World Neurosurg
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Level I trauma centers use patient triaging systems to deploy neurosurgical resources and pursue good outcomes; however, data describing the effectiveness these triage systems are lacking. We reviewed the leveling protocol (cases designated urgent and emergent) of a regional Level I trauma center to obtain epidemiologic data about the efficiency of that system and identify areas for improvement. ⋯ To our knowledge, this is the first study of variability in PTR timing as a function of surgical urgency or indication. The most common leveled cases were craniectomies or craniotomies to relieve increased intracranial pressure, which were also the most common level 1 cases. Significant variability occurred within each leveling category; thus, further investigation is required.
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Meningiomas are the most common benign intracranial tumor. Although meningiomas are slow growing and potentially highly vascularized, hemorrhage of these tumors is rare. We propose 2 novel modifiable risk factors that may provoke intratumoral hemorrhage of a World Health Organization grade I meningioma. ⋯ Spontaneous hemorrhage of meningiomas is a rare event. Known risk factors are age older than 70 or younger than 30; intraventricular or convexity location; malignant, fibrous, or angioblastic histopathology; and presence of hypertension, anticoagulation therapy, and traumatic brain injury. We propose 2 new risk factors to be considered that may predispose to hemorrhage of a meningioma: serotonin-modulating therapy and high-dose estrogen-replacement.
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Case Reports
Management of hydrocephalus in Paget's disease of bone: systematic review and illustrative case.
Paget's disease of the bone (PDB) is a focal bone disorder characterized by excessive resorption and deposition of pathologic bone. It can involve the skull and cause neurologic dysfunction. Hydrocephalus occurring as a complication has also been reported. However, owing to its rarity, the optimal treatment has not yet been determined. ⋯ Patients with hydrocephalus occurring as a complication of PDB will most commonly present with cognitive impairment, gait unsteadiness, and urinary incontinence. Surgery plays an important role in the treatment, with CSF diversion procedures resulting in significant neurologic recovery in most cases.
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Case Reports
Resolution of Trigeminal Neuralgia After Surgical Disconnection of a Foramen Magnum Dural Arteriovenous Fistula.
Trigeminal neuralgia (TN) resulting from dural arteriovenous fistulas (DAVFs) is rare. TN caused by a foramen magnum DAVF has not been reported yet. We report a patient with TN caused by a foramen magnum DAVF treated with surgical disconnection. ⋯ DAVF is a rare cause of TN. Surgical disconnection is an effective treatment method for TN caused by a foramen magnum DAVF.
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Case Reports
Total Spinal Epidural "Blood Patch" Application Through a Racz Catheter in Spontaneous Intracranial Hypotension.
Epidural "blood patch" (EBP) is a standard treatment of spontaneous intracranial hypotension (SIH). In recent years, there are some reports of Racz catheter use for EBP performance at upper cervical spine levels. However, the practical use of Racz catheter for single-entry multisite EBP has never been reported until now. ⋯ The Racz catheter can be a convenient means to deliver large-volume EBPs from a single entry point in the treatment of SIH.