World Neurosurg
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Methotrexate is an immunosuppressant commonly used to treat inflammatory conditions, such as rheumatoid arthritis. However, albeit exceedingly rare, it can have serious adverse effects within the central nervous system (CNS), such as methotrexate-associated lymphoproliferative disorder (MTX-LPD). Literature describing the natural history, treatment options, and clinical outcomes of patients with CNS MTX-LPD remains sparse. ⋯ CNS MTX-LPD should be considered in the differential diagnosis for patients who are taking MTX presenting with neurologic symptoms, as immediate withdrawal of MTX has demonstrated good prognosis.
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In endoscopic thoracic spine surgery, adaptations of thoracic surgical techniques such as full endoscopic uniportal and biportal surgical techniques have been developed. Full endoscopic uniportal surgery for thoracic disc herniation or thoracic ossified ligamentum flavum (OLF) has been performed via transforaminal and interlaminar approaches. In the case of thoracic OLF or thoracic spinal stenosis, the uniportal interlaminar approach is appropriate. ⋯ Based on the results of several previous studies, endoscopic thoracic spine surgery could be associated with fewer potential complications than conventional surgery. Endoscopic spine surgery has remarkable advantages; however, endoscopic thoracic surgery is technically challenging and is potentially associated with serious complications. To minimize the risk of avoidable complications, surgeons should be familiar with prevention methods and pitfalls.
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The pterional craniotomy is a workhorse of cranial surgery that provides access to the anterior and middle fossae. However, newer "keyhole" approaches, such as the micropterional or pterional keyhole craniotomy (PKC) can offer similar exposure for many pathologies while reducing surgical morbidity. ⋯ Furthermore, it represents an ongoing trend toward smaller craniotomy size for elective cranial procedures. In this historical vignette, we trace the history of the PKC from its origins to its current role in the neurosurgeon's armamentarium.
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Awake craniotomy is a unique method to prevent motor deficits during the resection of lesions located in or close to functional areas. We sought to study the outcomes of pediatric craniotomy on published studies. ⋯ This systematic review summarized that awake brain surgery can prevent significant motor and language deficits postoperatively in children after tumor resection as it is considered a feasible and safe procedure.
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Medical students are important team members and future healthcare providers in neurosurgery or other medical fields. We performed a systematic review evaluating studies assessing medical student guidance, mentorship, and career development in neurosurgery. The study aimed to identify the best practices and acknowledge gaps requiring improvement. ⋯ These studies highlight the current endeavors to encourage medical student careers. However, ample gaps and missed opportunities were also identified. Further work at both institutional and national levels is needed to improve the current environment.