World Neurosurg
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We report the first case of cervical spine chondrosarcoma in a Wilms tumor survivor. ⋯ Through our experience with this case, we would like to suggest a possible unknown genetic syndrome predisposing patients with Wilms tumor to chondrosarcoma as secondary neoplasms. We would also like to re-emphasize the need for vigilance when assessing patients with a history of Wilms tumor.
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Teaching hospitals are responsible for the training and education of residents and have been centers of research and advancement in an era of evidence-based medicine. Several studies have reported conflicting findings regarding the effects of teaching status on the outcomes of patients. In the present study, we aimed to identify the differences in surgical outcomes among patients who had undergone anterior cervical discectomy and fusion (ACDF) between teaching and nonteaching hospitals. ⋯ Our results have shown that patients undergoing ACDF at nonteaching hospitals had a greater odds of routine discharge and higher admission costs compared with those at teaching hospitals but similar outcomes in terms of inpatient mortality and morbidity.
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Case Reports
A case of spontaneous regression of radiologically diagnosed epidermoid cyst originated from cerebellopontine angle.
Generally, asymptomatic epidermoid cysts (ECs) or ECs with minor symptoms controlled by medication are not treated further. Although epidermoid carcinomas are only sporadically reported, the possibility of malignant transformation of ECs is of concern. ⋯ The reduction of an EC is extremely rare. We report a case of spontaneous regression of an EC and consider similar previous cases.
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Subdural empyema (SDE) is a well-known entity in pediatric populations and is associated with a high rate of morbidity and mortality. Large scale evacuation of empyema, although effective, places the bone flap at risk of failure when replaced. ⋯ Endoscopic-assisted burr hole evacuation of large panhemispheric and loculated SDE is feasible, effective, and safe. The primary advantage over conventional open evacuations is that it negates the need for a bone flap and its potential complications related to a secondary infection.
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Biochemical remission of adrenocorticotropic hormone (ACTH)-secreting macroadenomas can be challenging to achieve.1,2 Staying outside the adenoma pseudocapsule is an important technique to achieve gross total resection.1-3 Dural invasion is an important recognized factor that can prevent biochemical remission. In particular, invasion of the medial wall of the cavernous sinus has been implicated as an important determinant in remission and/or recurrence of ACTH-secreting macroadenoma.4,5 A 27-year-old patient presented with severe clinical features and biochemical workup consistent with ACTH-dependent hypercortisolism. Urinary free cortisol was nearly 10 times the upper limit of normal, and prolactin and insulin-like growth factor 1 were moderately elevated at 405 ng/mL and 577 ng/mL, respectively. ⋯ Care must be taken to identify parasellar ligaments and watch for the inferior hypophyseal artery.1-3 The medial wall CS specimen revealed focal invasion of adenoma cells. The tumor stained for ACTH, prolactin, and growth hormone, and Ki-67 index was 1%. The patient went into biochemical remission postoperatively and had significant improvement in preoperative symptoms.