Surgical neurology international
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Vascularized nasoseptal flaps allow for the reconstruction of large dural defects and have remarkably reduced the incidence of postoperative complications during endoscopic endonasal skull base surgery. Nevertheless, some complications related to nasoseptal flap have been reported. Flap necrosis is a rare, but serious issue is associated with meningitis and cerebrospinal fluid (CSF) leak. ⋯ Our case suggested that partial rather than total flap necrosis could occur, possibly due to variances of vascular anatomy, leading to focal ischemia. Debridement of the necrotic region may be an important solution for recurrent cerebrospinal leakage secondary to partial necrosis of a nasoseptal flap.
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Severe traumatic brain injury (TBI) is a significant cause of death and disability. The objective of this study was to provide an overview of whether adherence to brain trauma foundation (BTF) guidelines improved outcomes following TBI utilizing intracranial pressure (ICP) monitoring. ⋯ Adherence rates to BTF guidelines for ICP monitoring in patients with severe TBI were low. Further, these rates varied across centers and were correlated with higher mortality and morbidity rates. Although ICP insertion may be an indicator of TBI severity, the current BTF criteria for insertion of ICP monitors may fail to identify patients likely to benefit.
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The volume and spectrum of neurosurgical procedures being performed during the coronavirus disease 2019 (COVID-19) pandemic have significantly changed as compared to the pre-COVID-19 period. The objective of this study is to examine this change and draw useful conclusions. ⋯ This paper highlights the drastic reduction in the operative workflow and the outpatient clinic workflow during the ongoing corona pandemic which will have significant collateral damages in the long run. We will have to strike the right balance between providing our patients with the best medical treatment while limiting the spread of the COVID-19 infection.
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Case Reports
Foramen magnum osteochondroma causing myelopathy in a patient with hereditary multiple exostoses.
Osteochondromas are commonly occurring benign bone tumors which may be either a solitary lesion or occur due to association with hereditary multiple exostoses (HMEs). There have been several reported cases of spinal osteochondromas, but intracranial lesions are rare. ⋯ Osteochondromas of the skull are extremely rare. However, parts of the foramen magnum ossify in cartilage and can give rise to an osteochondroma. Here, we present a patient with HMEs who developed cervical myelopathy due to an osteochondroma arising from the foramen magnum. Due to the cartilaginous ossification of the foramen magnum, clinicians should be aware that osteochondromas can occur in this location and potentially give rise to cervical myelopathy.
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Unruptured intracranial aneurysms (UIAs) are not uncommon, especially in Japan. Treatment strategy for UIAs has evolved in the past decades in Western countries with the increased use of endovascular treatment as the primary option, but in Japan, clipping still has the upper hand. ⋯ Clipping and coiling were both safe and feasible in the treatment of unruptured aneurysms. The clipping was advantageous in durability, while the rate of morbidity was lower, and hospitalization period was shorter in the coiling group. The clipping and coiling should coexist while complementing each other by understanding the advantages and disadvantages of both.