World Neurosurg
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Comparative Study
A population-based study of inpatient outcomes after operative management of nontraumatic intracerebral hemorrhage in the United States.
In the United States, data on patient outcomes after operative management of nontraumatic intracerebral hemorrhage (ICH) have been largely derived from tertiary care academic institutions. Given that outcomes of patients treated at these specialized centers may differ from those treated at community hospitals, our aim was to report patient outcomes on a population-based, national level. ⋯ Patients with intracerebral hemorrhage who undergo craniotomy or craniectomy have a high morbidity and mortality. Male gender, preoperative comorbidities, complications, and low hospital volume were associated with an increased risk of in-hospital mortality.
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The use of nanoparticles in diagnostic imaging is rapidly gaining utility and acceptance. A handful of iron oxide nanoparticle compounds have already been approved by the U. S. ⋯ The ability of these particles to interact with cellular biology at a molecular level does have theoretical injurious potential. As with any medical intervention, its relative risks must be clearly understood. This article discusses the safety profile and potential toxicities of nanoparticles as used in diagnostic imaging, and serves to inform the prescribing physician of relative and potential risk to the patient.
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For children who survive traumatic atlantooccipital dislocation (AOD), early surgical stabilization and arthrodesis of the occipitoatlantoaxial complex is typically performed. Because of the unique and crowded anatomy of the occipitocervical junction, the creation of a fusion construct that is both safe and biomechanically sound is extremely challenging, especially in infants. We present a technical report of a patient with infantile type I AOD with gross instability, who underwent surgical stabilization consisting of occiput to C2 arthrodesis using autologous rib, augmented with bone morphogenic protein 2 (BMP-2), Mersilene suture, and Ethibond suture as "cross-connectors." ⋯ Significant surgical challenges exist regarding occipitocervical fusion in infants with AOD and gross instability. This case report illustrates the successful application of BMP-2-augmented occipitocervical fusion using autologous rib, in combination with Mersilene and Ethibond suture, in the treatment of an infant with type I AOD with gross instability.
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The optimal management of patients with recurrent glioblastoma multiforme (GBM) is a subject of controversy. These patients may be candidates for both reoperation and/or gamma knife surgery (GKS). Few studies have addressed the role of GKS for relapsing gliomas, and the results have not been compared with reoperation. To validate the efficacy and safety of GKS, we compared the survival and complication rates of GKS and reoperation for recurrent GBMs. ⋯ GKS may be an alternative to open surgery for small GBMs at the time of recurrences, with a significantly lower complication rate and a possible survival benefit compared with reoperation.
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Carotid endarterectomy (CEA) is a useful procedure to prevent subsequent ischemic stroke in patients with severe stenosis of internal carotid artery. However, lowering of morbidity is still essential to keep its clinical significance. This study aimed to evaluate the validity of dual monitoring using transcranial motor evoked potential (MEP) and near-infrared spectroscopy (NIRS) during CEA. ⋯ These findings strongly suggest that both MEP and NIRS can detect critical cerebral ischemia during CEA in most patients. Dual MEP and NIRS monitoring may further increase the sensitivity to identify it, being valuable to prevent perioperative complications due to cerebral ischemia during CEA.