World Neurosurg
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To determine the characteristic alignment change in patients with myelopathy recurrence after multilevel anterior cervical corpectomy and fusion (m-ACCF). ⋯ In patients with myelopathy recurrence after m-ACCF, the cranial side has significant kyphosis and the caudal side has lordosis. Moreover, 79.2% of the restenotic lesions were significantly maldistributed on the cranial side. Surgeons should pay close attention to cranial kyphosis inducing myelopathy recurrence after m-ACCF.
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Immuno-oncotherapy (IO) has revolutionized systemic cancer care but remains experimental in brain tumors. IO treatment risks multiorgan autoimmune inflammatory responses that limit its use. The central nervous system (CNS) is an immune-specialized compartment with restricted cellular access, thus fewer cases are reported for immune-mediated encephalitis. Interestingly, patients with history of blood-brain barrier compromise are potentially at higher risk for immune cell trafficking to the CNS. ⋯ We concluded the diagnosis of immune-mediated encephalitis secondary to IO with collection of reactive T-cells within the area of encephalomalacia. The area of encephalomalacia from prior TBI served to compartmentalize the reactive lymphocytes, giving the appearance of a mass. Taken together, new onset seizure in patients on IO might signal encephalitis and CNS metastatic mimicry should be considered in patients with a prior history of TBI and encephalomalacia.
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Cervical teardrop fractures are hyperflexion and axial loading injuries associated with significant ligamentous disruption. Patients sustaining these types of injury are classically treated with a cervical corpectomy and anterior fusion. However, there are notable disadvantages of this approach, namely, disruption of the patient's true anatomic alignment and a reduction in the number of fixation points available for cervical fusion. Here we present a novel method of open reduction and internal fixation in a neurologically intact patient with cervical teardrop fracture. ⋯ Here we present a novel technique for open reduction and internal fixation of a cervical teardrop fracture that does not require cervical corpectomy. This technique is particularly useful in patients with an anteriorly displaced fragment and without neurologic deficit or compromise.
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Despite the panic and chaos that coronavirus disease 2019 (COVID-19) has generated in over 200 countries, the role of neurosurgeons has never been more relevant and challenging. The health system in Nepal was never geared to face an onslaught of an infectious disease. ⋯ In these challenging times, we neurosurgeons, who are naturally primed and trained to respond and take on challenges in difficult situations, have the ideal opportunity to shine and make a true difference during this pandemic and beyond and be "5-star doctors."