World Neurosurg
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Symptomatic postoperative spinal epidural hematomas (PEDHs) are rare complications, with significant implications on patients' functional outcomes. Strategies for PEDH prevention are poorly understood. This study sought to evaluate preoperative and intraoperative variables predicting the risk of PEDH and patients' functional outcomes after PEDH evacuation. ⋯ Although the incidence of PEDH was less than 1%, nearly half of the patients developed motor weakness as a presenting symptom and a third of the patients never had resolution of the weakness.
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Surgical interventions for arachnoid cysts and glioependymal cysts primarily focus on cyst decompression and establishing communication with cerebrospinal fluid spaces. However, a standardized surgical strategy for symptomatic convexity cysts lacking surrounding cerebrospinal fluid space is still lacking due to the limited number of cases. This systematic review aims to evaluate surgical interventions for symptomatic convexity cysts and proposes a safe and effective treatment approach we have developed. ⋯ Furthermore, the surgery was conducted with the patient fully awake, and the use of electrical stimulation mapping enabled preservation of higher neurocognitive functions, including language, working memory, and spatial cognition, at the puncture site. This novel approach offers advantages such as minimally invasive procedure, preservation of safe brain function, and long-term patency. Further studies are warranted to validate these findings and improve surgical strategies for convexity cysts.
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The subsidence of vertebral body replacement may occur after anterior cervical corpectomy and fusion (ACCF), which may lead to cervical kyphosis, spinal cord compression, and neurological dysfunction. The authors aim to investigate the risk factors for early subsidence of 3D-printed artificial vertebral body (3D-PAVB) after ACCF surgery and to provide guidance for clinical practice. ⋯ The occurrence of early subsidence of 3D-PAVB post ACCF surgery is influenced by 2 independent risk factors: smoking and low HU. To predict the likelihood of this outcome, it is advisable to consider smoking history and measure CT HU value prior to surgery. A lower CT HU value is indicative of a greater risk of subsidence.
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Endoscopic endonasal surgery is a feasible approach to lesions of the pediatric skull base. Olfactory outcomes after endoscopic endonasal approach (EEA) have been reported in the adult literature, but pediatric outcome data are lacking. The purpose of this preliminary study is to evaluate postoperative olfactory outcomes in pediatric patients who underwent EEA through transsphenoidal and/or transclival corridors. ⋯ Olfactory preservation is possible after pediatric EEA, although 40% of patients will develop some degree of microsmia in the immediate postoperative period and 20% will have some persistent dysfunction at 6 months. Long-term data are necessary to determine whether microsmia continues to improve over time.
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Postoperative pain is the most common undesirable outcome after neurosurgery. Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that is administered parenterally and carries a theoretical increased risk of bleeding. Our study aims to determine whether ketorolac after craniotomy for tumor resection significantly changes the rate of postoperative adverse events, adequately controls pain, and decreases concurrent narcotic use. ⋯ Ketorolac is a safe and effective option for pain control after craniotomy for tumor resection. Prospective data are needed to better validate these retrospective observations.