World Neurosurg
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The coexistence of a primary brain tumor such as high-grade glioma and superimposed abscess is a rare entity and can present a diagnostic and therapeutic challenge. The concomitant abscess may not be recognized until surgery, and the overall course of treatment may require adjustment in the presence of a coinciding infection. In the present report we evaluate the diagnosis and treatment of a glioblastoma multiforme with an intratumoral abscess. ⋯ There are insufficient guidelines on the treatment of a primary brain tumor with intratumoral abscess. In this report we present our therapeutic decisions in this rare case.
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Anterior cervical discectomy and fusion (ACDF) procedures are increasingly being managed on an outpatient basis. Currently there are no definitive guidelines within the literature that delineate which patient population can safely be managed as such. The purpose of this study is to demonstrate that ACDF procedures, within a selective patient population at our institution, can be safely performed on an outpatient basis. ⋯ ACDF procedures involving single and two-level fusions can safely be performed on an outpatient basis. Complication rates associated with this procedure are low, with critical postoperative complications involving respiratory compromise occurring very infrequently and in the immediate postoperative period.
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Case Reports Clinical Trial
Placement of percutaneous thoracic pedicle screws using neuronavigation.
Percutaneous thoracic pedicle screw fixation is challenging because of the complexity of the spinal anatomy and obscuration of normal surgical landmarks by soft tissue. We report a novel percutaneous technique in which intraoperative Iso-C C-arm navigation was used to treat complex thoracic spinal fractures. ⋯ Percutaneous thoracic pedicle screw fixation with intraoperative neuronavigation for the stabilization of complex spinal fractures is feasible and associated with acceptable rates of accuracy and morbidity.
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Case Reports
Abnormal white matter changes after cerebral aneurysm treatment with polyglycolic-polylactic acid coils.
Polyglycolic-polylactic acid (PGLA) coils induce inflammation within a cerebral aneurysm, which in turn is hypothesized to decrease aneurysm recurrence. We present 2 patients, who after aneurysm coiling with PGLA coils, developed mild symptoms and extensive magnetic resonance imaging (MRI) white matter changes. ⋯ Conclusions: After extensive evaluation for alternate causes of disease, we hypothesize that the patients' symptoms and MRI findings, which were not all within the territory supplied by the coiled vessel, were due to an overexuberant inflammatory response related to the PGLA coils. These cases highlight the importance of heightened clinical suspicion of neurologic complaints in the subacute period after aneurysm coiling. We recommend a low threshold for neuroimaging of these patients.
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Randomized Controlled Trial
Applying cerebral hypothermia and brain oxygen monitoring in treating severe traumatic brain injury.
Severe traumatic brain injury (TBI) was to be one of the major health problems encountered in modern medicine and had an incalculable socioeconomic impact. The initial cerebral damage after acute brain injury is often exacerbated by postischemic hyperthermia and worsens the outcome. Hypothermia is one of the current therapies designed to combat this deleterious effect. The brain tissue oxygen (P(ti)o(2))-guided cerebral perfusion pressure (CPP) management was successfully reduced because of cerebral hypoxic episodes following TBI. ⋯ Therapeutic mild hypothermia combined with P(ti)o(2)-guided CPP/ICP management allows reducing elevated ICP before 24 hours after injury, and daily variations of ICP were shown to be significantly different among the three treatment groups after the third posttraumatic day. It means that the hypothermia groups may reduce the ICP earlier and inhibit the elicitation of acute inflammation after cerebral contusion. Our data also provided evidence that early treatment that lowers P(ti)o(2) may improve the outcome and seems the best medical treatment method in these three groups. We concluded that therapeutic mild hypothermia combined with P(ti)o(2)-guided CPP/ICP management provides beneficial effects when treating TBI, and a multicenter randomized trial needs to be undertaken.