Skaaninghart3539

Occipitocervical fusion is an important surgical procedure to treat instability of the upper cervical and craniocervical junction. Fixation to the dense cortical bone of the occiput, contemporaneously typically accomplished with a plate and screws, is known to be strong and durable, but there are many competing methods used to secure an adequate number of fixation points of sufficient strength at the cervical end. Extension of hardware to the midcervical region to acquire additional fixation points, however, results in loss of subaxial motion segments and additional potential morbidity. The C2 vertebra is unique in that its morphology and dimensions permit fixation with longer screws than are typically possible to place in the midcervical lateral masses. Translaminar and pars screw techniques, both commonly used to achieve C2 fixation, are not mutually exclusive, as their respective trajectories are considerably different and engage different portions of the bony anatomy.

We describe a novel, 4-point C2 fixation technique for OC fusion that may avoid the need to extend fusion to the subaxial spine.

This technical note illustrates how 4-point C2 fixation can be employed in occiptocervical fusion.

4-point fixation of C2 combining translaminar and pars screw placement is technically feasible and may be a suitable strategy to spare subaxial motion segments in OC fusion procedures. Futher investigation may establish its applicability to additional surgical procedures.

4-point fixation of C2 combining translaminar and pars screw placement is technically feasible and may be a suitable strategy to spare subaxial motion segments in OC fusion procedures. Futher investigation may establish its applicability to additional surgical procedures.

In our technical note, we have presented a technique of cranioplasty for large skull defects.

A thin-slice computed tomography scan is performed. A model of the skull is constructed using a desktop 3-dimensional printer from the computed tomography scan. The skull model is filled with towels of soft cotton and inserted in a sterile thin plastic bag. The implant is molded intraoperatively on the skull model under sterile conditions. After surgical exposure of the skull defect, the implant is inserted and fixed using miniplates and miniscrews. The technique was used in 6 patients and described in 2 representative cases.

The required time and cost are significantly lower than those for other techniques used for preoperative manufacture of implants. No technique-related complications occurred. The radiological and cosmetic results were satisfactory. In the present case series, no early or delayed complications occurred.

The presented technique is simple, safe, and time- and cost-effective. The technique and results are reproducible.

The presented technique is simple, safe, and time- and cost-effective. The technique and results are reproducible.

To test which intracerebral hemorrhage (ICH) characteristics impact incidence of hydrocephalus and characterize subsequent impact on outcomes.

A search of the electronic medical record of Sinai Grace Hospital between January 2009 and April 2018 using International Classification of Diseases, Ninth Revision and Tenth Revision codes for ICH identified 847 patients. After excluding patients with hemorrhagic conversion of stroke, subarachnoid hemorrhage, and traumatic hemorrhage, 560 patients remained for analysis. Generalized linear modeling was used to assess variance in modified Rankin Scale (mRS) score and length of stay.

Incidence of hydrocephalus on arrival varied with ICH volume (P < 0.001), intraventricular hemorrhage (IVH) status (P < 0.001), bleed location (P < 0.001), and external ventricular drain (EVD) status (P < 0.001). An EVD was inserted in 47% of patients presenting with IVH (n= 102/217), while 4% of patients without IVH received an EVD (n= 14/343) (P < 0.001). Hemorrhage locations had different rates of EVD placement thalamic 43%, basal ganglia 22%, cerebellar 28%, brainstem 21%, lobar 7% (P < 0.001). buy IWP-2 Shunt dependency did not vary between bleed locations (P= 0.072). Variance in mRS score was explained by IVH, bleed location, hydrocephalus on arrival, and ICH volumes. In particular, cerebellar hemorrhage location was associated with better outcomes (mean discharge mRS score of 3.3 vs. 3.9, P < 0.001).

Bleed characteristics affect incidence of hydrocephalus on admission, rates of long-term shunt dependency, and outcomes. Hemorrhage location did not predict shunt dependency; however, it did predict outcomes. Specifically, cerebellar ICH was associated with a better discharge mRS score.

Bleed characteristics affect incidence of hydrocephalus on admission, rates of long-term shunt dependency, and outcomes. Hemorrhage location did not predict shunt dependency; however, it did predict outcomes. Specifically, cerebellar ICH was associated with a better discharge mRS score.

Previous reports suggest that more experienced surgeons have better postoperative outcomes in neurosurgery. We studied whether this association is found in a fragile cohort of ≥80-year-old intracranial meningioma (IM) patients.

We identified 83 very old IM patients who were operated on by 12 different surgeons between 2010 and 2018. Besides general patient- and tumor-related characteristics, we collected information about the surgeons' case volume and length of surgical career (LSC). We classified neurosurgeons into 3 different categories 1) low-volume (8 surgeons; 1-4 operations per surgeon); 2) moderate-volume (3 surgeons; 8-12 operations per surgeon); and 3) high-volume (1 reference surgeon; 37 operations). We calculated odds ratios (ORs) with 95% confidence intervals for 1-year mortality and 3-month independency (capability to live at home) by surgeon volume categories and per 5-year increase of LSC.

We found no significant differences in any preoperative characteristics between the surgeon volume categories. IM patients operated on by low-volume surgeons had the lowest risk of first-year mortality (OR, 0.15 [0.01-2.05]) and the highest likelihood of living at home 3 months after surgery (OR, 12.61 [1.21-131.03]). Increasing LSC was associated with 1-year mortality (OR, 1.34 [1.03-1.73]) and with lower likelihood to live at home 3 months after surgery (OR, 0.83 [0.69-1.00]), but these associations were slightly nonsignificant after adjusting for IM patients' age, sex, and preoperative independency.

In a high-volume academic hospital, less experienced neurosurgeons seem to achieve similar results as the more experienced neurosurgeons, even when operating on selected highly fragile meningioma patients.

In a high-volume academic hospital, less experienced neurosurgeons seem to achieve similar results as the more experienced neurosurgeons, even when operating on selected highly fragile meningioma patients.