World Neurosurg
-
To assess the association of insurance status and inpatient hospital outcomes among a nationally representative population of pediatric trauma neurosurgery patients. ⋯ Insurance status is significantly associated with mortality, length of stay, and favorable discharge disposition among pediatric neurosurgery trauma patients. Further studies are needed to examine the underlying mechanism of the observed associations.
-
Larger craniotomy is expected to increase blood flow over a wider range after indirect revascularization. However, the optimal size of craniotomy has not been established. In this study perioperative complications in revascularization surgery for moyamoya disease are evaluated, focusing on craniotomy size. ⋯ Large craniotomy is associated with more frequent perioperative complications, especially transient symptoms.
-
Review
Diffusion and perfusion weighted magnetic resonance imaging methods in non-enhancing gliomas.
Routine diagnostic magnetic resonance imaging (MRI) uses enhancement of the tumor tissue as a marker of malignancy in intracranial gliomas. However, several high-grade tumors do not exhibit enhancement, and, conversely, some low-grade gliomas do demonstrate enhancement. ⋯ These advanced MRI methods include diffusion-weighted imaging, diffusion tensor imaging, diffusion kurtosis imaging, arterial spin labeling imaging, dynamic susceptibility contrast imaging, and dynamic contrast-enhanced imaging. This review focuses on the utility of these methods for better characterization and grading of nonenhancing gliomas, as it is more difficult to accurately devise an optimal treatment strategy for these tumors compared with enhancing gliomas.
-
Decompression illness often presents with a wide variety of vague neurologic symptoms. Animal models have suggested that intracranial hemorrhages may result from nitrogen bubble ischemic insults. However, there is a paucity of cases and no known case reported to date of non-aneurysmal subarachnoid hemorrhage after rapid ascension from diving. ⋯ In patients presenting with persistent headache, nausea, emesis and/or other neurologic symptoms after diving, health care providers should consider intracranial hemorrhage in their work up.
-
Carotid blowout syndrome (CBS) is a potential complication of head and neck cancer, and its therapy is associated with high morbidity and mortality. Recent advances in endovascular techniques have improved patient outcomes. In this study, we report outcomes of emergent endovascular intervention for CBS. ⋯ The endovascular treatment of CBS is safe and effective with relatively low rates of morbidity and mortality compared with other currently available treatment modalities. However, the overall rate of complications demands attention and sheds light on the need for further improvement in management.