World Neurosurg
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Case Reports
Ruptured Intracranial Dermoid: Is surgery indispensible. 11 Year follow up of a rare entity.
Dermoid cysts are rare intracranial lesions that can occasionally rupture into intraventricular and subarachnoid spaces and can present with a myriad of symptoms. The surgical intervention in such cases is demanding, because the disseminated contents are spread widely in intraventricular and subarachnoid space. ⋯ Surgical intervention may not be essential in all patients with ruptured intracranial dermoids. In a few selected patients who do not manifest increased intracranial pressure and show no change in the size of the lesion on sequential radiologic follow-up, conservative management may be attempted, especially when the ruptured intracranial dermoid is located at eloquent areas and with wide dissemination of contents.
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Biomechanical studies demonstrate that cortical bone trajectory pedicle screws (CBTPS) have greater pullout strength than traditional pedicle screws with a lateral-medial trajectory. CBTPS start on the pars and angulate in a mediolateral-caudocranial direction. To our knowledge, no large series exists evaluating the perioperative outcomes and safety of CBTPS. ⋯ As CBTPS becomes increasingly popular among spine surgeons performing lumbar fusion, this report provides an important evaluation of technique safety and acceptable perioperative outcomes.
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Intraventricular meningiomas (IVMs) are rare tumors compared with intracranial meningiomas. Optimal surgical management of IVMs is controversial. The objective of this article was to review the outcomes and complications of meningiomas treated with various surgical approaches. ⋯ Based on a literature review and our experience, surgical approaches for patients with IVM vary according to size, location, and laterality of the meningioma. In addition, the growth pattern of the tumor (transependymal extension), vascular supply of the tumor, and brain function (particularly visual function) can affect surgical treatment and should be identified preoperatively.
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Segmental arterial mediolysis (SAM) is not yet well known in the neurosurgical field, even though it has become an increasingly recognized pathology in arterial dissection. ⋯ It is very important that SAM is recognized as a systemic disease that affects the central nervous system, visceral arteries, and coronary arteries. The possibility of SAM should always be considered, particularly in patients with ruptured VA dissection-which is nowadays treated by endovascular techniques-since concomitantly involved visceral arteries may cause unexpected hemorrhagic complications other than SAH.
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This is the first nationwide study to evaluate the factors associated with developing hospital-acquired infections (HAIs) after aneurysmal subarachnoid hemorrhage (SAH) and analyze their impact on the efficiency of hospital care. ⋯ In this nationwide analysis, urinary tract infections and pneumonia were the most common hospital-acquired infections after SAH. Although all infections were associated with significantly longer hospitalizations and greater charges, pneumonia and CVC-associated infections were also associated with increased likelihood of a poor outcome.