Macdonaldbang5024

BACKGROUND Pineal lesions are common causes of dorsal midbrain syndrome and typically require surgical intervention in symptomatic patients. We describe a unique case of spontaneous resolution of dorsal midbrain syndrome resulting from a pineal gland cyst. CASE DESCRIPTION A 23-year-old woman developed a supranuclear upgaze palsy, convergence-retraction nystagmus, and light-near dissociation from a pineal gland cyst (1.0 × 1.3 × 1.2 cm) with mild mass effect on the posterior surface of the tectum. Seven days after symptom onset, she had complete, spontaneous resolution of her symptoms, and examination returned to normal. VP-16 Repeat magnetic resonance imaging demonstrated an unchanged pineal cyst with new T2/fluid attenuated inversion recovery hyperintensity along the mesial surface of the left thalamus. CONCLUSIONS Dorsal midbrain syndrome resulting from a pineal cyst may spontaneously improve even without a significant change in lesion size. This suggests that observation may be an appropriate initial management strategy. OBJECTIVE Sphenoid wing meningiomas (SWMs) can be treated with complete surgical resection and recent endoscopic transorbital approach (ETOA) offers one of minimally invasive alternatives. The authors compare the surgical outcome of ETOA and extended mini-pterional approach (eMPTA) for SWMs with osseous involvement. METHODS From October 2015 to May 2019, a total of 24 patients underwent surgery for SWMs with osseous involvement. Among them, tumor resection was performed by ETOA for 11 patients (45.8%) and eMPTA for 13 patients (54.2%). The tumor characteristics, surgical outcome and morbidity, and approach-related aesthetic outcome were analyzed and compared retrospectively between ETOA and eMPTA based on SWM classification. RESULTS The location of SWMs was mostly middle sphenoid ridge (group III) (45.8%), followed by greater sphenoid wing (group IV) (29.2%). Simpson resection grades I/II were achieved in 9 of 11 patients (81.8%) with ETOA and 11 of 13 patients (84.6%) with eMPTA. There were no differences in tumor characteristics between the two approaches. Surgery time, surgical bleeding, and hospital length of stay were significantly shorter with ETOA. Three patients had transient surgical morbidities such as diplopia (n=1), ptosis (n=1), and cerebrospinal fluid leak (n=1) after ETOA. No differences could be seen in surgical morbidities between ETOA and eMPTA. CONCLUSIONS ETOA can provide direct access to the sphenoid bone and resectability with a more rapid and minimally invasive exposure than eMPTA. link2 Maximal subtotal resection with extensive sphenoid bone decompression for tumors with CS infiltration is the key to a good clinical outcome, regardless of the surgical approach. BACKGROUND Acquisition of neurosurgical anatomy knowledge requires the progressive construction of a 3-dimensional (3D) mental image from the study of 2-dimensional pictures. Tridimensional neuroimaging modeling and 3D pictures and videos have facilitated a better understanding of intricate brain anatomy. One of the main limitations of these methods however is that the user is unable to freely change his or her own point of view of the observed structures. The objective of this paper was to develop a 3D reconstruction method to facilitate learning and teaching of neurosurgery. link3 METHODS We developed a 3D reconstruction method by using 3D photogrammetry to convert intraoperative images into a fully explorable 3D textured model. We also developed a mobile application to navigate the virtual scenario by using the gyroscopic technology of mobile devices to simulate the different movements of the surgical microscope. We named this process 3D virtual intraoperative reconstruction (VIR). RESULTS We report the detailed methodology for picture acquisition, 3D reconstruction, and visualization with some surgical examples since the first applications in 2015. We also demonstrate how these navigable models can be used to buildup hybrid images derived by the fusion of 3D intraoperative scenarios with neuroimaging-derived 3D models. CONCLUSIONS 3D VIR is a digital reconstruction method developed with the goal of facilitating the teaching and learning of neurosurgical anatomy by allowing the user to directly explore a surgical field and anatomic structures. The result is an interactive navigable 3D textured model for the analysis of the surgical approach and regional anatomy and for reconstruction of hybrid 3D scenarios. OBJECTIVE Increasing patient demand for minimally invasive surgery and increased payer emphasis on quality-based payment schema have created a need for technologies that provide consistent, high-quality outcomes for patients undergoing spine surgery. Robotic assistance is one such technology. We report our early experience with a novel real-time, image-guided robot system for use in short-segment lumbar fusion in patients diagnosed with degenerative disease. METHODS A consecutive series of patients undergoing robot-assisted 1-level or 2-level lumbar fusion procedures were compared with matched controls who underwent freehand surgery. Screw accuracy, intraoperative outcomes, and 30-day outcomes were compared. RESULTS We identified 56 patients who underwent 1-level or 2-level lumbar fusion during the study period 28 who underwent robot-assisted procedures and 28 matched controls who underwent freehand instrumentation placement. No significant differences were found between the robot-assisted surgery cohort and the freehand surgery cohort with respect to matched variables. Patients who underwent robot-assisted surgery had less intraoperative blood loss (266.1 ± 236.8 mL vs. 598.8 ± 360.2 mL; P less then 0.001) and shorter hospitalizations (3.5 ± 1.8 days vs. 4.5 ± 2.0 days; P = 0.01). No differences were noted in complication rates, 30-day outcomes, or screw accuracy. Profiling of our initial series showed an average reduction in operation duration of 4.6 minutes with each additional case. CONCLUSIONS Patients undergoing robot-assisted fusion experienced less intraoperative blood loss and shorter hospitalizations. The results of this initial experience suggest that an image-guided robotic system may provide similar short-term outcomes compared with freehand instrumentation placement. OBJECTIVE To investigate the effects of early intensive rehabilitation management on the recovery of motor function and activities of daily living in patients with moderate traumatic brain injury. METHODS Eighty-seven patients (age range, 18-65 years) with traumatic brain injury that met the enrollment criteria were randomly divided into 2 groups. Group 1 received early and high-intensity rehabilitation management (from 7 days after injury, 7 d/wk, 4 times/d, 1 h/session) for 4 weeks; group 2 received ordinary rehabilitation (from 14 days after injury, 5 d/wk, 2 times/d, 1 h/session) for 4 weeks. The Fugl-Meyer Assessment (FMA, motor function) and Barthel Index (BI) were used to assess the daily living functional state before treatment, 3 months after injury, and 6 months after injury. The Glasgow Coma Scale (GCS) was used to assess outcomes 6 months after injury. RESULTS Three months after rehabilitation, the FMA (motor function) score was significantly higher in the early intensive intervention group versus the control group (59.83 ± 11.87 vs. 44.56 ± 8.32, respectively; P 0.05). Six months after rehabilitation, the FMA score and BI score were significantly higher in the early intensive intervention group versus the control group (FMA 73.18 ± 16.55 vs. 57.86 ± 10.67, P less then 0.01; BI 87.17 ± 13.85 vs. 60.68 ± 11.98, P less then 0.01, respectively). The GCS score was higher in the early intensive intervention group versus the control group (4.24 ± 0.91 vs. 3.43 ± 0.88, P  less then  0.05, respectively) 6 months after injury. CONCLUSIONS Early intensive rehabilitation management might be more beneficial for neurologic function and activities of daily living in patients with moderate traumatic brain injury. BACKGROUND Symptomatic peritumoral edema (PTE) is a known complication after radiosurgical treatment of meningiomas. Although the edema in most patients can be successfully managed conservatively with corticosteroid therapy or bevacizumab, some medically refractory cases may require surgical resection of the underlying lesion when feasible. Laser interstitial thermotherapy (LITT) continues to gain traction as an effective therapeutic modality for the treatment of radiation necrosis where its biggest impact is through the control of peritumoral edema. CASE DESCRIPTION A 56-year-old woman with neurofibromatosis 2 presented with a symptomatic, regrowing left frontotemporal lesion that had previously been radiated, then resected with confirmed recurrence of grade I meningioma, and subsequently radiated again for lesion recurrence. Given her history of 2 prior same-side craniotomies, including a complication of wound infection, she was not a candidate for further open surgical resection. Having failed conservative management, she underwent LITT with intraoperative biopsy demonstrating viable grade I meningioma. Postoperatively, she demonstrated radiographic marked, serial reduction of PTE and experienced resolution of her symptoms. CONCLUSIONS This case demonstrates that LITT may be a viable alternative treatment for patients with meningioma with symptomatic PTE who have failed medical therapy and require surgical intervention. OBJECTIVE The HOSPITAL score (HS) and LACE index (LI) are 2 validated methods for quantifying the risk of 30-day unplanned readmission after discharge. However, neither score has been validated in the neurosurgical population. This study evaluated the HS and LI in the neurosurgical population as effective predictors for 30-day unplanned readmission. METHODS We performed a prospective, cohort analysis of all consecutive adult patients admitted to the neurosurgical service between October 1, 2018 and May 1, 2019. Patient medical records were used to calculate HS and LI. HS defined groups as low risk (0-4), intermediate (5-6), and high (7-12); LI defined risk as low (1-4), moderate (5-9), and high (10-19). Data analysis used univariate and multivariate logistic regressions. RESULTS The 1242 patients included 626 women (50.4%). The average age was 57.9 years, and most patients (86.5%) underwent surgery during their admission. In multivariate logistic regression, intermediate-risk HS was not predictive of 30-day readmission (odds ratio [OR], 1.04; 95% confidence interval [CI], 0.57-1.88; P = 0.53), whereas high-risk HS did predict readmission (OR, 2.87; 95% CI, 1.49-5.54; P = 0.002). Likewise, moderate-risk LI was not predictive of 30-day unplanned readmission or mortality (OR, 1.59; 95% CI, 0.88-2.85; P = 0.12); however, high-risk LI did predict unplanned readmission or mortality (OR, 2.58; 95% CI, 1.16-5.73; P = 0.02). Both HS and LI showed poor to moderate discrimination (C = 0.62 and 0.60, respectively). CONCLUSIONS A high-risk HS and high-risk LI were predictive of 30-day unplanned readmission. Although neither score is ideal for predicting moderate risk for 30-day unplanned readmission in neurosurgical patients, both have some predictiveness that may be clinically valuable.