Zobrazení zdroje stránky Hollowaylindegaard8246

OBJECTIVE CT reduction in favor of rapid sequence MRI to decrease pediatric radiation exposure has varied across institutions. We aim to understand national trends in CT and rapid sequence MRI usage, as well as identify variables affecting imaging practices and obstacles to CT reduction. METHODS Retrospective review of deidentified discharge data for children with hydrocephalus and TBI in the Healthcare Cost and Utilization Project's Kid's Inpatient Database (KID) in 2000, 2003, 2006, 2009, 2012, and 2016. MRI without contrast and CT use were extracted using ICD9 and ICD10 codes. Hospital region and age cohorts were extracted and used to categorize data. Chi square tests and logistic regression were used for analysis. RESULTS Hospitalization utilizing CT use decreased (p less then 0.05) and those using MRI increased (p less then 0.05) overall in both diagnosis groups throughout the years analyzed. However, there was significant regional variation in imaging. The Northeast had higher CT rates (p less then 0.05) and the South had lower CT rates in hydrocephalus and TBI patients (p less then 0.05). No regional variation was found for TBI patients receiving MRIs. CONCLUSIONS Nationwide, the average number of discharges after hospitalizations involving CT use in hydrocephalus and TBI patients has decreased, while those involving MRI use as an alternative imaging modality has increased. Despite successful overall CT reduction, significant regional variation exists within this trend showing inconsistent reduction of CT use. BACKGROUND Hemifacial spasm (HFS) is a debilitating disorder characterized by intermittent involuntary movement of muscles innervated by the facial nerve. HFS is caused by neurovascular compression along the facial nerve root exit zone and can be treated by microvascular decompression (MVD). OBJECTIVE Determine rates and predictors of spasm freedom after MVD for HFS. METHODS A literature search using key terms "microvascular decompression" and "hemifacial spasm" was done. The primary outcome variable was spasm freedom at last follow up. Analysis was completed to evaluate for variables associated with spasm free outcome. RESULTS A total of 39 studies including 6249 patients were analyzed. Overall spasm freedom rate was 90.5% (5652/6249) at a follow up of 1.25 ± 0.04 years. There was no significant relationship between spasm freedom vs. persistent spasm and age at surgery, timing of follow up, gender, disease duration, side of disease, or vessel type. Spasm freedom was more likely after an initial surgery vs. a redo MVD (OR 4.16, 95% CI 1.99 to 8.68; p 90% at 1 year follow up in 6249 patients from 39 studies included in this report. A significant predictor of long-term spasm freedom at 1 year was an initial MVD as compared to repeat MVD. The majority of published manuscripts on MVD for HFS are heterogeneous single-institutional retrospective studies, as such, a large-scale meta-analysis reporting outcome rates and evaluating significant predictors of spasm freedom provides utility in the absence of randomized controlled studies. OBJECTIVE The goal of this study was to retrospectively analyze clinical and surgical data of a consecutive series of twenty-six patients with unilateral cystic vestibular schwannomas. METHODS Tumors were classified as type A (central cyst) and type B (peripheral cyst), and as small (tumor diameter 95%) was achieved in 16 cases (61.5%), subtotal removal (90-95%) in 9 cases (34.6%), and partial removal ( less then 90%) in 1 case (3.9%). Position pattern of FN was anterior-inferior in 10 cases (38.4%), anterior-superior in 10 cases (38.4%), anterior in 23.2% of cases. At hospital discharge, 9 (36%), 10 (38%), 3 (12%), 3 (12%) and 1 (4%) patients had a FN function of HB I-V, respectively; at final follow-up HB I, II, III and IV accounted respectively for 18 (72%), 6 (24%), 1 and 1 cases. At a follow-up ranging from 6 months to 10 years, a reoperation for growing of residue was never necessary. CONCLUSIONS According to the literature and to the results of our series, microneurosurgery of cystic vestibular schwannomas is associated with good outcomes in terms of extent of resection and FN function. In particular, long-term FN result is much more satisfactory than short-term function. In majority of cases microsurgery represents the treatment of choice of cystic vestibular schwannomas. OBJECT This case series examined patients undergoing caudal extension of prior fusion without alteration of the prior UIV to assess patient outcomes and rates of PJK/PJF. METHODS Patients eligible for 2-year minimum follow-up undergoing caudal extension of prior fusion with unchanged UIVs were identified. These patients were evaluated for PJK/PJF, and patient reported outcomes were recorded. RESULTS In total, 40 patients were included. Mean follow-up duration was 2.2 years (SD 0.3). Patients in this cohort had poor preoperative sagittal alignment (PI-LL 26.7°, TPA 29.0°, SVA 93.4mm) and achieved substantial sagittal correction (ΔSVA -62.2mm, ΔPI-LL -19.8°, ΔTPA -11.1°) following caudal extension surgery. At final follow-up, there was a 0% rate of PJF among patients undergoing caudal extension of previous fusion without creation of a new UIV, but 27.5% of patients experienced PJK. Patients experienced significant improvement in both ODI and SRS-22r total score at 2-years post-operatively (p less then 0.05). In total, 7.5% (n=3) of patients underwent further revision, at an average of 1.1 years (SD 0.54) after the surgery with unaltered UIV. All three of these patients underwent revision for rod fracture with no revisions for PJK/PJF. CONCLUSIONS Patients undergoing caudal extension of previous fusions for sagittal alignment correction have high rates of clinical success, low revision surgery rates, and very low rates of PJF. Minimizing repetitive tissue trauma at the UIV may result in decreased PJF risk, as the PJF rate in this cohort of unaltered UIV patients is below historical PJF rates of patients undergoing sagittal balance correction. OBJECTIVE We aimed to determine the characteristic alignment change in patients with myelopathy recurrence after multilevel anterior cervical corpectomy and fusion (m-ACCF). METHODS Fifty-two patients who underwent m-ACCF, including 20 who underwent revision surgeries for myelopathy recurrence (R-group) and 32 postoperative asymptomatic patients (A-group), were analyzed. Classic alignment parameters (cervical lordosis angle [CL], cervical sagittal vertical axis, and fusion area angle and length) and original alignment parameters (α-β, β-BG, BG-γ, and γ-δ angles) were measured preoperatively, postoperatively, and at follow-up or before revision surgery. The difference in the amount of change in parameters between the groups was analyzed. The relationship between the distribution of restenotic lesions and characteristic alignment change in the R-group was evaluated. RESULTS The CL, fusion area angle, and fusion area length in the R-group significantly decreased postoperatively compared with those in the A-group (p less then 0.01, p less then 0.01, p=0.04, respectively). Compared with those in the A-group, α-β and β-BG angles in the R-group significantly decreased (p less then 0.01), indicating kyphotic change on the cranial side. BG-γ and γ-δ angles in the R-group significantly increased (p less then 0.01), indicating lordotic change in the caudal fused area. Restenotic lesions significantly increased on the cranial side in the R-group (cranial side, 19 levels; caudal side, 5 levels; p less then 0.01). CONCLUSIONS In patients with myelopathy recurrence after m-ACCF, the cranial side has significant kyphosis and the caudal side has lordosis. Moreover, 79.2% of the restenotic lesions were significantly maldistributed on the cranial side. Surgeons should pay close attention to cranial kyphosis inducing myelopathy recurrence after m-ACCF. OBJECTIVE We evaluated whether a previously developed educational material by health professionals about hydrocephalus and its treatment corresponded with the daily life of caregivers of children with. METHODS We conducted a qualitative study at a university hospital in Brazil, interviewing 32 informal caregivers of children with hydrocephalus. The methodological framework of Bardin's content analysis was used to analyze the data. RESULTS The educational material adequately represented caregivers' experience regarding daily life, surgery experiences, and care needed by children with hydrocephalus. Additionally, the educational material may help to identify the signs and symptoms of ventriculoperioteneal shunt. However, the material did not address the limitations of children disabled with hydrocephalus in daily life. CONCLUSIONS From the perspective of informal caregivers of children with hydrocephalus, the educational material corresponded with families' daily life and surgical experience and may be used by health professionals to reinforce important points for the care for children with hydrocephalus, facilitating the health education process. BACKGROUND Subdural drain (SDD) and Subdural Evacuating Port System (SEPS) are bedside options for management of non-acute subdural hematomas (SDH). These interventions have not been compared with each other. Our objective is to compare the need for second bedside procedure, need for craniotomy, complication rate and other outcomes related to bedside drainage of SDH with SDD or SEPS. We hypothesized that SDD would be associated with superior outcomes to SEPS. METHODS Database queries and direct patient chart reviews were used to gather patient data. T-tests, Fisher's exact tests, and proportional odds models were performed. RESULTS Of 41 SDD and 25 SEPS, baseline characteristics were similar except more isodense SDHs were present in SDD (p = .0312). SEPS was associated with significant risk of requiring a second bedside procedure (OR 3.2381, 99% CI 1.0345 - 10.1355) relative to SDD. Need for craniotomy did not differ between groups (12.1% SDD vs 16% SEPS; p = .721). The complication rate was similar between groups (2.4% SDD vs 12% SEPS; p = .1484). Symptom resolution, condition at latest follow-up, and post-hospital disposition was similar between groups, but SEPS was associated with longer intensive care unit (ICU) and total hospital length of stay (LOS) (p = .02 and .04, respectively). CONCLUSION SEPS was associated with higher risk for need of second bedside procedure and longer ICU and hospital LOS than SDD, although not increased need for craniotomy. Additional studies are needed to confirm our findings and determine if SDD may be more effective than SEPS for the treatment of non-acute SDH. Published by Elsevier Inc.OBJECTIVE Paralysis (paraplegia or quadriplegia) after posterior fossa surgery is a rare but devastating complication. [https://www.selleckchem.com/products/ch6953755.html CH6953755 Src inhibitor] The authors investigated prior reports of this complication to examine similarities among cases, risk factors, and methods by which it may be prevented. METHODS A systematic review was completed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases were searched until November 2019 using keywords "paraplegia," "quadriplegia," or "spinal cord injury" added to "posterior fossa surgery." RESULTS Thirteen case reports published between 1996 and 2019 were included. Five (38.5%) involved quadriplegia/quadriparesis and 8 (61.5%) involved paraplegia after surgery. Ten cases (76.9%) were tumor resections and 3 (23.1%) were for posterior fossa decompressions (2 for Chiari malformations, 1 for Morquio syndrome). Seven surgeries (53.8%) were performed in the sitting position and 6 (46.2%) were prone. Proposed mechanisms of paralysis involved cervical hyperflexion yielding spinal cord ischemia in 8 cases (61.