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Neurosurgical complications

Panagiotis Kerezoudis, Amy E Glasgow, Mohammed Ali Alvi, Robert J Spinner, Fredric B Meyer, Mohamad Bydon, Elizabeth B Habermann
BACKGROUND: Return to the operating room (ROR) has been put forth by the National Quality Forum and the American College of Surgeons as a surgical quality indicator. However, current quality metrics fail to consider the nature and etiology of the ROR. OBJECTIVE: To provide a comprehensive description of all reoperations after neurosurgical procedures and assess the validity of ROR as a quality measure in neurosurgery. METHODS: We retrospectively analyzed all neurosurgical procedures performed in a high-volume, tertiary care academic medical center between June 1, 2014 and December 31, 2016...
October 8, 2018: Neurosurgery
Sean P Polster, Shirlene Obuobi, Victor J Del Brutto, Kenneth Avner, Aikaterini Markopoulou, Ricky H Wong
Background: Pneumocephalus is a common finding following intracranial procedures, typically asymptomatic and resolves within several days. However, in some cases, pneumocephalus presents with headache, encephalopathy, or symptoms of elevated intracranial pressure. Here, we present a case of iatrogenic tension pneumocephalus following endoscopic sinus surgery, presenting as abnormal involuntary movements resembling a movement disorder with choreiform movements. Case Description: A 67-year-old previously healthy male presented with new onset chorea and dystonia associated with headache, encephalopathy, and postural instability 4 days after undergoing endoscopic sinus surgery for chronic sinusitis and nasal polyps...
2018: Surgical Neurology International
Celina Crisman, Max Ward, Neil Majmundar, Nitesh Damodara, Wayne D Hsueh, Jean Anderson Eloy, James K Liu
BACKGROUND: Pituitary apoplexy is an uncommon neurosurgical emergency which may be the initial presentation of undiagnosed pituitary adenomas. Though the exact pathogenesis is unclear, there appears to be an association between pituitary apoplexy and medical interventions which disturb the blood supply and venous drainage of the abnormal sellar region. We present the first case of pituitary apoplexy occurring after an endoscopic retrograde cholangiopancreatography (ERCP). CASE DESCRIPTION: A 43-year-old male who was several hours status post ERCP presented with severe headache, bilateral ptosis and multi-directional ophthalmoplegia...
October 3, 2018: World Neurosurgery
Maria A Bustillo, Cynthia A Lien, Patricia Fogarty Mack, David J Kopman, Seyed A Safavynia, Lori Rubin, David Stein, Roger Hartl, Philip E Stieg, R Nick Hernandez, Peter A Goldstein
BACKGROUND: As minimally invasive spine surgery evolves, spine surgeons increasingly rely on advanced intraoperative computed tomography (iCT). iCT provides rapid acquisition of high-resolution images, reduces radiation exposure, improves surgical accuracy, and decreases operative time. However, all iCT systems currently available pose a patient safety risk as their physical space requirements limit patient access in the event of an emergency, particularly when patients are in the prone position...
September 25, 2018: World Neurosurgery
Nathaniel Mohney, Jacques Morcos, Amedeo Merenda
BACKGROUND: The use of ECMO for cardiopulmonary support is indicated for refractory respiratory failure, but carries a high morbidity and mortality in the neurosurgical setting due to associated risks of intracranial hemorrhage. CASE DESCRIPTION: We describe the case of a 62-year-old man who underwent craniotomy for resection of an esthesioneuroblastoma involving the anterior skull base and extending intracranially, through the cribriform plate into the right epidural space...
September 24, 2018: World Neurosurgery
Komal A Chughtai, Omar P Nemer, Alexander T Kessler, Alok A Bhatt
Craniotomy and craniectomy are widely performed emergent neurosurgical procedures and are the prescribed treatment for a variety of conditions from trauma to cancer. It is vital for the emergency radiologist to be aware of expected neuroimaging findings in post-craniotomy and craniectomy patients in order to avoid false positives. It is just as necessary to be familiar with postsurgical complications in these patients to avoid delay in lifesaving treatment. This article will review the commonly encountered normal and abnormal findings in post-craniotomy and craniectomy patients...
September 25, 2018: Emergency Radiology
James A D Berry, Dan E Miulli, Benjamin Lam, Christopher Elia, Julia Minasian, Stacey Podkovik, Margaret R S Wacker
Surgically accessing pathological lesions located within the central nervous system (CNS) frequently requires creating an incision in cosmetic regions of the head and neck. The biggest factors of surgical success typically tend to focus on the middle portion of the surgery, but a vast majority of surgical complications tend to happen towards the end of a case, during closure of the surgical site incisions. One of the most difficult complications for a surgeon to deal with is having to take a patient back to the operating room for wound breakdowns and, even worse, wound or CNS infections, which can negate all the positive outcomes from the surgery itself...
September 24, 2018: International Wound Journal
Mauricio Daniel Sánchez-Calderón, Diego Ochoa-Cacique, Oscar Medina Carrillo, Ulises García González, Rosa María Vicuña González, Carlos Cesar Bravo Reyna, José Raúl Guerra-Mora
INTRODUCTION: Brown tumors are non-neoplastic, expansive bone lesions that occur only in the setting of hyperparathyroidism. The most usual localization of brown tumors is in mandible, ribs and large bones. In cervical spine, to date, there are only 11 cases reported. The aim of this work is to report the case of a patient with Wegener´s granulomatosis with secondary end stage renal failure who developed a brown tumor in C4 vertebra. PRESENTATION OF CASE: A 25-year-old woman with an history of 2 months of worsening cervicalgia without history of trauma...
September 18, 2018: International Journal of Surgery Case Reports
Sameer Jain, Michael A Fishman, Chengyuan Wu
Spinal cord stimulation has been an effective therapy for treatment of chronic low back pain over the last four decades. Over the years, there have been significant technological advances in the neuromodulation devices. Externally powered neuromodulation devices, that do not require an internal pulse generator (IPG) implantation, have recently been approved for treatment of chronic pain and the data on potential pitfalls and unforeseen complications with these devices is minimal. Here, we report a case of a 60-year-old woman with chronic back pain who underwent the implantation of one of such devices and developed complication that required neurosurgical intervention...
September 21, 2018: BMJ Case Reports
Martin U Schuhmann, Cahit Kural, Lisanne Lalla, Florian H Ebner, Christoph Bock, Hans-Christoph Ludwig
OBJECTIVE: The aim of this study is to present the clinical experience of two neurosurgical centers with the use of a 2-micron continuous wave laser (2μ-cwL) system as standard tool in neuroendoscopic procedures and to discuss the safety and efficacy of this system. METHODS: 469 patients underwent neuroendoscopic procedures using 2μ-cwL between September 2009 and January 2015. All patient data were retrospectively reviewed. 241 (51%) patients were children and 228 (49%) adults...
September 20, 2018: World Neurosurgery
Yu-Tse Liu, Tao-Chieh Yang, Shih-Ming Jung, Cheng-Chi Lee
Arteriovenous malformations (AVMs) usually manifest as headaches, seizures, focal neurological signs, and spontaneous intracerebral or subarachnoid hemorrhages. An untreated AVM with associated cyst formation is extremely rare, and the probable pathogenesis is unclear. We propose and discuss the possible pathogenesis of this condition and its diagnosis and management. A 26-year-old male presented with a generalized tonic-clonic seizure. Computed tomography showed a cystic lesion in the left frontal lobe and magnetic resonance imaging revealed a complex composition within the lesion, without a flow-voiding signal...
September 21, 2018: Acta Neurologica Belgica
Victor M Lu, Anshit Goyal, Christopher S Graffeo, Avital Perry, Benjamin P Jonker, Michael J Link
BACKGROUND: Glossopharyngeal neuralgia (GPN) is a rare neuralgic pain syndrome amenable to neurosurgical treatments including nerve section (NS), microvascular decompression (MVD), and stereotactic radiosurgery (SRS). However, thorough comparisons between the modalities have not been performed to date. The objective of this study was to compare the pain and complication outcomes following these approaches to GPN. METHODS: Searches of 7 electronic databases from inception to June 2018 were conducted following appropriate guidelines...
September 18, 2018: World Neurosurgery
Raphaël Cinotti, Nicolas Bruder, Mohamed Srairi, Catherine Paugam-Burtz, Hélène Beloeil, Julien Pottecher, Thomas Geeraerts, Vincent Atthar, Anaïs Guéguen, Thibault Triglia, Julien Josserand, Doris Vigouroux, Simon Viquesnel, Karim Lakhal, Michel Galliez, Yvonnick Blanloeil, Aurélie Le Thuaut, Fanny Feuillet, Bertrand Rozec, Karim Asehnoune, Marie-Pierre Bonnet, Morgan Le Guen, Valeria Martinez, Romain Pirracchio, Amélie Yavchitz
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Craniotomy for brain tumor displays significant morbidity and mortality, and no score is available to discriminate high-risk patients. Our objective was to validate a prediction score for postoperative neurosurgical complications in this setting. METHODS: Creation of a score in a learning cohort from a prospective specific database of 1,094 patients undergoing elective brain tumor craniotomy in one center from 2008 to 2012...
September 28, 2018: Anesthesiology
Joel Z Passer, Christopher M Loftus
Management of anticoagulation and antiplatelet medications after neurosurgery can be complex, especially given that these patients have multiple medical comorbidities. In turn, neurosurgical patients are at high risk for the development of venous thromboembolism after surgery, so neurosurgeons must consider the use of pharmacologic prophylaxis. Developments in endovascular neurosurgery have produced therapies that require close management of antiplatelet medications to prevent postoperative complications. Any of these patient populations may need intrathecal access...
October 2018: Neurosurgery Clinics of North America
James J Zhou, Tsinsue Chen, Peter Nakaji
Intraoperative blood and coagulation factor transfusion is of particular importance to neurosurgeons. Maintaining the hematologic and coagulation parameters of the patient within normal limits during surgery is critical to facilitate normal hemostasis, reduce transfusion requirements, and prevent complications associated with excessive blood loss. In this article, the authors review topics relevant to intraoperative transfusion during neurosurgery, including laboratory studies and other diagnostic modalities available to help with decision making, blood components and coagulation factors currently available for transfusion, and indications for intraoperative transfusion during cranial and spinal neurosurgical procedures...
October 2018: Neurosurgery Clinics of North America
Augustus J Perez, Gerald A Grant
Long-term anticoagulant therapy prevents thrombosis. Management of neurosurgical patients with conditions such as atrial fibrillation, mechanical heart valves, and other prothrombotic states necessitates application of a strategy to mitigate hemorrhagic complications of anticoagulation. Development of direct oral anticoagulants, which include the direct thrombin and factor X inhibitors, yields new considerations to be had, in particular, the introduction of reversal agents. This article reviews the more common chronic clinical entities that require the use of prolonged anticoagulant therapy with special consideration for neurosurgical patients...
October 2018: Neurosurgery Clinics of North America
Anders Kjellberg, Harriet Nyström, Martin Söderberg, Aldona Dlugosz, Henrik Jörnvall, Anna Steinberg
Cerebral air embolism should be considered in case of stroke symptoms during any invasive procedure. Transport to a hospital with neurosurgical/hyperbaric oxygen treatment (HBOT) facility could improve the outcome for the patient. Absence of air on computed tomography (CT) scan should not disqualify a patient from HBOT if air embolism is suspected.
September 2018: Clinical Case Reports
Adiguno Suryo Wicaksono, Wiryawan Manusubroto
STUDY DESIGN: Observational, cross-sectional study. PURPOSE: The purpose of this study was to evaluate the clinical efficacy and safety profile of open-door laminoplasty (ODL) using titanium mesh. OVERVIEW OF LITERATURE: The most appropriate surgical management of degenerative spine disorders, particularly ossification of the posterior longitudinal ligament, remains controversial and continues unabated in the neurosurgical community. However, recently, ODL has become popular among surgeons...
October 2018: Asian Spine Journal
Yimeng Xia, Xin Ma, Brian B Griffiths, Yan Luo
RATIONALE: Being required to perform neurosurgery on a pregnant woman is rare, but occasionally unavoidable. In these cases, clinical anesthesiologists are confronted with conflicting information and few evidence-based guidelines. PATIENT CONCERNS: Here, we describe the successful anesthetic management of a 24-week pregnant woman with macroprolactinoma who underwent endonasal transsphenoidal resection of pituitary adenoma. DIAGNOSES: According to the prolactin (PRL) level and magnetic resonance imaging (MRI) results, the patient was diagnosed with macroprolactinoma and kept stable after taking the regular bromocriptine treatment...
September 2018: Medicine (Baltimore)
Lingyang Hua, Hongda Zhu, Jiaojiao Deng, Mi Tian, Xuewei Jiang, Hailiang Tang, Shihai Luan, Hiroaki Wakimoto, Qing Xie, Ye Gong
PURPOSE: The aim of this study was to thoroughly analyze the clinical characteristics of a large cohort of spinal meningioma (SM) from a single neurological center and identify risk factors associated with worse progression free survival and neurological function outcome. METHODS: Clinical information was retrieved from 483 SM and 9806 cranial meningioma cases who were operated in our center between 2003 and 2013. 194 SM patients who were followed at the main branch were used for prognostic analyses that included both recurrence free survival and neurological functions based on Modified McCormick scale (MMS)...
September 12, 2018: Journal of Neuro-oncology
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