World Neurosurg
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Existing scoring system's comparative effectiveness in identifying patients with poor prognosis (i.e., <6 months survival) has not been thoroughly explored. ⋯ This study shows that most scoring systems have low discriminative power, with only the SORG nomogram having moderate power for predicting poor prognosis. Recent and future advances in treatment, laboratory markers, and our understanding of tumor biology should be incorporated into prognostic models to improve their accuracy.
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Early diagnosis of diabetes insipidus (DI), a complication following pituitary surgery, can avoid catastrophic results such as lethargy or even death. Measurement of arginine vasopressin (AVP) may help the early diagnosis, but its direct assaying is challenging. Copeptin, which is co-secreted in equimolar quantities to AVP, is suggested to be a reliable marker in prediction of postoperative DI. Therefore, this systematic review plus meta-analysis aims to discover this possible role. ⋯ Copeptin level was significantly lower in DI patients than in non-DI patients who underwent pituitary surgery. Early measurement, as soon as possible (from the first hour to 48 hours after the operation) of copeptin after pituitary surgeries has good, but not excellent, accuracy to exclude postoperative DI.
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Numerous studies have demonstrated a strong association between traumatic brain injury (TBI) and an increased risk of meningioma. However, this correlation remains controversial. This study utilized Mendelian randomization to explore this relationship from the perspective of genetic evidence. ⋯ The Mendelian randomization study revealed that TBI does not increase the risk of meningioma based on genetic evidence.
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Complete traumatic dorsal spondyloptosis with no neurological involvement is so rare due to the inherent stability of the thoracic spine, that only 2 other cases are reported in literature. A 31-year male with history of fall, and normal neurological examination was noted to have grade 5 dislocation at D7-D8, with locking of D7-8 bodies and expanded canal due to pedicle fractures accommodating the displaced spinal cord. As the excessive manipulation to achieve reduction was deemed too risky to be worthy, it was decided to do in-situ fixation without reduction. ⋯ Under O-arm navigation, pedicle screws were placed in D5,6,8,9&10, with D8 screws crossing onto D7. The rods had to be contoured in S shape and maneuvered across all screw heads. The patient has remained asymptomatic for more than 2 years after surgery.
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Five billion people worldwide lack access to safe, timely, and affordable surgical and anesthesia care. This deficit is greatest in low- and middle-income countries, especially for specialty surgical services including neurosurgery, due to insufficient personnel, resources, and infrastructure. The southeastern European nation of the Republic of Moldova is one such middle-income country. ⋯ This article provides the first-ever description of the history and current state of neurosurgery in Moldova and presents key recommendations to guide the international neurosurgery community in developing neurosurgical care in countries with an unmet need.