poor outcomes in a comparison with patients with supratentorial intracranial hemorrhage. Recently, it has been reported that the neutrophil-to-lymphocyte ratio (NLR) represents a novel composite inflammatory marker to predict the prognosis of patients with intracranial hemorrhage, a majority of whom have supratentorial hemorrhage. In this report, we aim to assess the potential predictive value of NLR in patients with PBH. In addition, other available laboratory parameters, including platelet-to-lymphocyte ratio (PLR), and admission blood glucose level (ABG), will be also investigated as markers for prognosis in patients with PBH. ⋯ NLR, PLR, and ABG can be used to independently predict 90-day functional outcome in patients after PBH. When combined, they have better predictive power in identifying PBH patients with a poor prognosis. To our knowledge, this study is the first to reveal the associations between NLR, PLR, and hyperglycemia and the functional outcomes of patient with PBH. In associating with previously studies on hemorrhage site, our results provide a good opportunity to elucidate the underlying mechanisms of PBH.
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Intracranial dermoid cysts are benign embryologic tumors. They occur most often in children and young adults. Infected intradural dermoid cyst with complete dermal sinus of posterior fossa is rare. The main feature of this dermal sinus is the continuity from the intradural cyst through the occipital bone to the skin. ⋯ Infected intradural dermoid cyst with complete dermal sinus of posterior fossa is rare, and a double dermal sinus has not yet published, to our knowledge.
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Dermoid cysts are rare tumors usually seen in the midline structure of the brain but rarely arise in the petrous apex and cavernous sinus. There have been very few reports of dermoid cysts arising in the infratemporal fossa, with scarce anatomic descriptions. Here we report the case of a patient with a dermoid cyst in the left infratemporal fossa. ⋯ Dermoid cysts in the infratemporal fossa are extremely rare. However, tumor resections can be performed safely and efficaciously using anatomically detailed preoperative planning.
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Case Reports
Straight Fenestrated Clips in Surgical Management of Internal Carotid Artery Aneurysms: Technical Note.
Using angled fenestrated clips for posteromedially projecting internal carotid artery (ICA) aneurysms may allow the surgeon to simultaneously obliterate the aneurysmal neck and preserve the branching artery by applying the blade of the clip parallel to the ICA. However, using these clips when the aneurysm neck involves the branching artery may have a risk of branching artery stenosis, occlusion, or incomplete obliteration of the aneurysm. ⋯ When using angled fenestrated clips is unsuitable because of a risk of branching artery stenosis, occlusion, or incomplete obliteration of the aneurysm, using multiple straight fenestrated clips may be a useful alternative.
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Ventriculostomy-associated cerebrospinal fluid infection (VAI) is a major complication limiting the use of an external ventricular drain (EVD) in treating patients with intraventricular hemorrhage (IVH). Risk factors of VAI are still under wide discussion. ⋯ Patients with a high mGS are vulnerable to VAI. Bilateral EVD may be an appropriate treatment option for patients with a high mGS, but might increase the risk of infection in those with a low mGS.