World Neurosurg
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Middle meningeal artery (MMA) embolization could be an effective method of inhibiting neovascularization of the subdural capsular membrane and preventing hematoma maintenance. We sought to better understand how the MMA might affect subdural hematoma physiology and how this process might be modified by embolization. ⋯ Our data lend support to the theory of contiguous vascular networks between the MMA and SDH membranes. Targeting these leaky vascular networks might remove the source of hematoma accumulation. These data add to the pathophysiological understanding of the disease and suggests potential insights into the mechanism of action of MMA embolization.
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Despite increasing interest in endovascular therapy (EVT) for large-core strokes, little is known about the predictors of good outcome in these patients. The aim of this study was to analyze patients with large-core strokes post-EVT and to define the predictors of favorable outcome in this population. ⋯ For patients with large-core strokes (≥70 cm3) after EVT, approximately one third have favorable outcome at 90 days. Independent predictors of favorable 90-day outcomes include male sex, intravenous tissue plasminogen activator use, and lower FIV.
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A 39-year-old man with a history of recurrent pituitary tumor, Cushing disease, and Nelson syndrome presented with neck stiffness. He previously had bilateral adrenalectomy and hypophysectomy 27 years ago. He subsequently had repeat pituitary surgery, stereotactic radiosurgery, and chemotherapy for recurrent pituitary tumor. ⋯ Histologic analysis revealed a tumor of pituitary origin with synaptophysin and ACTH expression. Pituitary drop metastasis is a rare entity and should raise a high index of suspicion given this clinical presentation. The radiologic appearance can mimic benign lesions such as meningioma or schwannoma.
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Sacral-alar iliac (SAI) screws constitute a relatively new technique for pelvic fixation. Since their initial description in 2007, SAI screws have gained wide popularity among the spine surgery community. ⋯ In this brief technical note, we present the first clinical report of the use of S3 SAI screws as a salvage method for pelvic fixation in a patient with suboptimal anatomy that prevented proper placement of S1 and S2 SAI screws. We also discuss the recommended anatomical entry points and trajectory of such screws.
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Ping-pong fracture in neonates is a well-known complication. There have been many reports on methods to achieve closed reduction using a suction technique. Here we describe in detail the steps for such a maneuver and show the favorable cosmetic outcome without the need for surgery. ⋯ The images here after reduction show a favorable cosmetic outcome. An ultrasound was done after reduction and 1 day later to exclude any intracranial complications. Images are then shown after 24 hours without recurrence of the deformity and minimal bruising of the scalp because of the suction applied to the skin over the depressed fracture.