World Neurosurg
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Multicenter Study Observational Study
High serum sCD40L during the first week of malignant middle cerebral artery infarction and mortality.
Higher circulating soluble cluster of differentiation 40 ligand (sCD40L) levels at admission of an ischemic stroke have been found in nonsurvivor than in survivor patients. The objectives of this study were to determine whether serum sCD40L levels during the first week of a severe malignant middle cerebral artery infarction (MMCAI) are higher in nonsurvivor than in survivor patients and whether they could be used as biomarker of mortality prediction. ⋯ The findings that nonsurvivors showed higher serum sCD40L levels during the first week of MMCAI than did survivors and that serum sCD40L levels during the first week of MMCAI could be used as a mortality predictor biomarker are 2 novel findings.
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Case Reports
Sudden onset of paraparesis caused by an hemorrhagic thoracic synovial cyst. Case report.
Hemorrhage is a rare presentation of spinal synovial cysts, which are usually located in the lumbar spine. They may cause an epidural hematoma and compression of the cauda equina. Infrequently, they may be located in the thoracic spine. ⋯ This report describes a unique case of hemorrhagic synovial cyst at the mid-thoracic spine. These lesions are rarely located in the cervico-thoracic spine but should be included in the differential diagnosis of myelopathy.
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To compare the cervical sagittal balance and surgical outcomes between anterior cervical discectomy and fusion (ACDF) and hybrid decompression and fusion (HDF; 1-level corpectomy combined with 1-level discectomy) for consecutive 3-level cervical spondylotic myelopathy (CSM). ⋯ Both ACDF and HDF were safe and effective for the treatment of 3-level CSM. ACDF showed superiority to HDF in terms of less blood loss, shorter operation time, and better postoperative sagittal balance.
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To explain why some chronic subdural hematomas (CSDHs) grow and/or resorb, a physically decreasing outer membrane (OM) surface area (SA) to CSDH volume (V) ratio has been reexplored, and a critical CSDH size inferred (OM SA ≈ V). Gardner showed that since CSDH protein exceeded cerebrospinal fluid (CSF) protein, CSF→CSDH osmosis occurred across a semipermeable inner membrane (n = 1). By contrast, Zollinger and Gross demonstrated that serum→CSDH osmosis could also occur across the OM (n = 1). Notably, Weir refuted Zollinger and Gross by finding equal CSDH and serum total protein (n = 20); however, Weir did not refute Gardner. Although all extant mechanisms, especially rehemorrhages, explain CSDH growth, only OM SA ≥ V simultaneously permits resorption. We aimed to reevaluate the osmotic hypothesis. ⋯ Only crystalloids equilibrated. CSDH colloids were significantly decreased. CSDH dilution or colloidal flocculation is implied. CSDH dilution (by CSF→CSDH inner membrane [IM] osmosis or OM transudation/exudation) could favor CSDH growth, as would repeated OM hemorrhages. Contrariwise, isolated colloidal flocculation could favor CSDH shrinkage by OM CSDH→serum osmosis. The latter may result in OM SA ≥ V favorable for ultimate resolution. Our results refute Weir and Zollinger and Gross, but not Gardner. Osmotic gradients simultaneously exist for both CSDH growth and resorption. Each equilibrium could depend on each gradient relative to each IM/OM semipermeability.
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Case Reports
Linac-based fractionated stereotactic radiotherapy with a micro-multileaf collimator for brainstem metastasis.
To assess the neuroimaging and clinical outcomes in patients with brainstem metastasis (BSM) treated with linac-based fractionated stereotactic radiotherapy (fSRT) with a micro-multileaf collimator. ⋯ Linac-based fSRT with a micro-multileaf collimator delivered in the doses of 24-40 Gy in 7-13 fractions is a safe and effective local therapy for patients with BSM.