World Neurosurg
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Visual impairment affects 55%-80% of medial sphenoid wing meningiomas (mSWMs) patients, making optic nerve decompression a critical surgical goal. Complete resection often leads to better visual outcomes. However, involvement of critical neurovascular structures increases postoperative morbidity and mortality, with vascular injury reported in 18%-20% of cases. This study aims to evaluate the relationship between the extent of resection (EOR), visual outcomes, and the incidence of vascular injury, seeking to identify the optimal surgical approach for mSWMs. ⋯ Cavernous sinus-extension and T2-hyperintensity predict poor resection rates in mSWMs. While visual outcomes are not directly affected by EOR, long-term visual status may decline due to tumor recurrence and radiotherapy. Vascular injury incidence is not associated with EOR. Thus, the "maximal safe resection" of mSWMs involves a surgical strategy balancing targeted aggressive and conservative resection for maximal cytoreduction and functional preservation.
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To evaluate current usage and barriers of electronic consent (e-consent) implementation in neurosurgical practice. E-consent forms provide an alternative method for conducting the informed consent (IC) procedure. IC requires an ability to understand, retain, weigh up, and communicate decisions regarding the proposed procedure. Currently, e-consent has shown promise as a method of improving IC, yet barriers to implementation exist. ⋯ Despite the advantages conferred by e-consent for the administration of IC in neurosurgical procedures, reflected in our survey data, there remains limited use of the technology. Limitations remain relating to ease of access and complexity of use in trauma scenarios.
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Acute kidney injury (AKI) is a complication often observed in critically ill patients, indicating a worsening prognosis. However, factors predicting AKI in subarachnoid hemorrhage (SAH) patients are unclear. This study aims to elucidate the predictors of AKI occurrence. ⋯ AKI occurred in 16.3% of the patients with SAH. Patients who developed AKI had significantly higher uric acid levels. SAH with high uric acid levels warrants attention for AKI.
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Epidermoid cysts are prevalent noncancerous cutaneous lesions known to exhibit unusually extended periods of growth. In this study, we present a remarkable case of an epidermoid cyst located on the scalp, which exhibited a growth period of 76 years, the longest growth time documented in the literature to date. ⋯ This case highlights the ability of epidermoid cysts to manifest as slow-growing entities over an exceptionally prolonged timeframe. Furthermore, instances of rapid growth may be attributed to a combination of mass rupture and inflammatory processes.
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Endoscopic pituitary adenoma surgery has a steep learning curve, with varying surgical techniques and outcomes across centers. In other surgeries, superior performance is linked with superior surgical outcomes. This study aimed to explore the prediction of patient-specific outcomes using surgical video analysis in pituitary surgery. ⋯ Superior surgical skill and shorter surgical time were associated with superior surgical outcomes, at a generic and phase-specific level. Such video-based analysis has promise for integration into data-driven training and service improvement initiatives.