World Neurosurg
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There are currently no standard criteria for evaluating the risk of recurrent disk herniation after surgical repair. This study investigated the predictive values of 5 presurgical imaging parameters: paraspinal muscle quality, annular tear size, Modic changes, modified Phirrmann disk degeneration grade, and presence of sacralization or fusion. ⋯ Patients with poor clinical scores and recurrence exhibited additional radiologic abnormalities before surgery, such as poor paraspinal muscle quality, longer annular tears, higher Modic change type, higher modified Phirrmann disk degeneration grade, and sacralization or fusion. This risk evaluation protocol may prove valuable for patient selection, surgical planning, and choice of postoperative recovery regimen.
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Glioblastoma multiforme (GBM) is the most common and lethal central nervous system cancer and is associated with a poor prognosis. Simvastatin, a kind of widely used hypolipidemic agent, has been investigated for its beneficial effects on various types of cancers. The main purpose of this paper is to investigate the potential inhibitory effects of simvastatin on GBM and the underlying mechanism. ⋯ Simvastatin inhibits GBM progression by suppressing caspase-1-dependent pyroptosis, regulated by miR-214.
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A career in academic neurosurgery is an arduous endeavor. Specific factors influencing physician practice preferences remain unclear. This study analyzes data from the American Association of Neurological Surgeons membership identifying the impact of several demographic and educational characteristics influencing neurosurgical career choices centered on academia, private practice, or a combination in the United States. ⋯ Neurosurgery as a field has grown significantly over the past century. The authors recommend that future efforts seek to diversify the neurosurgical workforce by considering practice setting, demographic characteristics, and educational background.
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Spine surgeons have a heuristic sense of how to surgically restore alignment and address adult spinal deformity (ASD) symptoms, but consensus on the extent of treatment remains unclear. We sought to determine the variability of surgical approaches in treating ASD. ⋯ Spinal deformity surgeons lack consensus on the optimal surgical approach for treating ASD. Classifying surgeons as performing MIS or open surgery does not mitigate this variability.
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Case Reports
Racemose fourth ventricle neurocysticercosis excision through telovelar approach and hydrodissection.
Intraventricular neurocysticercosis is associated with more severe complications and a worse overall outcome.1,2 Fourth ventricle neurocysticercosis (FVNCC) often presents with cerebrospinal fluid obstruction and hydrocephalus by means of direct mechanical occlusion of ventricular outlets by the cysts or due to an ependymal inflammatory response. Unfortunately, there is little consensus on the optimal management for FVNCC. If possible, surgical removal of cysticerci rather than medical therapy and/or shunt surgery is recommended.3 Endoscopic removal of cysts is described to be an effective treatment modality.4 However, endoscopic removal of inflamed or adherent ventricular cysticerci is associated with increased risk of complications.5 Although microdissection through a posterior fossa telovelar approach is a valid method for FVNCC,6,7 scarce reports describe the therapeutic decision making and provide a surgical video of adherent FVNCC cyst resection. ⋯ Magnetic resonance imaging demonstrated obstructive hydrocephalus secondary to a multiloculated cystic mass within the fourth ventricle. According to the diagnostic criteria, probable racemose FVNCC was suspected.8 Magnetic resonance imaging raised suspicion that the cysts could be densely adherent to surrounding structures,9 precluding endoscopic removal. We performed a combined microscopic and endoscopic approach, which permitted removal of the cysts through a telovelar approach and hydrodissection technique without damaging nearby structures and treatment of the associated hydrocephalus through an endoscopic third ventriculostomy, allowing complete resolution of symptoms and avoidance of cerebrospinal fluid shunting.