World Neurosurg
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Significant morbidity and mortality is associated with surgical evacuation of acute subdural hematomas (ASDHs) in the elderly population. The literature remains mixed on risk factors associated with poor outcomes, specifically preoperative antithrombotic usage and postoperative seizures. ⋯ A high percentage of morbidity and mortality remains in the management of ASDHs in the elderly population; however, a significant percentage (27%) can still go on to have a favorable outcome.
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Optimal transfusion thresholds have been extensively studied for various surgical procedures; however, no transfusion threshold has been set for patients undergoing complex spine surgery. The aim of this study was to compare postoperative outcomes relative to perioperative hemoglobin (Hb) levels for patients undergoing complex spine surgery for adult spinal deformity and to evaluate impact of blood transfusion timing on clinical outcomes. ⋯ In patients with adult spinal deformity undergoing complex spine surgery, earlier targeted blood transfusions during surgery, rather than in the postoperative period, may lead to improved postoperative outcomes.
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Migration of distal ventriculoperitoneal (VP) shunt catheter into another body part has been described as a potentially serious surgical complication. We present the first case of sepsis caused by transcardial and pulmonary migration of a distal catheter into the heart and pulmonary artery, which was subsequently colonized by Klebsiella pneumoniae. ⋯ Migration of a distal VP shunt catheter into the heart should be considered in patients with a previously placed VP shunt presenting with cardiopulmonary problems, arrhythmia, and/or fever. Neurosurgeons should be involved as soon as possible, and a multidisciplinary approach is warranted.
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Spinal surgery is a procedure that causes intense and severe pain in the postoperative period. Erector spinae plane (ESP) block can target the dorsal-ventral rami of thoracolumbar nerves, but its effect on lumbar surgery is unclear. The aim of this study was to investigate the effect of the ESP block on postoperative opioid consumption and pain scores in patients undergoing spinal surgery. ⋯ ESP block can be used in multimodal analgesia practice to reduce opioid consumption and relieve acute postoperative pain in patients undergoing open lumbar decompression surgery.
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The objective of this study was to evaluate the association between asymptomatic unruptured intracranial aneurysms (IAs) and pituitary adenomas (PAs) in Chinese people. ⋯ The patients with PA have an increased incidence of IA compared with age-matched control subjects. Older age and cavernous sinus invasion might be correlated with the increased prevalence of IAs in Chinese patients with PA.