World Neurosurg
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Observational Study
Pilot study of neurological pupil index as a predictor of external ventricular drain clamp trial failure after subarachnoid hemorrhage.
External ventricular drains (EVDs) provide a temporary egress for cerebrospinal fluid (CSF) in patients with symptomatic hydrocephalus following aneurysmal subarachnoid hemorrhage. Before EVD removal, a wean trial, which involves clamping the EVD, is typically attempted to ensure that CSF self-regulation is achieved. Automated infrared pupillometry (AIP) has been shown to detect early neurologic decline. We sought to explore the use of AIP to detect early EVD clamping trial failure. ⋯ The pilot study data support that Neurological Pupil index <3 is a potential indicator of early clamp trial failure, but a CT scan has a higher sensitivity and NPV for predicting successful EVD removal. This finding suggests the benefits of including AIP assessments during clamping trials.
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Suboccipital decompression with duraplasty is being increasingly accepted for treating patients with Chiari malformation type I (CM-1). To date, the optimal duraplasty for CM-I has not been delineated. This study aims to compare the clinical and radiologic effects of duraplasty performed using 2 types of grafts and 2 graft fixation methods in 3 combinations. ⋯ Autologous and nonautologous dural grafts can be performed using either sutures or sutures plus glue, as both result in similar outcomes.
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Arterial supply of the spinal cord is derived from the anterior spinal artery (ASA) and 2 posterior spinal arteries. In the thoracic spine, a few segmental arteries give origins to radiculomedullary arteries (RMAs) that supply the ASA and posterior spinal arteries.1 In the lower thoracic spine, the supply is provided by the Adamkiewicz artery. Spinal meningiomas may be embedded and/or supplied by the RMA, which may be sacrificed to obtain complete resection. ⋯ The clipping test with MEP monitoring is a useful and simple intraoperative tool to identify the critical afferents of the ASA. It doesn't require planification or supplementary materials. Further study might be performed to validate the technique.
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The treatment of osteosarcoma of the spine remains controversial. Our aim was to explore the treatment of patients with spinal osteosarcoma. ⋯ Surgery can provide survival benefits for patients with osteosarcoma of the spine. The patients with spinal osteosarcoma who had undergone surgery experienced favorable survival benefits. Thus, surgery can be a suitable treatment for patients with spinal osteosarcoma.
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Cerebral arteriovenous malformations (AVMs) can be treated by microsurgery, stereotactic radiosurgery (SRS) as a stand-alone procedure, or combining embolization and conservative management. This single-center, retrospective review explored the outcomes of patients treated with SRS alone, embolization before SRS (ESRS), or conservative management for cerebral AVMs. ⋯ Findings suggest that SRS and ESRS are safe and effective treatments for cerebral AVM (when quantified by obliteration, rebleed, and disease-specific mortality rates). With multinational, prospective, randomized controlled trials with long follow-up periods, the effectiveness and safety of SRS and ESRS compared with conservative management for AVM will be further clarified.