World Neurosurg
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We describe a 2-stage strategy utilizing the endoport-assisted endoscopic technique for the evacuation of severe intraventricular hemorrhage (IVH) with a cast third ventricle, and discuss potential pitfalls in the implementation of this method in clinical practice. ⋯ The endoport-assisted 2-stage endoscopic technique marks a significant advancement in treating severe IVH with a cast third ventricle. By combining dry and underwater approaches, it provides an innovative solution for effectively and safely clearing hematomas in both lateral and third ventricles. This technique addresses the crucial need for early cerebrospinal fluid circulation restoration, potentially improving outcomes for patients with these complex cases.
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A rare presentation of unilateral carotid rete mirabile (RM) in a 70-year-old male manifesting as limb-shaking transient ischemic attacks, a disorder typically associated with carotid artery stenosis. The patient experienced recurrent left-sided limb shaking and numbness, with angiography revealing an anomalous microarterial collateral network replacing the right internal carotid artery's cavernous segment, indicative of RM. ⋯ The patient's management involved antiplatelet therapy and lifestyle changes, following which he reported no further cerebrovascular events. This case underscores the importance of considering RM in differential diagnoses of limb-shaking transient ischemic attack and suggests conservative management as a favorable approach.
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Pseudarthrosis is a common complication of transforaminal lumbar interbody fusion (TLIF) that can affect the long-term prognosis and increase revision surgery risk. Therefore, it is crucial to investigate the risk factors associated with pseudarthrosis and develop a predictive model. ⋯ History of smoking, osteoporosis, and change of mean disc height are all independent risk factors of pseudarthrosis following TLIF surgery; a nomogram based on these may help predict the probability of pseudarthrosis.
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Burnout syndrome impacts 1 of 2 neurosurgeons and negatively impacts both the individual and institution. The impact of burnout on neurosurgeons may have increased due to the SARS-CoV-2 pandemic. Characteristics of burnout may differ among neurosurgeons and non-neurosurgeon physicians, and this may better target wellness initiatives designed to alleviate burnout. ⋯ We show that although the rate of burnout does not differ for neurosurgeons, the characteristics of burnout may. This may represent the key to providing specialty-specific targeted interventions to alleviate burnout. Furthermore, there is a significant proportion of neurosurgeons at risk for subsequent burnout for which additional importance must be placed to prevent progression to burnout.
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Meningiomas are the most frequently diagnosed benign intracranial tumors. However, meningioma en plaque (MEP) is a rare subset accounting for 2.5% of all meningiomas and is characterized by flat, carpetlike proliferation along the dura, typically arising in the spheno-orbital region, and, therefore, causes proptosis, decreased visual acuity, and orbital pain. We present a unique case of a patient with MEP presenting with cerebrospinal fluid (CSF) rhinorrhea and conduct a systematic review of the literature. ⋯ MEP associated with spontaneous CSF rhinorrhea is extremely rare and poses diagnostic and therapeutic challenges. Conservative management for select cases of MEP can be a good choice, sparing the patient from surgical complications, especially for skull base areas that are difficult to access.