World Neurosurg
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Hydrocephalus is a common diagnosis worldwide that is treated with shunts and is associated with potential life-threatening risks of shunt dysfunction and infection. We investigated differences in rates of shunt revisions and infections including various factors in patients with different causes of hydrocephalus. We also studied causes of infections and efficacy of perioperative antibiotic regimens. Our objective was to identify patients at risk of higher revision and infection rates after shunt treatment. ⋯ We found revision and infection rates in accordance with other studies. We showed a significantly increased risk in younger patients. Previous shunts also increased the risk of revisions and infections. We showed a small but significant effect of perioperative prophylaxis with broader-spectrum antibiotics compared with cloxacillin. Our study identified a group of younger patients with congenital hydrocephalus and prior implants with an increased risk of shunt infection in whom additional preventive measures should be employed.
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This work aims to describe the evolution of the video-assisted Thoracoscopic Surgery (VATS) approach from a multiportal access to a biportal access for thoracic herniated disc surgery. Thoracic disc herniation remains a challenging pathology for spine surgeons. VATS of the thoracic spine was described in the 90s and represented an important technical leap by including minimally invasive options for thoracic pathology. Nowadays, VATS in thoracic surgery tends to evolve towards an even less invasive technique, from a multiportal approach to a biportal one. ⋯ This access allows the surgeon to manipulate the instrumentation confidently and the camera does not fog up as often. Extracting a piece of rib is unnecessary and theoretically, we only manipulate 1 or at most 2 intercostal nerves, so the patient's recovery is favorable.
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Relationships between low socioeconomic status and surgical outcomes are well established for certain procedures. However, scant literature has focused on relationships between median household income and lumbar fusion outcomes. ⋯ Reduced household income significantly affected perioperative outcomes after lumbar fusion and should be taken into consideration during the perioperative period.
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This study assessed neurological outcomes and variables associated with favorable outcomes in aneurysmal subarachnoid hemorrhage patients with low functional status (Glasgow Coma Scale [GCS] score ≤8) on postbleed day 7 (PBD7). ⋯ This study yielded no significant physical examination findings that predict a favorable outcome in patients with a GCS score ≤8 on PBD7. This finding may inform the decision of whether to prolong hospital management or arrange for end-of-life care.
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The endoscopic combined transseptal-transnasal technique for pituitary adenoma excision is notable for enhanced postoperative functional outcomes. Our study compared the incidence of anterior nasal septal perforation and the resulting sinonasal complications between this method and the bilateral transnasal approach. ⋯ For the surgical treatment of pituitary adenomas, the transseptal-transnasal approach offers several advantages over the bilateral transnasal method, particularly in reducing postoperative complications. However, this technique requires careful attention for preventing the occurrence of anterior septal perforation.