World Neurosurg
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Delayed symptomatic hyponatremia (DSH) is one of the common complications following endoscopic endonasal surgery (EES). Currently, published studies have predominantly focused on delayed postoperative hyponatremia, while there is relatively limited research on DSH. ⋯ The incidence rate of DSH after EES in patients was 16.8%. Knosp grade ≥3, intraoperative cerebrospinal fluid leaks, serum sodium concentration on the second day after surgery, and postoperative DI were associated with the occurrence of DSH.
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The contralateral transmaxillary corridor improves access to anterior petrous apex lesions back to the level of the internal auditory canal without the need to mobilize the paraclival internal carotid artery. In this Video 1, we present the case of 31-year-old female patient who presented with new left abducens palsy during pregnancy. Imaging revealed a heterogeneous enhancing extradural mass within the left petrous apex region extending posterior to the horizontal segment of the petrous internal carotid artery, consistent with chondrosarcoma. ⋯ The patient consented to the procedure. A complete resection of the mass was performed with pathology demonstrating a grade 2 chondrosarcoma. The patient tolerated the procedure without any complications, the left abducens palsy resolved in follow-up by 3 weeks, and a multidisciplinary tumor board recommended postoperative observation without adjuvant therapy.7 An endoscopic endonasal and contralateral transmaxillary approach is a feasible option for petrous apex lesions such as chondrosarcoma.
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Postoperative delirium (POD) is frequently reported in the elderly after major surgery. Several risk factors have been identified, including age, surgical complexity, and comorbidities. ⋯ Nearly 0.5% of patients who underwent posterior spinal fusion between 2010 and 2022 developed delirium, although incidence rates have decreased over time. POD was common in elderly patients with electrolyte disturbances who underwent multilevel fusions. Patients suffering from POD had higher rates of 90-day postoperative complications. Ongoing efforts to deliver interventions to mitigate the consequences of POD among spine surgery patients are warranted.
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The presented surgical video (Video 1) demonstrates the resection of an intradural extramedullary metastasis in a 62-year-old female patient with a history of metastatic small cell lung cancer (SCLC). SCLC commonly metastasizes to the central nervous system.1,2 However, the vast majority of such metastases are to the brain.1,2 Interestingly, the presented patient had a cerebellar SCLC metastasis operated on 10 months earlier. Several cases of intradural extramedullary spinal drop metastases arising from cerebellar tumors have been described in the literature, suggesting that a drop metastasis is a likely mechanism to explain this rare topography.3-5 Preoperatively, the patient presented with 1 month of back pain and rapidly progressing left lower extremity weakness and myelopathic signs so surgery was offered.6-10 Interval imaging showed an intradural extramedullary T4-T5 lesion suspicious for metastatic disease. ⋯ Complete resection required sacrifice of the left T5 nerve root and cutting of the dentate ligament in 2 locations for adequate visualization. Postoperative neurologic exam demonstrated improvement in her lower extremity weakness, and postoperative magnetic resonance imaging showed gross total resection. The postoperative course was uneventful, and the patient was discharged home on postoperative day 6.
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The link between tethered cord syndrome (TCS) and neurofibromatosis type 1 (NF1) remains unclear. To date, only 2 studies have indicated a high occurrence of TCS in the pediatric NF1 patient population. Our study aims to ascertain the incidence of TCS among Chinese pediatric patients with NF1. ⋯ In the group of pediatric patients with NF1, the incidence of TCS, presenting to the pediatric neurosurgery clinic for any reason, is significantly higher than that of the general population. However, the pathophysiological relationship between NF1 and TCS is still not clear. It is essential to provide counseling to NF1 patients and their families about the symptoms of TCS to make sure they are aware and can seek the necessary care when needed. This underscores the importance of not only diagnosing NF1 but also staying alert for related conditions like TCS, which may have a higher occurrence in this demographic.