World Neurosurg
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Intracranial penetrating traumas (IPTs) are rarely encountered in neurosurgery practice. Here, we report the case of a patient with orbital and cranial trauma caused by an unexpected object. ⋯ IPTs have high morbidity and mortality rates. Early surgical intervention is often the first treatment option. Intracranial injury caused by a fishing sinker is an extremely rare low-energy intracranial penetrating trauma, and in the literature, this is the first reported case in which the patient survived.
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Trapped or isolated fourth ventricle is a known, late sequela after lateral ventricular shunt placement for hydrocephalus, particularly after infection or hemorrhage. It may cause brainstem compression and insidiously present with ataxia, dysarthria, and intracranial hypertension, further delaying diagnosis. There is no universally agreed on treatment algorithm, and options include open fenestration through a suboccipital craniotomy, fourth ventricle shunting, and minimally invasive options including endoscopic stenting and fenestration through a precoronal approach. ⋯ Magnetic resonance imaging (MRI) demonstrated complex, loculated hydrocephalus and a dilated fourth ventricle. Under electromagnetic navigation, we endoscopically fenestrated his fourth ventricle using a rarely described suboccipital, transaqueductal approach. He tolerated the procedure without complication and improved neurologically, although his follow-up MRI demonstrated no change in fourth ventricular dilation at 1 year. Although there was no decrease in size of the fourth ventricle on follow-up MRI, we describe an alternative, well-tolerated, suboccipital approach for the management of a trapped fourth ventricle. Fenestration of a web of tissue in the aqueduct of Sylvius provided long-term clinical improvement and may provide a rescue approach for patients who are not candidates for standard approaches.
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Arteriovenous malformations have a significant cumulative risk for hemorrhage. Treatment options include observation, microsurgical resection, stereotactic radiosurgery, embolization, and multimodal treatment. Treatment selection and timing are based on arteriovenous malformation (AVM) features including size, location in eloquent versus noneloquent parenchyma, pattern of venous drainage, surgical access, rupture status, and previous treatments. ⋯ Embolization in the treatment of AVMs is thus most commonly used as a preoperative or, occasionally, preradiosurgical adjunct. The concept of curative AVM embolization is an attractive one that has emerged within the past few decades, with increasing clinical evidence for its safety and efficacy in recent years. Obliteration rates for curative AVM embolization will be improved by innovation in endovascular techniques and technologies.
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The purpose of this study was to determine the number of cases needed to achieve the level of competence for percutaneous endoscopic lumbar diskectomy (PELD) via the bi-needle technique using the cumulative summation test for learning curve (LC-CUSUM). ⋯ The novel bi-needle technique is safe and effective for PELD with appropriate patients, and the learning curve is acceptable. A substantial learning period (50-54 cases) is needed before a spine surgeon can master the bi-needle technique.
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To review the surgical outcomes of the octogenarian population at a single institution after spinal traumatic injury. ⋯ Although the octogenarian population has increased risk for postoperative events after acute spinal injuries, surgical intervention may be worthwhile in the elderly population. Although direct surgical complication rates are not higher, medical risks are significantly higher after surgery.