World Neurosurg
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While firearms projectile injuries to the head carry a high rate of morbidity and mortality, current literature in clinical management remains controversial. Decompressive hemicraniectomy (DHC) has been previously described in the neurosurgical literature for traumatic brain injuries, with positive results in the reduction of mortality. Here we aim to assess DHC as a damage control approach for multilobar firearm injuries to the head and compare our results with what is present in the literature. ⋯ DHC should be considered as a damage control strategy for young patients with multilobar firearm injuries and GCS >5, having yielded favorable results in this study when compared to current literature.
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Brainstem cavernous malformations (BSCMs) are rare and challenging neurosurgical lesions that demand a sophisticated and nuanced strategy for resection. A key element of surgical planning for BSCM resection is brainstem safe entry zones, a set of neuroanatomically defined locations where a pial resection can be executed with minimal risk to the adjacent central nervous system tracts and nuclei.1-5 Quadrigeminal BSCMs are particularly unusual and can be accessed via the supra-, inter-, or infracollicular safe entry zones.2,4,5 We report a unique demonstration of the supracollicular safe entry zone for the resection of a symptomatic hemorrhagic quadrigeminal plate BSCM. A man in his early 60s presented with transient hearing loss and visual dysfunction. ⋯ A bipedicular suboccipital flap, torcular craniotomy, and midline supracerebellar infratentorial approach were used. The lesion itself was accessed via the supracollicular safe entry zone, where pial hemosiderin staining was also encountered, using a linear transverse incision just above the right superior colliculus. Gross total resection was achieved, and the patient recovered from surgery with no new neurologic deficits (Video 1).
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To determine the effect of operative duration on the rate of postoperative symptomatic venous thromboembolic (VTE) events in patients undergoing thoracolumbar spine fusion. ⋯ Operative duration significantly predicted symptomatic VTE, especially after surgical time cutoff of 218 minutes. Each additional hour of operative duration was found to increase VTE risk by 18%. We also identify the impact of VTE on 90-day readmission rates, suggesting significantly higher costs and opportunity for hospital acquired conditions, in line with prior literature.
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Hydrocephalus is a common complication of intra- and paraventricular tumors both before and after tumor resection. We investigated the risk factors for postoperative hydrocephalus and established a predictive nomogram to improve surgical planning and adjust the frequency of postoperative clinical and radiographic monitoring. ⋯ The established nomogram performs well for predicting postoperative hydrocephalus. Clinicians can use this nomogram to review their practice regarding hydrocephalus associated with intra- and paraventricular tumors, plan surgical treatment and adjust the frequency of postoperative clinical and radiographic monitoring.
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The residency program director (PD) position is a valued leadership appointment in academic medicine. PDs are responsible for the success of their program and its residents. The objective of this study is to provide a cross-sectional analysis of baseline demographics and academic backgrounds of current neurosurgery program directors. ⋯ The position of neurosurgery residency PD is dominated by fellowship-trained men in their late 40s to 50s. The gender ratio of neurosurgery residents is consistent with the underrepresentation of women in this position. With increasing female representation in neurosurgery, more women may assume this leadership position and begin to hasten the gender balance.