World Neurosurg
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Hydrocephalus remains a common sequela of intraventricular hemorrhage (IVH) despite adequate drainage of the hematoma, including endoscopic surgery, intraventricular fibrinolysis, and external ventricular drainage (EVD). Moreover, the appropriate timing for conversion from EVD to ventriculoperitoneal shunt (VPS) is uncertain. This study aimed to evaluate the predictors of shunt dependency in patients with IVH based on the early EVD weaning protocol in our institution. ⋯ This study showed that a large temporal horn diameter and a lower degree of IVH removal were predictors of shunt dependency in patients with IVH. In addition, early conversion from EVD to ventriculoperitoneal shunt is safe and feasible.
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During the past decades, different methods have been described for anterior skull base reconstruction. Regarding larger skull base defects, few investigators have described the use of bone grafts to foster support and prevent frontal lobe sagging, herniation, or falling. The aim of this study is to describe the use of a rib bone graft, which could be an option in these cases due to its rigidity and dimensions. ⋯ The use of a cortical rib bone graft could be a safe and effective option in skull base reconstruction when managing large defects after cancer removal.
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Neurosurgeons occasionally encounter cases of subarachnoid hemorrhage (SAH) in admitted walk-in patients, termed "walk-in SAH." However, their clinical characteristics have not been fully understood. We thus, aimed to investigate several characteristics of patients with walk-in SAH and compare them with those of patients with good grade SAH who arrived at the hospital by ambulance. ⋯ Patients with walk-in SAH exhibit radiological characteristics associated with a more favorable outcome among patients with good grade SAH. Therefore, these patients may have a positive prognosis.
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Synovial cysts of the spine are degenerative cystic lesions that can lead to severe symptoms secondary to compression of the spinal cord, individual nerve roots, and/or the cauda equina. Some believe the etiology of this entity is related to increased motion across the facet joint and instability. We report a case of a lumbar synovial cyst located at the same level as a previously inserted spinous process fusion device. This case illustrates that, unlike a transpedicular instrumented fusion where the risk of synovial cyst formation is zero, a spinal process fusion can still lead to synovial cyst formation likely due to persistent micromotion across that segment.
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Case Reports
Intraoperative Ultrasound and Findings of Lumbar Intradural Disc Herniation causing Cauda Equina Syndrome.
Intradural lumbar disk herniation (ILDH) is a rare variant and accounts for 0.33%-1.5% of lumbar disk herniations. Although clues exist on preoperative imaging, they remain subtle and most cases of ILDH are diagnosed intraoperatively. Intraoperative ultrasound is a useful adjunct in diagnosing and managing ILDH. We present a case to demonstrate the features of an intradural herniated disk on ultrasound imaging and highlight the utility of intraoperative ultrasonography in establishing diagnosis, guiding dural opening, and confirming adequate nerve root decompression following diskectomy.