World Neurosurg
-
Multinodular and Vacuolating Neuronal Tumors of the cerebrum (MVNTs) are rare, seizure-related, low-grade tumors of the Central Nervous System (CNS) which usually affect young adults. First described by Huse et al. in 2013, these neoplasms are usually located within the deep cortical ribbon and the superficial white matter and have a characteristic cytoarchitecture of cells with neuronal and glial differentiation that form multiple nodules with conspicuous vacuolation. Due to their benign nature and indolent clinical course, its radiological-based differentiation from other entities is of paramount importance to avoid unnecessary surgical intervention. ⋯ Their most frequent initial clinical manifestation was either seizures or headaches. On conventional Magnetic Resonance Imaging (MRI) techniques, they usually appear hypointense in T1-weighted images and hyperintense in T2-weighted and FLAIR images, while lacking perilesional edema or post-contrast enhancement. MVNTs do not appear to change size or recur, even after partial resection of the tumor, indicating their indolent course and thus, surveillance with serial MRI scans immerses as the most appropriate management technique for these lesions.
-
Chemoprophylaxis for preventing VTE in spine surgery is debated due to effectiveness and safety concerns. Guidelines lack consensus on regimens and timing for spinal trauma. We examined chemoprophylaxis in spine trauma surgery to further guide surgeon decision-making. ⋯ No significant association was found between chemoprophylaxis use or timing and VTE risk after spine trauma surgery, though this finding may be underpowered. Chemoprophylaxis did not appear to significantly increase postoperative bleeding.
-
The minimally invasive (MI) lateral approach to the TL junction for treating various spinal pathologies is quite challenging for spine surgeons due to this region's unfamiliar and complex anatomical structures. In addition, controversy still exists regarding approach selection, the need for rib resection, and diaphragm manipulation. ⋯ Intercostal subdiaphragmatic retroperitoneal access without rib resection is an alternative MI lateral approach to the upper lumbar spine. These reproducible techniques could help surgeons access the L1/2 disc level without unnecessary rib resection. Surgeons can utilize this technique for performing a single-level lateral approach at L1/2 or incorporate this MI technique with a standard lateral approach to the lower lumbar spine for performing sequential multilevel lateral fusion for patients diagnosed with adult spinal deformity (ASD).
-
Prognosis of adult tuberculous meningitis patients undergoing a ventriculoperitoneal (VP) surgery is not well known. Prognostic models developed to predict the prognosis might help the clinicians immensely. ⋯ About 39% adult tuberculous meningitis patients die or remain disabled after VP shunt surgery. MRC grade III illness, papilledema, seizures and size of hydrocephalus are the most important baseline predictors that can help in prognostication. The nomograms developed may help the treating physician in prognostication.