World Neurosurg
-
Preoperative testing and evaluation for coronavirus disease 2019 (COVID-19) have been an enigmatic challenge for the neurosurgical community during the pandemic. Since the beginning of the pandemic, laboratory diagnostic methods have evolved substantially, and with them has been the necessity for readily available, fast, and accurate preoperative testing methods. ⋯ Through this review, we highlight the guiding principles for preoperative testing, which may serve as a road map for other medical institutions to follow. In addition, we provide an Indian perspective of preoperative testing and share our experience in this regard.
-
Malformations in the craniocervical junction (CCJ) are rare in the pediatric population but often need surgical treatment. We present a pediatric case series of patients treated with a 2-stage surgical approach with a halo vest and occipitocervical fusion and review complications and outcomes. ⋯ The 2-stage approach was a suitable and effective treatment for craniocervical junction anomalies in pediatric patients.
-
Review Case Reports
Intraoperative Thrombolysis of Massive Pulmonary Embolus During Spine Surgery: Case Report of Survival Complicated by Massive Bleeding and Review of the Literature.
Pulmonary embolism (PE) is a known risk of lumbar spinal fusion surgery that can lead to sudden and unexpected death. Treatment often involves systemic anticoagulation when the risk of potentially fatal hemodynamic deterioration is judged to outweigh the risk of epidural hematoma and paralysis. Acute massive PE with obstruction of more than 50% of the pulmonary arterial tree causes right heart failure, hypotension, and often rapid death, and may require aggressive medical intervention with thrombolytic agents, such as alteplase, although in the postoperative period this entails an extremely high risk of bleeding and the associated potential neurologic morbidity. ⋯ Our experience is that chemical thrombolysis can be a lifesaving option to address pending circulatory arrest, but that severe bleeding is a likely consequence. If used to treat an intraoperative emergency, a smaller than standard dose of thrombolytic should be considered.
-
Randomized Controlled Trial
Single versus Double Burr Hole for Drainage of Chronic Subdural Hematoma: Randomized Controlled Study.
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical emergencies. Most neurosurgeons currently drained CSDH through single or double burr holes; however, few studies have compared the 2 approaches to drainage. The aim of this study is to compare the recurrent rate following double and single burr hole for CSDH in our practice. ⋯ A single burr hole is as efficacious as a double burr hole in terms of relief of symptoms and recurrence, and it has a shorter duration of surgery.
-
Permanent cerebrospinal fluid diversion has a lengthy list of complications. We present an unusual clinical image of shunt catheter migration. A 54-year-old female had a history of subarachnoid hemorrhage that resulted in communicating hydrocephalus, which needed a ventriculoperitoneal shunt placement. ⋯ On review of the patient's previous imaging, an area indicative of a minor pleural breach was identified that exposed the catheter to the negative thoracic pressure, which resulted in progressive catheter migration. The patient then underwent removal of the shunt system since her hydrocephalus had resolved. A pleural breach during shunt placement can result in the migration of the shunt catheter into the thoracic cavity under the effect of negative thoracic pressure.