World Neurosurg
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Orbital compartment syndrome (OCS) is a rare post operative complication of Neurosurgery. It presents typically acutely with loss of vision, loss of pupillary reaction, and limitation of extraocular movement. The etiology of OCS is most typically associated with increased pressure from a mass lesion in the orbit compromising the blood supply of orbital structures. Emergent bedside decompression of the orbit by lateral canthotomy is indicated to quickly treat OCS in an attempt to save visual acuity and extraocular function. ⋯ This case demonstrates that although very rare, OCS can occur without compression of the eye or an intra-orbital mass. Visual loss is a devastating complication. Constant vigilance to ensure adequate arterial and venous supply to the orbit, with great care to prevent external compression on the eye, hopefully, will continue to make this complication rare.
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The diagnostic and surgical management of epilepsy has made enormous strides over the past 3 decades, concomitant with advances in technology and electrophysiologic understanding of neuronal connectivity. Distinct zones have been identified within this network that each communicate and play a role in the genesis of seizures. ⋯ Ablative, palliative, and disconnecting procedures have been developed as alternatives for traditional open resection techniques, and in recent studies, they have shown excellent seizure control and mitigation of complications. In this review, we discuss the evolution of these advancements in the management of epilepsy and provide an overview of current and future neurosurgical therapeutic modalities.
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Technical limitations and clinical challenges have historically limited the diagnostic tools and treatment methods available for surgical approaches to the management of epilepsy. By contrast, recent technological innovations in several areas hold significant promise in improving outcomes and decreasing morbidity. ⋯ Investigation into genetic causes of and susceptibilities to epilepsy has introduced a new era of precision medicine, enabling the understanding of cell signaling mechanisms underlying epileptic activity as well as patient-specific molecularly targeted treatment options. We discuss the emerging path to individualized treatment plans, predicted outcomes, and improved selection of effective interventions, on the basis of these developments.
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Multicenter Study
Sexual Dysfunction Secondary to Lumbar Stiffness in Adult Spinal Deformity Patients before and after Long-Segment Spinal Fusion.
Sexual function is an important factor contributing to quality of life. Adult spinal deformity (ASD) patients may have sexual limitations due to lumbar spinal stiffness that may be affected by long-segment fusion. ⋯ This study found that sexual dysfunction scores due to lumbar stiffness significantly improved after surgery for ASD. Additionally, lumbar stiffness-related sexual dysfunction is strongly related to overall outcome measured by Oswestry Disability Index and Scoliosis Research Society-22r total score, highlighting the importance of sexual health on overall outcome in ASD patients.
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To assess the early mortality in pediatric glioma and identify predictors of early mortality, which may provide insight into the therapeutic strategies for children with a high risk of early mortality. ⋯ We found a decrease in early mortality during the past 40 years. The death rates within 1 month and 3 months after diagnosis were 1.32% and 2.44%, respectively. Age at diagnosis, histologic subtype, the extent of resection, chemotherapy, and radiation were associated with early mortality in pediatric glioma.