World Neurosurg
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Comparative Study
The Role of Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke with Large Vessel Occlusion.
The goal of the present study was to determine the safety and efficacy of intravenous tissue plasminogen activator (IVT) in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) undergoing mechanical thrombectomy (MT). ⋯ Administration of IVT before MT to patients with AIS with LVO resulted in reperfusion before MT in 10% of patients, reduced the incidence of mortality and severe disability at 90 days, did not affect the door-to-puncture time, and was associated with a similar incidence of systemic and intracranial hemorrhage compared with MT only.
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A 63-year-old man with a history of motorcycle accident 42 years ago suffered a left brachial plexus avulsion (BPA). Neuropathic pain in his left upper limb was felt in the C6-C7-C8 dermatomes. The rationale for performing "DREZotomy" is to preferentially interrupt the nociceptive inputs in the lateral part of the dorsal root entry zone (DREZ).1-3 For pain with complete deafferentation, as observed in BPA, the aim is to destroy the hyperactive nociceptive neurons deep in the apex of the dorsal horn (DH).4 Surgery is performed under general anesthesia, with the patient in prone position. ⋯ Thirdly, scarring can be seen along the sulcus with small holes where the rootlets used to penetrate the cord. DREZotomy is performed using a graduated sharp bipolar instrument to allow precise microcoagulations of the DH. Preoperative surgical planning helps the surgeon by giving the angle between the DH and median plane.6 In the immediate postoperative period, the patient described the complete disappearance of neuropathic pain in his left upper limb, persistent at last follow-up (1 year) (Video 1).
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Intrasellar cephalocele is very rare and is often overlooked because of its atypical clinical demonstration. A 2-year, 10-month-old girl was referred to our hospital with short stature. Magnetic resonance imaging revealed an extension of the anterior third ventricle, which protruded into the pituitary fossa, but not into the craniopharyngeal canal, sphenoid bone, or sphenoid sinus. ⋯ Thus the patient was clinically diagnosed with intrasellar cephalocele, which is considered as a rare subtype of transsphenoidal cephalocele. Instead of surgical intervention, the patient was given growth hormone replacement therapy. After 1-year follow-up, the patient had significant increase in height.
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Postoperative dysesthesia (POD) is a common complication in surgery involving foraminal diseases, including lumbar foraminal or extraforaminal herniated nucleus pulposus (HNP). Minimal dorsal root ganglion (DRG) retraction is key to preventing POD. We compared the clinical results, safety, and efficacy between the paraspinal transforaminal approach requiring DRG retraction and the interlaminar contralateral approach without DRG retraction for foraminal and extraforaminal diseases. ⋯ Both TELD and ICELF were found to treat foraminal or extraforaminal HNP with good clinical outcomes. ICELF might have a lower POD rate in complicated cases such as adjacent segment disease, degenerative spondylolisthesis, and isthmic spondylolisthesis. This surgical procedure could be an alternative in complicated cases or in patients with an anatomically limited L5-S1 level. However, the procedure is technically challenging to perform.
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The institution-wide response of the University of California San Diego Health system to the 2019 novel coronavirus disease (COVID-19) pandemic was founded on rapid development of in-house testing capacity, optimization of personal protective equipment usage, expansion of intensive care unit capacity, development of analytic dashboards for monitoring of institutional status, and implementation of an operating room (OR) triage plan that postponed nonessential/elective procedures. We analyzed the impact of this triage plan on the only academic neurosurgery center in San Diego County, California, USA. ⋯ During the COVID-19 pandemic, the University of California San Diego Department of Neurosurgery maintained an operative volume that was only modestly diminished and continued to meet the essential neurosurgical needs of a large population. Lessons from our experience can guide other departments as they triage neurosurgical cases to meet community needs.