World Neurosurg
-
Case Reports
Success and Failure of Percutaneous Minimally Invasive Direct Pars Repair: Analysis of Fracture Morphology.
Spondylolysis is a defect in the pars interarticularis that typically presents with axial back pain. Recently, minimally invasive spine techniques have increased in popularity and have been applied to the Buck technique of direct pars repair. ⋯ Minimally invasive direct pars repair can be performed safely and effectively with shortened hospital stays and reduced morbidity. Fracture morphology and orientation could be important predictors of the success of surgery.
-
Decompression alone is a treatment option in patients with lumbar spinal stenosis (LSS) and degenerative lumbar spondylolisthesis (DLS). This study aims to describe the procedure of percutaneous transforaminal endoscopic ventral decompression technique and to demonstrate the clinical outcomes. ⋯ Based on the initial short-term follow-up results, transforaminal endoscopic ventral decompression by partially removing the posterosuperior margin underneath the slipping vertebral body, combined with dorsal decompression, might be an efficient alternative treatment for leg dominant symptoms in patients with LSS and low-grade DLS.
-
Contrast-induced encephalopathy (CIE) is a rare and misdiagnosed complication of intravascular injection of contrast, responsible for arterial vasospasm and neurologic effects. Conventional radiologic findings are not in themselves specific for cerebral vasospasm diagnosis. We present a case in which arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) was useful in early diagnosis of CIE. ⋯ CIE should always be considered in patients with focal neurologic deficits after iodinate contrast exposure. ASL perfusion MRI with CBF maps could be a promising tool for prompt, early confirmation of underlying vasospasm, as cortical edema and distal vasospasm could not be detected on conventional radiologic imaging.
-
Endoscopy is now a staple of any neurosurgical practice. The versatility of this approach and gratifying results has resulted in its increased popularity. The objective of this paper is to report our experience of managing various cerebellopontine angle (CPA) pathologies by endoscopic keyhole retromastoid suboccipital craniectomy (RMSO) approach. ⋯ Endoscopic keyhole RMSO approach is minimally invasive and yields an excellent outcome in the management of various CPA lesions.
-
Variance between providers in neurosurgery can lead to inefficiencies and poor patient outcomes. Evidence-based guidelines (EBGs) have been developed; however, they have not been well implemented into the clinician workflow. Therefore, clinicians have been left to make decisions with incomplete information. Equally underused are the electronic health records (EHRs), which house enormous amounts of health data, but the power of that "big data" has failed to be capitalized on. ⋯ Variance reduction in neurosurgery through the integration of evidence-based decision support in EHRs will lead to improved patient safety, a reduction in medical errors, maximization of the use of the available data, and enhanced decision-making power for clinicians.