Devinelanghoff2123

OBJECTIVE Subdural hematoma (SDH), a form of traumatic brain injury, is a common disease that requires extensive patient management and resource utilization; however, there remains a paucity of national studies examining the likelihood of readmission in this patient population. The aim of this study is to investigate differences in 30- and 90-day readmissions for treatment of traumatic SDH using a nationwide readmission database. METHODS The Nationwide Readmission Database years 2013 - 2015 was queried. Patients with a diagnosis of traumatic SDH and a primary procedure code for incision of cerebral meninges for drainage were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification coding system. Patients were grouped by no readmission (Non-R), readmission within 30 days (30-R), and readmission within 31 to 90 days (90-R). RESULTS A total of 14,355 patients were identified, with 3,106 (21.6%) patients encountering a readmission (30-R n = 2,193 [15.3%]; 90-R n = 913 [6.3%]; Non-R n = 11,249). The most prevalent 30- and 90- day diagnoses seen among the readmitted cohorts were postoperative infection (30-R 10.5%, 90-R 13.0%) and epilepsy (30-R 3.7%, 90-R 1.1%). On multivariate logistic regression analysis, Medicare, Medicaid, hypertension, diabetes, renal failure, congestive heart failure and coagulopathy were independently associated with 30-day readmission; Medicare and rheumatoid arthritis/collagen vascular disease were independently associated with 90-day readmission. CONCLUSION In this study, we determine the relationship between readmission rates and complications associated with surgical intervention for traumatic subdural hematoma. BACKGROUND The growing interest in minimally invasive approaches to the thoracic and lumbar spine is mostly secondary to the high surgical morbidity and complication rates associated with conventional open approaches. OBJECTIVE To report the largest series of patients with thoracic and lumbar vertebral osteomyelitis who underwent multilevel corpectomies using the minimally invasive lateral (MIL) retropleural and retroperitoneal approaches. METHODS The surgical techniques of the MIL approaches are illustrated and described in detail. The MIL retropleural approach was performed in 9, MIL retroperitoneal approach in 3, and combined MIL retropleural/retroperitoneal approach in 2 patients with thoracic, lumbar and thoracolumbar vertebral osteomyelitis, respectively. RESULTS Multilevel corpectomies were successfully accomplished in all 14 patients using the MIL approaches (11 patients with 2-level corpectomy, 2 patients with 3-level corpectomy, and 1 patient with extension of a 3-level corpectomy to 6 levels). Correction of kyphotic deformity was achieved postoperatively in all 14 patients and remained stable with no proximal junctional kyphosis for a median of 10 months of follow-up on 10 patients; 4 patients were lost to follow-up after discharge from hospital. Posterior instrumentation was performed in 12 patients to further support the spinal alignment. CONCLUSION The MIL retropleural and retroperitoneal approaches described in this manuscript are feasible and safe in achieving multilevel corpectomies, anterior column reconstruction, and spinal deformity correction is patients with thoracic, lumbar, and thoracolumbar vertebral osteomyelitis. OBJECTIVE Acute subdural hematoma (aSDH) is a common pathology encountered in neurosurgery. While most cases are associated with trauma and injuries to draining veins, traumatic aSDH from injury to arteries or spontaneous aSDH due to a ruptured intracranial aneurysm can occur. For some patients without a clear clinical history, it can be difficult to distinguish between these etiologies purely based on radiography. The objective of this research was to describe a case series in which imaging was suggestive of the presence of distal cortical intracranial aneurysm associated with aSDH, but operative management demonstrated no evidence of aneurysm. METHODS We retrospectively reviewed 2 patients known to have aSDH with suspicion for associated aneurysm between May 2019 and September 2019 at our institution. Data collected included demographic, clinical and operative course, including age, gender, past medical history, presenting symptoms, and pre and post operative imaging. RESULTS In 2 patients presenting with aSDH with pre operative radiographic imaging suggesting distal middle cerebral artery (MCA) aneurysms, surgical exploration revealed no aneurysm. In both cases, non-iatrogenic active arterial bleeding from an injured cortical MCA branch was identified. CONCLUSION While there are prior reports of arterial aSDH, this is the first to describe the radiographic 'ghost aneurysm' sign. It is important for clinicians to be aware of this potential misleading radiographic sign, which indicates active extravasation into a spherical cast of clot. INTRODUCTION Cranioplasty is a common neurosurgical procedure with the goal to restore skull integrity. Custom-made porous hydroxyapatite prostheses have long been used for cranial reconstruction in patients with traumatic brain injury. selleck inhibitor We present a large consecutive series of two groups of patients undergoing cranioplasty with hydroxyapatite custom bone and compare the adverse events between the two groups. MATERIALS AND METHODS We examined a series of consecutive patients who underwent cranioplasty using custom-made porous hydroxyapatite implants following tumor resection and traumatic brain injury from March 2013 to May 2018 at a single center. The implants were designed and produced according to the surgeon's specifications and based on the patient's CT scan data which were obtained through a standardized protocol. Adverse events were recorded. RESULTS Information on thirty-eight patients with tumor and thirty-nine patients with traumatic brain injury were collected and analyzed. A significant difference in the timing of surgery was found between the two groups (single-stage surgery was performed in 84% of tumor patients versus 8% in traumatic brain injury group; P less then .0001). The rate of adverse events did not significantly differ between the two groups (P = 0.4309) and it was not related to the timing of surgery. CONCLUSIONS Custom-made hydroxyapatite cranioplasty is a solution for cranial reconstruction in patients with cranial tumors. The low incidence of adverse events in a consecutive series of patients with either trauma or tumors demonstrates that these prostheses represent a safe solution independently from the characteristics of cases.