World Neurosurg
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Review Case Reports
Split-Pons Syndrome by Epidermoid Cyst: A Case Report and Review of the Literature.
Epidermoid cysts are slow-growing extra-axial lesions that account for approximately 1% of all brain tumors. They rarely occur in the brain stem, and those possessing both intra-axial as well as extra-axial components represent an even smaller subset. ⋯ To the best of our knowledge, there are only 8 other cases of brainstem epidermoid lesions reported in the literature that are presumed to have originated extrinsically and thereafter transgressed the pons. However, we are the first to provide radiographic documentation confirming the progression of the lesions from extra-axial to intraparenchymal. Furthermore, although clinically subtle, we have decided to coin the term "split-pons syndrome" to better define this radiologic entity. Based on the evolution of the epidermoid's growth pattern, the authors propose a delayed posterior approach (telo-velo-tonsillar) to minimize morbidity.
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In the present study, we sought to evaluate the timing and outcomes in patients with hemorrhagic stroke who received tracheostomy. ⋯ In our cohort, early tracheostomy in patients with hemorrhagic stroke may help reduce hospital stays and hospital costs, but not in-hospital mortality. Future prospective multicenter studies are warranted to validate these findings.
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Meta Analysis
Single vs. double burr hole craniostomy in surgical treatment of chronic subdural hematoma: A meta-analysis.
Chronic subdural hematoma (cSDH) is one of the most common illnesses seen in neurosurgery departments worldwide. For surgical treatment, some neurosurgeons prefer single burr hole craniostomy (SBHC), whereas others prefer double burr hole craniostomy (DBHC). We performed a meta-analysis to investigate whether DBHC is associated with increased risks of recurrence, complications and mortality compared with SBHC in patients with cSDH. ⋯ This meta-analysis demonstrates that there are no significant differences in recurrence rate, complication rate, and morbidity between SBHC and DBHC in the treatment of patients with cSDH.
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Traumatic brain injury (TBI) refers to any insult to the brain resulting in primary (direct) and secondary (indirect) damage to the brain parenchyma. Secondary damage is often linked to the molecular mechanisms that occur post TBI and result in excitotoxicity, neuroinflammation and cytokine damage, oxidative damage, and eventual cell death as prominent mechanisms of cell damage. ⋯ We also mention the long-term sequelae and their pathophysiology in relation to TBI focusing on Parkinson disease, Alzheimer disease, epilepsy, and chronic traumatic encephalopathy. Understanding of the molecular mechanisms is important in order to realize the secondary and long-term sequelae that follow primary TBI and to devise targeted therapy for quick recovery accordingly.
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Lumbar fusions are routinely performed by either orthopedic or neurologic spine surgeons. Controversy still exists as to whether a provider's specialty (orthopedic vs. neurosurgery) influences outcomes. ⋯ It seems that a provider's specialty does not largely influence 90-day surgical outcomes and costs after elective PLFs. The results of the study promote the formation and acceptance of dual training pathways for entry into spine surgery.