World Neurosurg
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Review Case Reports
Diffuse Traumatic Sub Arachnoid Hemorrhage Mimicking Aneurysmal Bleeding Secondary to Ophthalmic Artery Avulsion: A Case Report and Literature Review.
Traumatic subarachnoid hemorrhage (SAH) is a common finding following traumatic brain injury. In some cases, it can be associated with hydrocephalus. This type of hemorrhage is mostly caused by the rupture of small vessels in the brain and is usually managed conservatively. ⋯ Traumatic avulsion of the ophthalmic artery may result in diffuse SAH, mimicking that of aneurysmal rupture. This case shows that management of early complications, such as hydrocephalus and seizures, should be the main aim. Surgical or endovascular treatment of the injured artery, however, would be unnecessary.
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Review Case Reports
Diagnosis, management, and clinical outcomes of tandem thoracic and lumbar stenosis: a systematic literature review and case series.
A scarcity of data has been reported on tandem thoracic lumbar stenosis, which might be related to either the rarity or underdiagnosis of the condition. We have presented a systematic review of the clinical presentation, diagnosis, and treatment patterns for patients with symptomatic tandem thoracic and lumbar stenosis. ⋯ Ossification of the ligamentum flavum might play a key role in the pathogenesis of the condition. Most patients with tandem thoracic and lumbar stenosis will show improvement after surgical decompression. Although the limited evidence available has raised concerns regarding neurologic deterioration after initial lumbar decompression in patients with coexisting thoracic stenosis, the data are insufficient to definitively determine an optimal surgical strategy. Further research is needed to identify the optimal diagnostic and management criteria for patients with symptomatic tandem thoracic and lumbar stenosis.
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Observational Study
One-year outcome after aneurysmal subarachnoid hemorrhage in elderly patients.
The number of elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) admitted to intensive care units (ICUs) has increased. We aimed to analyze the characteristics and outcomes of such patients in a tertiary university hospital during a 5-year period. ⋯ Half of elderly patients with aSAH admitted to a neuro-ICU were able to live at home after 12 months. Mortality was significant, but the number of severely disabled patients was low. Clinical status at admission was the strongest predictor of outcome, whereas intraventricular hemorrhage increased the risk of poor outcome as well. GCS motor score 3 days after admission seemed to predict mortality and outcome.
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Research output on global neurosurgery (GNS) has exponentially increased in recent years. As research efforts increase, we must first analyze how the current body of GNS literature fits into the macroscopic schema of systems-based policies. The aim of this study was to identify and categorize GNS research based on health system domains. ⋯ This review highlighted the pressing need for more research into information management in the context of GNS. In addition, health system-focused GNS literature represented only 20% of all LMICs (30/143). The trends in authorship should be noted, because many ethical (and practical) issues may arise if there is a disconnect in the objectives of the authors and the neurosurgeons in LMICs.
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Review
Learning curve for transforaminal percutaneous endoscopic lumbar discectomy: A systematic review.
Transforaminal percutaneous endoscopic lumbar discectomy (TPELD) has become an alternative and minimally invasive surgical technique for soft lumbar disc herniation. However, the learning curve has been relatively long and difficult. In the present study, we have summarized the characteristics of the learning curve of TPELD, including the number of cases required to achieve technical proficiency, and discussed the strategies to improve the learning curve. ⋯ We found insufficient evidence to support a cutoff point of 20 or other numbers of cases for determining when the learning curve has reached a plateau. Therefore, these numbers should be interpreted with great care, and high-quality prospective studies evaluating the actual learning curve are required.