World Neurosurg
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Nontraumatic pedicle fracture is uncommon, with sparsely described cases of conservative management versus surgical treatment by open fusion or percutaneous fixation. ⋯ A trial of conservative management is typically warranted in most cases of nontraumatic pedicle fracture, but there is risk of refractory or progressive symptoms and subsequent fracture. Minimally invasive fixation is a viable surgical option that can be used in multilevel fractures.
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At some level, intraoperative hypotension causes strokes. Elderly neurosurgical patients are presumably at especially high risk. We tested the primary hypothesis that intraoperative hypotension is associated with postoperative stroke in older patients undergoing brain tumor resection. ⋯ Postoperative strokes were common in older patients who underwent brain tumor resection, with about 14% having ischemic cerebrovascular events within 30 days, of which 86% were clinically silent. Malignant brain tumors and previous ischemic vascular events were associated with postoperative strokes, but area under 75 mm Hg was not.
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A 6-year-old girl presented with moderate-intensity headache, frequent vomiting, visual disturbance, and left-sided decreased hearing for 7 months. The neurologic examination revealed a right upper motor neuron facial nerve palsy, left-sided 4-mm sluggish pupil (right: 3-mm reactive), and unsteady gait. Fundoscopy was notable for bilateral papilledema. ⋯ Histopathologic sections were compatible with adamantinomatous craniopharyngioma. Giant craniopharyngiomas have rarely been reported. This article presents the clinical and radiologic outcomes of a patient with a giant craniopharyngioma.
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There are limited data evaluating the outcomes of attending neurosurgeons with different types of first assistants. This study considers a common neurosurgical procedure (single-level, posterior-only lumbar fusion surgery) and examines whether attending surgeons deliver equal patient outcomes, regardless of the type of first assistant (resident physician vs. nonphysician surgical assistant [NPSA]), among otherwise exact-matched patients. ⋯ For single-level posterior spinal fusion, in the setting described, there are no differences in short-term patient outcomes delivered by attending surgeons assisted by resident physicians versus NPSAs.
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Calvarial hyperstosis can be an idiopathic benign finding or secondary to a metabolic pathology. We herein describe a case of diffuse calvarial hyperstosis. A 26-year-old man known to have end-stage renal disease on regular hemodialysis, tertiary hyperparathyroidism, extensive brown tumors, and severe developmental impairment with skeletal deformities was referred to us for macrocephaly. ⋯ There was mild generalized prominence of cortical sulci and ventricular system. The findings were in keeping with his known hypermetabolic state and tertiary hyperparathyroidism. The patient was managed conservatively with regular follow-up in the clinic.