Ottokidd9108

This shows the need to address fear of movement in prehabilitation/rehabilitation pre- or postsurgically to improve health outcomes for patients who undergo lumbar spine surgery. BACKGROUND Cavernous-carotid fistulas (CCFs) can present with a variety of symptoms depending on the anatomy of the fistula and its venous drainage. Patients most commonly present with scleral injection, pulsatile exophthalmos, and/or chemosis. CASE DESCRIPTION We report a patient who presented with intraparenchymal hemorrhage in the absence of any of the commonly associated ocular symptoms and signs. After multiple imaging studies, the CCF was diagnosed and treated with endovascular embolization that resulted in complete occlusion of the fistula and reflux of embolysate into one of its connecting veins. CONCLUSIONS The morphology of the venous drainage can lead to atypical hemorrhagic presentation, whereas dilatation of one of the tributary veins with cortical venous reflux should warn the interventionist the path the embolysate may follow. We provide our experience with this unique presentation and its treatment. BACKGROUND An 11-year-old girl had undergone posterior spinal fusion surgery for scoliosis. The surgery was complicated by intraoperative bleeding, and hemostasis was achieved by topically applying gelatin sponges. CASE DESCRIPTION She developed acute pulmonary embolism and cardiac arrest during the surgery, which was confirmed by transesophageal echocardiography. CONCLUSIONS Autopsy shortly after revealed that her death was associated with unintended intravascular entry of gelatin sponge fragments, resulting in an embolic event and secondary cardiopulmonary collapse. BACKGROUND Lumbar total disc replacement is increasingly becoming a more common treatment for discogenic low back pain refractory to conservative measures. Nevertheless, several complications have been reported, including, among others, wound infection, vascular injury, retrograde ejaculation, postsympathectomy syndrome, ileus, and cerebrospinal fluid (CSF) leak. Although CSF leakage is rare, we discuss a case of CSF leakage and the diagnosis and management of CSF leakage after lumbar total disc replacement. CASE DESCRIPTION A 25-year-old man had presented with discogenic low back pain caused by degenerative disc disease of 9 years' duration. His symptoms were exacerbated by activity, worse with sitting, and relieved by ice baths. He developed a cerebrospinal fluid leak after L5-S1 lumbar total disc replacement. CONCLUSIONS Our patient ultimately required device removal, direct repair, and replacement with a different prosthesis to treat his CSF leak. BACKGROUND Historically, practicing neurosurgeons have been key drivers of neurosurgical innovation. We sought to describe the patents held by U.S. academic neurosurgeons and to explore the relationship between patents and royalties received. METHODS The Centers for Medicare and Medicaid CMS Open Payments Data was used to identify academic neurosurgeons who had received royalties and royalty amounts during a 5-year period (2013-2017). Online patent databases were used to gather patent details. Patent citations and 5-year individual and departmental patent Hirsch (h)-indexes were calculated. Royalties were correlated with the number of patents, patent citations, and patent h-index. RESULTS We found that 119 academic neurosurgeons (7.8%) from 57 U.S. teaching programs (48.3%) had received royalty payments; 72 (60.5%) had published 648 patents. All surgeons were men, with approximately one half in the "late" stages of their career (45.3%) and subspecializing in spinal surgery (50.4%). The patented products or devices were most commonly used for spinal surgery (72.1%), with 2010-2019 the most productive period (n = 455; 70.2%). The median number of citations per patent was 32 (range, 0-620), with 33% having ≥100 citations. The highest individual and institutional patent h-index was 95; 25 (34.7%) neurosurgeons had a patent h-index of ≥5. The median total royalty payment per individual neurosurgeon was $111,011 (range, $58.05-$76,715,750.34). Royalties were correlated with the number of patents (Spearman r = 0.37; P ≤ 0.001), citations (Spearman r, 0.38; P ≤ 0.001), and inventor h-index (Spearman r = 0.38; P ≤ 0.001). CONCLUSIONS Few U.S. academic neurosurgeons (7.8%) receive royalties and hold patents (4.7%), with an even smaller select group having a patent h-index of ≥5 (1.6%). BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the most commonly diagnosed primary non-Hodgkin lymphoma of the spine and can induce spinal compression. Reports of lymphoma arising in bone adjacent to metallic prostheses are increasing. However, to our knowledge, DLBCL arising from a scar after lumbar fusion surgery has not been reported previously. CASE DESCRIPTION A 63-year-old man complained of a 2-month history of severe pain in the back and both legs, radiating down to the ankle, similar to sciatica with a past history of L2-S1 decompression and fusion 7 years ago. Imaging revealed an irregular mass in the epidural space and around the internal fixation surgical site, which was initially diagnosed as an epidural infectious abscess. Most of the lesion was completely excised and a detailed immunohistopathologic analysis was performed revealing the diagnosis of a DLBCL. After surgery and chemotherapy, he was discharged without complications. Unfortunately, he died 2 years later because of brain metastasis. CONCLUSIONS This case highlights the need to consider malignancy in the differential diagnosis and carefully examine surgical specimens in revision surgery. Further understanding of the role of metal implants in the development of lymphoma is required. BACKGROUND Anterior cervical diskectomy and fusion (ACDF) is the main surgical treatment of cervical radiculopathy. Controversy exists about the need to resect the posterior longitudinal ligament (PLL) to directly decompress the nerve roots, or if it is sufficient to indirectly decompress with diskectomy and graft placement. The objective of this study was to determine the effect of PLL resection after ACDF. METHODS A retrospective review was performed of all patients that underwent first-time ACDF for cervical radiculopathy at a single tertiary care institution between 1999 and 2013. Comparative analyses and multivariable logistic regression were performed. RESULTS Two hundred patients were included with a mean follow-up of 39 months. Average age was 54 years, 62% were women, and diabetes and current smoking status were noted in 11% and 15%, respectively. PLL resection was performed in 127 patients (64%), and no significant differences in baseline characteristics were observed between the 2 cohorts. One durotomy occurred in the resected PLL cohort, and none were seen in the unresected PLL group. No differences were seen in perioperative complications. At the time of last follow-up, improvement in radiculopathy was observed in 94% of the resected PLL group compared with 81% of the unresected PLL group (P = 0.008). Bobcat339 After controlling for confounders, PLL resection had 3.8 times greater odds of leading to postoperative improvement in radiculopathy. CONCLUSIONS ACDF leads to a high rate of success in improvement of preoperative radiculopathy. Excision of PLL during surgery leads to 3.8 times greater odds of improvement in this symptom, with no significant difference in the complication rate. BACKGROUND Rheumatoid meningitis is a rare manifestation of autoimmune rheumatoid arthritis. CASE DESCRIPTION A 70-year-old man with rheumatoid arthritis had presented with speech difficulties and limb weakness. Magnetic resonance imaging of his brain demonstrated diffuse meningeal enhancement. A biopsy confirmed the presence of rheumatoid meningitis. CONCLUSION In the present report, we have discussed the diagnostic and therapeutic approach to rheumatoid meningitis. BACKGROUND Few studies have examined the usefulness of intraoperative magnetic resonance spectroscopy (iMRS) for identifying abnormal signals at the resection margin during glioma surgery. The aim of this study was to assess the value of iMRS for detecting proliferative remnants of glioma at the resection margin. METHODS Fifteen patients with newly diagnosed glioma underwent single-voxel 3-T iMRS concurrently with intraoperative magnetic resonance imaging-assisted surgery. Volumes of interest (VOIs) were placed at T2-hyperintense or contrast-enhancing lesions at the resection margin. In addition to technical verification, the correlation between the MIB-1 labeling index (a pathologic feature) and metabolites measured using iMRS (N-acetyl-L-aspartate [NAA], choline [Cho], and Cho/NAA ratio) was analyzed. RESULTS iMRS was performed for 20 VOIs in 15 patients. Fourteen (70%) of these VOIs were confirmed to be MIB-1-positive. There was a significant positive correlation between the Cho/NAA ratio and MIB-1 index (r = 0.46, P = 0.04). Cho level (P = 0.003) and Cho/NAA ratio (P = 0.002) were significantly higher in VOIs that were MIB-1-positive than in those that were MIB-1-negative. Detection of a Cho level >1.074 mM and a Cho/NAA ratio >0.48 using iMRS resulted in high diagnostic accuracy for MIB-1-positive remnants (Cho level sensitivity 86%, specificity 100%; Cho/NAA ratio sensitivity 79%, specificity 100%). CONCLUSIONS This study provides evidence that 3-T iMRS can detect proliferative remnants of glioma at the resection margin using the Cho level and Cho/NAA ratio, suggesting that intraoperative magnetic resonance imaging-assisted surgery with iMRS would be practicable in glioma. BACKGROUND M2 occlusions represent 16%-41% of all middle cerebral artery occlusions, with >50% of functional independence achieved. The American Heart Association/American Stroke Association 2018 guidelines suggest that, with a level of evidence B-R, thrombectomy with stent retrievers may be appropriate for selected patients with M2 or M3 occlusions. The purpose of this study is to illustrate a new technique of distal (M2-M3) thrombectomy. METHODS Eight patients from May 2018 to February 2019 underwent a thrombectomy procedure for a M2 or M3 occlusion with a 3MAX or 4MAX intermediate aspiration catheter, a Headway Duo 167 cm microcatheter, and a Catchview Mini stent retriever. RESULTS All thrombectomies were technically successful, defined as thrombolysis in cerebral infarction score ≤2b. Five out of the 8 patients attained a good functional outcome at 3 months, defined as modified Rankin scale score ≤2. CONCLUSIONS This technique allows a safe and effective distal thrombectomy for M2-M3 occlusions. Implantation of blood-contacting materials/devices usually causes severe thrombus formation, inflammatory reactions, excessive hyperplasia, and ultimately, induce endothelial dysfunction. In this work, a biomimetic approach was established to address those adverse problems through constructing a catechol-mediated and copper-incorporated multilayer coating. The biomimetics was mainly obtained via two paths. The first one was structure bionics, which used polyelectrolytes (heparin and polyethyleneimine) to modify with catechol moieties and then further formed a multilayer coating via layer-by-layer assembly, so as to mimic the mussel adhesive DOPA-rich structure; the second one was function bionics, which copper ions were then incorporated to function as the catalysts to decompose the endogenous S-nitrosothiols to release nitric oxide (NO), so as to mimic the key function of healthy endothelial cells. The quartz crystal microbalance with dissipation (QCM-D) was used to monitor the multilayer construction process and demonstrated the enhanced stability of the catechol-mediated multilayer coatings.