World Neurosurg
-
The diagnosis and timely treatment of shunt infections (SI) in children is of paramount importance. In some cases, the standard cerebrospinal fluid (CSF) variables will not be sufficient for an accurate diagnosis of SI. CSF lactate (LCSF) has been found to assist in differentiating bacterial from nonbacterial meningitis in non-neurosurgical patients. To the best of our knowledge, the use of lactate in diagnosing or confirming the presence of SI has not yet been discussed. The goal of the present study was to describe the role of LCSF levels in children with shunts and Ommaya reservoirs and to evaluate its role in the accurate diagnosis of shunt-related infection. ⋯ LCSF levels can be used as an additional chemical marker for the diagnosis and confirmation of SIs. An LCSF value of <2.95 mmol/L had a high negative predictive value.
-
The benefits of minimally invasive spine surgery are attainable only if hospitals have the financial resources to acquire essential equipment. We present a surgical approach readily available to countries where unacceptably expensive materials are the main limitation for use of minimally invasive spine surgery. ⋯ This is a safe and feasible technique with excellent results obtained at low cost and is becoming an attractive surgical option in developing countries.
-
To characterize the intratumoral immune microenvironment and evaluate its clinical implications in patients with primary axial osteosarcoma. ⋯ Our results suggested that the immune microenvironment is of clinically relevant significance in patients with axial osteosarcoma. Specifically, we identified both PD-L1+ TILs and CD8+ TILs as independent favorable prognostic markers.
-
The concept of enhanced recovery after surgery (ERAS) spread to different surgical specialties to minimize surgical stress response and to reduce length of hospital stay (LOS) and cost. Recently, several studies have reported experience with the ERAS program for spine surgery. The aim of this study is to introduce the establishment and implementation of the ERAS pathway for minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF). ⋯ Our ERAS program tailored for MIS-TLIF is able to reduce LOS and cost with minimal complications. The ERAS pathway expedites recovery in patients undergoing lumbar spine fusion.
-
Cranioplasty (CP) is an obligatory surgery after decompressive craniectomy (DC). The primary objective is to protect the brain from external injury and prevent syndrome of trephined. In a government hospital, such cases pose a significant burden to a trauma center. Because of this reason, cosmetic outcome is never taken into account for the CP. We present results of CP performed at our hospital. ⋯ The cosmetic outcome is overlooked for CP. The bone flap fixation has to be rigid for a good outcome.