World Neurosurg
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External ventricular drain (EVD) placement can be performed at the bedside in the neurosurgical intensive care unit (ICU) or in the operating room (OR). Systematic review and meta-analysis may permit stronger recommendations to improve accuracy and complication rates. ⋯ There are likely specific patient populations who would benefit from EVD placement in the ICU versus OR setting. The literature comparing efficacy and morbidity between EVDs placed in the ICU and OR settings is overall inconclusive in both sample size and congruence of methodology. Agreement in outcome metrics and data reporting on this topic is necessary to synthesize high-quality evidence to form practice-changing recommendations for this debated topic.
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Review Case Reports
Sellar-Suprasellar Paraganglioma: Report of 2 Cases and Review of Literature.
Intracranial paragangliomas are infrequent and those occurring in the sellar-suprasellar region are rare, with only 31 cases described in literature. ⋯ We report 2 cases of paraganglioma occurring in a rare location. Presence of flow voids within tumors in the sellar-suprasellar location should alert the surgeon to this entity. The hypervascular nature of these tumors may limit the extent of resection. In cases of inadequate tumor decompression, or if there is evidence of growth of residual tumor, radiotherapy can help to stabilize the disease.
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Low- and middle-income countries continue to suffer from a lack of access to basic neurosurgical care. The 2015 Lancet Commission on Global Surgery estimated essential surgical care was lacking to 5 billion people and that 143 million essential surgeries were not performed annually. A significant part of this need is neurosurgical care. Countries lacking basic neurosurgical services cannot have a true trauma system, or complete care for tumor, stroke, pain, and congenital defects in children. Episodic service missions from developed countries cannot fill these large gaps. To maximize the impact of global neurosurgery, the framework through which humanitarian neurosurgeons respond to international need should incorporate sustainable practices that empower the recipient population. ⋯ To meet the global need for neurosurgical care, self-sustaining neurosurgical programs must be locally developed in the countries of need. International support must be built on "Service through Education" rather the service alone.
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The after-hours effect on postoperative complications has been poorly studied in the neurosurgical literature. A recent retrospective analysis showed that patients with a surgical start time (SST) between 09:01 pm and 07:00 am had a greater risk of complications. This study used a prospective registry to examine the relationship between SST and postoperative complications in a large neurosurgical population. ⋯ Patients undergoing emergent operations with a later SST were significantly more likely to have a postoperative complication. Patients who were extubated in the NICU versus the operating room were significantly more likely to have a medical complication. Patients were more likely to be extubated in the NICU if they had a later SST; therefore, SST may indirectly be associated with an increase in medical complications.
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Review Case Reports
Delayed fragmentation and distal embolisation of retained microcatheter causing lower limb ischaemia: A case report and review of the literature.
Endovascular microcatheter adherence and retention is an uncommon complication during brain arteriovenous malformation (AVM) embolization with glue or ethylene-vinyl alcohol copolymer that has previously reported, although there are sparse reports of symptomatic complications thereafter. ⋯ Fragmentation over retained microcatheters remains a concern that may be worth monitoring in the long term, although there are no recommendations for timing.