World Neurosurg
-
Radiographic methods for evaluating skeletal maturity traditionally include the Risser sign and the hand-wrist maturation method. While the cervical vertebral maturation (CVM) stage is widely recognized in orthodontics, its application in assessing spinal growth, particularly in adolescent idiopathic scoliosis (AIS), has been less explored. This study explores the correlation between CVM, chronological age, and the Risser sign to evaluate the feasibility of CVM in assessing skeletal development in adolescents. ⋯ The CVM stage, which shows a strong correlation with Risser sign grading, could serve as a reliable alternative for assessing skeletal maturity in adolescent subjects, particularly in clinical scenarios where minimizing radiation exposure is a priority.
-
Case Reports
Intradural Extramedullary Small Cell Lung Cancer Metastasis Resection: 2-Dimensional Operative Video.
The presented surgical video (Video 1) demonstrates the resection of an intradural extramedullary metastasis in a 62-year-old female patient with a history of metastatic small cell lung cancer (SCLC). SCLC commonly metastasizes to the central nervous system.1,2 However, the vast majority of such metastases are to the brain.1,2 Interestingly, the presented patient had a cerebellar SCLC metastasis operated on 10 months earlier. Several cases of intradural extramedullary spinal drop metastases arising from cerebellar tumors have been described in the literature, suggesting that a drop metastasis is a likely mechanism to explain this rare topography.3-5 Preoperatively, the patient presented with 1 month of back pain and rapidly progressing left lower extremity weakness and myelopathic signs so surgery was offered.6-10 Interval imaging showed an intradural extramedullary T4-T5 lesion suspicious for metastatic disease. ⋯ Complete resection required sacrifice of the left T5 nerve root and cutting of the dentate ligament in 2 locations for adequate visualization. Postoperative neurologic exam demonstrated improvement in her lower extremity weakness, and postoperative magnetic resonance imaging showed gross total resection. The postoperative course was uneventful, and the patient was discharged home on postoperative day 6.
-
This study investigates the predictive values of the Risk Analysis Index (RAI), the modified 5-item Frailty Index (mFI-5), and advanced age for predicting 30-day extended length of stay (LOS), 30-day complications, and readmissions in patients undergoing posterior spinal fusion (PSF) for adult spinal deformity (ASD). ⋯ This study suggests that the utility of RAI and mFI-5 in predicting extended LOS patients undergoing PSF for ASD. RAI was found to be superior to mFI-5 for predicting 30-day readmissions, while mF-5 was greater for 30-day complications. These findings highlight the need for future studies to identify optimal methods in incorporating frailty assessments into preoperative surgical planning and patient discussions.
-
ChatGPT is a natural language processing chatbot with a significant prevalence in modern media with a clear application in the medical triage workflow. ChatGPT has shown significant capacity for understanding clinical vignettes, radiology reports, and even passing the American Board of Neurological Surgery board examination. There has never been an evaluation of the chatbot in triage and diagnosing spinal vignettes common to primary and urgent care practice. ⋯ ChatGPT is a powerful tool for primary triage of spinal issues. It can rapidly and accurately evaluate clinical scenarios and provide clear diagnostic reasoning. GPT-4 is not designed for medical use and will provide a disclaimer as such. It did tend toward over-referring patients to the ER. With specific training, it is likely that artificial intelligence and natural language processing chatbots will become widely used in primary triage of spinal issues.
-
Intracranial pressure (ICP) is a well-established measure in managing not only traumatic brain injury but also nontraumatic intracranial bleeding or edema. When ICP increases despite nursing or medical management, ICP may be reduced via surgical measures. Deciding whether to perform a craniotomy vs. craniectomy (whether the bone flap is replaced or not, respectively) is commonly made intraoperatively following preoperative planning. While ICP monitoring (ICPm) is standard pre- and postoperatively, its intraoperative utility remains understudied. ⋯ These results bring forward the potential pivotal role of intraoperative ICPm in guiding surgical strategies for elevated ICP, suggesting a novel data-driven approach to intraoperative management of decompression surgery.