World Neurosurg
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Preoperative diagnoses of psychiatric disorders have a demonstrated association with higher rates of perioperative complications. However, recent studies examining the influence of psychiatric disorders on lumbar fusion outcomes are scarce. Our objective was to determine the relationship between the most common psychiatric disorders and perioperative outcomes after lumbar fusion. ⋯ Patients with depression, bipolar disorder, or anxiety exhibited higher rates of certain types of complications. However, they appeared to have fewer neurological injuries and wound complications than patients without these psychiatric disorders. These findings highlight the necessity for additional studies to elucidate underlying reasons for these disparities.
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Metastasis of WHO grade II or grade II meningiomas are rare. The aim of this study was to investigate their incidence, associated risk factors and treatment course. ⋯ The presence of metastasis contributed to poor outcomes and was related to earlier tumor relapse and major vessel compromise. Subtotal resection should be followed by adjuvant radiotherapy to reduce the risk of metastasis. Further research is warranted to identify circulating or pathologic biomarkers for the early detection of metastasis.
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Length mismatch between the aspiration catheters and microcatheters can hinder optimal thrombus engagement, particularly in tortuous vessels and cases of vascular stenosis. We present a case in which a side puncture technique was employed to deploy the stent retriever when exchangeable devices is unavailable. A man in his seventies with basilar artery occlusion underwent mechanical thrombectomy. ⋯ Thrombus extraction was then successfully performed using the Solumbra technique. This approach is advantageous for its simplicity and eliminates the need for additional devices. However, it also has specific drawbacks, such as damaging the aspiration catheters.
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There is a well-documented association between Cushing's syndrome (CS) and hypercoagulability. However, there is limited data on the risk of venous thromboembolic events (VTEs) after surgery for Cushing's disease (CD). There is no consensus on optimal postoperative anticoagulation strategies in this group. This review gathers information on the rates of VTE after surgery for CD, as well as reported prophylaxis strategies in this population. ⋯ Postoperative VTE in CD is a source of morbidity, with a rate of 2% and mortality rate of 0.2%, highlighting that surgical resection of the corticotroph adenoma does not necessarily result in immediate resolution of hypercoagulability. Increased production of coagulation factors, impaired fibrinolysis, inflammation, and CS-associated metabolic risk factors all factor into the pathogenesis of CS-associated hypercoagulability. Further study is needed on an optimal pharmacologic prophylaxis strategy.