World Neurosurg
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Quality of life is paramount in patients with advanced cancer and may be adversely affected by comorbid depression. We hypothesized that comorbid depression is associated with higher rates of postoperative complications, worse functional outcomes, and higher rates of readmission after craniotomy for resection of malignant intracranial tumors. ⋯ There is a clinically significant rate of comorbid MDD in patients with malignant intracranial tumors, and MDD is associated with worse perioperative outcomes. Given the wealth of behavioral and pharmaceutical therapies available, MDD is a modifiable risk factor in this cohort that clinicians should be vigilant in screening for and initiating appropriate treatment protocols.
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Managing unilateral vertically displaced sacral fractures remains a challenge. A triangular osteosynthesis (TOS), which involves fixing the fractured sacrum using unilateral spinopelvic fixation and a supplemental ilio-sacral screw, continues to gain popularity as it facilitates early mobilization and improves the long-term outcome. However, it has limitations, such as destruction of the L5-S1 joint, the need for additional removal surgery, and an increased risk of infection due to the large incision. An S1 pediculoiliac construct was proposed to overcome this limitations. Its use also has complications, however, including a painful hardware prominence due to the traditional iliac screw, excessive soft tissue retraction, and limited reduction capability. ⋯ For unilateral vertically unstable sacral fractures, TOS using S1 pedicle screws and S2AIS is safe and has the advantage such as maintaining mobility in the lumbar pelvic region, small size wounds, and reduced soft tissue damage, and it may have a potentially low infection rate. Further studies are needed to determine the specific indications and validate the effectiveness of this procedure.
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Debate still exists regarding whether preventive surgical decompression should be offered to high-risk patients experiencing cerebellar stroke. This study aimed to predict neurologic decline based on risk factors, volumetric analysis, and imaging characteristics. ⋯ Volumetric studies and CIS score are objective measures that may help predict decline on imaging before clinical deterioration.
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The temporal muscle (TM) needs to be dissected and reflected downward in some anterolateral cranial approaches, and failing to preserve its integrity could have severe functional and cosmetic consequences. Most articles focus on techniques to prevent vascular injury during retrograde dissection or techniques to preserve the facial nerve; however, information on how to take care of the muscle during hook retraction is limited. We presented an anatomic study of vascularization of the TM, and we established safe areas for muscular hook retraction. ⋯ We delimited 2 safe zones for hook placement during TM retraction aiming to avoid direct vascular damage in anterolateral cranial approaches.
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Case Reports
L1/2 intradural disc herniation with compression of the proximal cauda equina nerves: a surgical challenge.
Intradural disc herniation (IDH) in the upper lumbar spine is rare. Preoperative radiologic diagnosis can be difficult, making operative planning challenging. We report on a 74-year-old female patient who was diagnosed with an L1-L2 IDH intraoperatively. This case report aims to highlight and discuss the radiological features of IDH and operative challenges when approaching IDH. ⋯ Upper lumbar IDH represent a surgical challenge. Intraoperative considerations include identification of the disc, intentional or incidental durotomy, intradural discectomy, and anatomical restrictions of operating at the level proximal to the cauda equina.