World Neurosurg
-
The purpose of this population-based case-control study was to evaluate analgesic use after subarachnoid hemorrhage (SAH) caused by rupture of a saccular intracranial aneurysm (sIA). ⋯ Our results indicate that patients with sIA-SAH had an increased risk for new pain after sIA-SAH as compared with that of matched control population.
-
Dissection of C2 guiding to the C1 lateral mass and facilitation of screw placement: Technical note.
Surgical intervention at the craniovertebral junction requires preoperative and intraoperative planning to get optimum postoperative results. Careful positioning minimizes the risk of iatrogenic injury and can also facilitate adequate surgical exposure. Tortuous venous channels that are usually encountered as the dissection proceeds may cause excessive bleeding before reaching the lateral mass (LM). However, both localization and placement may be made easier by altering the dissection technique and modifying the patient's position. Traditionally, the military tuck position is described for the dorsal approach to the craniovertebral junction. The objective of this study is to emphasize the role of arc or bow like position, a modification of prone position for adequate placement of C1 LM screw in these cases. ⋯ Visual axis to the lateral mass of C1 in an arc/bow position with head elevation puts C1 LM more in the visual axis of the operator, which makes the trajectory straight without causing much angulation while inserting the screw. At the same time, the axis vertebra guides the surgeon to the C1 lateral mass with no handling of dura.
-
Destruction of the spine is a huge complication of infectious spondylitis and surgical intervention is required. However, vertebral defect is a major problem after surgical intervention and numerous methods have been researched to solve this problem. There are known methods that use variously designed, patient-customized 3-dimensional (3D)-printed implants in various medical fields. The use of 3D-printed implants has also been attempted in treating defects in the spine. We present a case of failure of expandable titanium cage fusion after infection, treated using a 3D-printed implant. ⋯ A 3D-printed implant could be an acceptable and alternative treatment option for replacing a large vertebral defect.
-
To study whether and when mere dorsal decompression is enough in the full endoscopic key hole technique for foraminal stenosis. ⋯ Stenosis is mainly caused by dorsal structures; mere dorsal decompression is enough. In both cases, the ventral and dorsal structures contributed to the stenosis. When there is no herniated soft fragment contributing to the stenosis, ventral decompression is not always necessary. If intraoperative exploration detects less tension formed by the ventral abnormal structures, mere dorsal decompression is enough to settle the symptoms.
-
Recent advances in endoscopic surgery have led to more patients being able to undergo endoscopic removal of hypertensive intracerebral hemorrhage (HICH). However, because of the minimal invasiveness, endoscopic HICH removal through a narrow surgical window can result in a low removal rate. The goal of the present study was to investigate the factors that affect the removal rate of HICH evacuation. ⋯ To achieve a good removal rate, surgeons should have experience performing the endoscopic procedure. Also, patients with end-stage chronic renal failure or liver cirrhosis should be excluded.