World Neurosurg
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Thromboembolic complications are serious adverse events associated with stenting of intracranial aneurysms. For the development of novel devices, currently no practical model exists to evaluate distal embolic events. The purpose of the current study was 2-fold: 1) assess the feasibility of a porcine carotid bifurcation model for in vivo testing of stent thrombogenicity and 2) compare the thrombogenicity of the Enterprise vascular reconstruction device versus the Pipeline embolization device (PED). ⋯ The swine carotid stent model allows in vivo analysis of device-related thrombogenicity and distal embolic event rates. Size reduction of the perfused rete mirabile indicates the presence of thromboembolic events. Both Enterprise and PED were associated with similar thrombogenicity in this experiment.
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Subaxial cervical spine injuries may be treated with either nonoperative stabilization or surgical fixation. The subaxial injury classification (SLIC) provides 1 method for suggesting the degree of necessity for surgery. In the current study, we examined if the SLIC score, or other preoperative metrics, can predict failure of nonoperative management. ⋯ Management of subaxial spine injuries is complex. In our cohort, SLIC scoring did not adequately predict odds of failure of nonoperative management. Time to evaluation, however, did. We created a modified SLIC score that significantly predicted failure of nonoperative management.
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Spinal arachnoid cysts (SACs) are uncommon lesions in the spinal canal. They are usually asymptomatic, but can occasionally cause mass effect leading to neurologic symptoms. They can be congenital or secondary to a variety of causes. They can produce a variety of neurologic symptoms including pain, weakness, sensory changes, incontinence, and more. Surgical intervention may be necessary when SACs cause symptomatic mass effect. ⋯ SACs are usually asymptomatic, but rarely cause mass effect and neurologic deficits requiring surgical intervention. Surgical intervention is tailored to the position of the cysts' dorsal or ventral locations. Pain and weakness are the most likely symptoms to improve, whereas sensory symptoms are least likely to improve.
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Spinal cord injury (SCI) is a devastating event often leading to poor neurologic outcomes. One of the most widely practiced treatments has been the administration of methylprednisolone. However, today its use has been called into question over concerns of efficacy and safety. The present study evaluated the changes in the practice of steroid administration in acute SCI among members of the National Spinal Society in Poland in comparison with the results of the survey conducted in 2013. ⋯ A significant decrease was observed in the number of surgeons using steroids in the acute SCI, similar to that reported in the literature. The critical appraisal of the existing clinical evidence, as well as the formulation of guidelines by professional organizations, exerted a profound impact on the practice pattern.
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An epidermoid cyst is a congenital benign tumor and is extremely rare at the presacral region. Only a few cases have been reported in the literature. ⋯ The diagnosis and surgical management of this case are discussed.