World Neurosurg
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To assess the role of the difference between the proximal junctional angle (PJA) and rod contouring angle (RCA) (PJA-RCA) in the development of postoperative proximal junctional angle (PJK) in Lenke I and II adolescent idiopathic scoliosis (AIS) patients. ⋯ Large postoperative PJA-RCA and decreased TK are risk factors for PJK in Lenke I and II AIS patients, especially those with PJA-RCA greater than 5°, and the occurrence of PJK should be highly considered.
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Case Reports
Interhemispheric Transcallosal Approach for Resection of Choroidal Arteriovenous Malformation: Operative Video.
Choroidal arteriovenous malformations (AVMs) are rare vascular entities located deep within the brain and in close relationship with vital paraventricular structures.1,2 Recruitment of feeders from the anterior and posterior choroidal arteries is typical in these lesions.3 We present the case of a 38-year-old woman who presented initially to an outside hospital with an intracranial hemorrhage 17 months prior. Initial computed tomography scan showed a large intraventricular hemorrhage and a right thalamic hemorrhage. She was diagnosed with a cerebral AVM and underwent treatment with placement of an external ventricular drain followed by partial embolization of a feeder with Onyx liquid embolic system (ev3, Irvine, California, USA). ⋯ Drainage was noted into an arterialized vein that coursed anteriorly and inferiorly prior to joining the internal cerebral vein and ultimately draining into the vein of Galen. After reviewing the management options, decision was made to proceed with microsurgical resection via an interhemispheric transcallosal approach (Video 1). The patient tolerated the procedure well and was discharged home on postoperative day 4 with no evidence of residual AVM on DSA and no neurologic deficit noted at last follow-up.
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Indirect bypass surgery is used to improve the hemodynamic status of pediatric patients with moyamoya disease (MMD). Symptomatic cerebral infarction during the early postoperative period may be the most frustrating complication. This study was conducted to investigate the factors associated with early postoperative symptomatic cerebral infarction. ⋯ Postoperative symptomatic infarctions can occur despite a unified surgical method and formulaic perioperative management protocol. Patient-centered factors, such as young age, genetic background of MTHFR, and certain medical conditions, including hyperthyroidism, renovascular hypertension, and hemolytic uremic syndrome, as well as management-related factors, including 2 craniotomies and low immediate postoperative hemoglobin level, could be risk factors for early postoperative symptomatic cerebral infarction.
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Enthusiasm for research and teaching are often the main reasons neurosurgical residents choose academic careers, and subspecialty choice usually stems from an interest in that particular field. However, recent salary data bring to light a work relative value unit-related trend in American academic neurosurgeon salaries, one that is similar to private practice, where compensation is strongly correlated with clinical productivity. ⋯ For example, functional and pediatric specialists earn significantly lower salaries on average compared with their spine and endovascular colleagues. These trends have important implications both for neurosurgical trainees and for institutions in the United States.
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Ventriculostomy-related infection with multidrug-negative strains are challenging to treat. We report the use of new antibiotics in such a case. ⋯ We observed than even in the case of mild meningeal inflammation, ceftaroline penetration in CSF, although moderate, enabled efficient bacterial clearance and clinical efficacy, in adjunction to correct ventriculoperitoneal shunt management.