Notes

MOrgAna: offered quantitative investigation of organoids using device mastering.
Most lumbar disc herniations can be successfully treated conservatively. However, massive lumbar disc herniations are often treated surgically to avoid permanent cauda equina syndromes/neurological deficits and potential litigation. Nevertheless, here, we present a 51-year-old female who refused lumbar surgery due to coronavirus disease 2019 (COVID-19) and sustained a full spontaneous recovery without surgical intervention.

A 51-year-old female presented with a massive lumbar disc herniation at the L5S1 level. Despite refusing surgery for fear of getting COVID-19, she spontaneously neurologically improved without any residual neurological or radiographic sequelae.

Although the vast majority of patients with massive lumbar disc herniations are managed surgically, there are rare instances in which nonoperative management may be successful.
Although the vast majority of patients with massive lumbar disc herniations are managed surgically, there are rare instances in which nonoperative management may be successful.
Intradural disc herniations (IDHs) are rare, are difficult to diagnose on preoperative MR/CT imaging, and typically, are most readily confirmed at the time of surgery. However, one of the greatest challenges posed by these lesions, is the repair of the ventral dural rent.

A 55-year-old male with a 20-year history of lumbago presented with low back pain and right lower extremity sciatica of 3 months' duration. The MR and CT studies showed a compressive lesion at the L1-2 level. There was no original suspicion that this was an IDH. At surgery, performed under the operating microscope, a subtotal L1-L2 laminectomy was performed (i.e. while lysing severe adhesions between the posterior longitudinal ligament and the ventral dura, a traumatic durotomy occurred. White, spongious, friable, soft tissue, and free-floating disc fragments extruded through the durotomy site. Notably, it was initially considered to be a tumor rather than a disc. Once all fragments had been delivered, unsuccessful attempts were made to repair the ventral dura. Further efforts were curtailed due to concern that they would result in damage to multiple ventral nerve rootlets. Despite the lack of primary dural repair, the secondary measures resulted in no postoperative recurrent cerebrospinal fluid leakage (CSF) and a smooth postoperative surgical course.

IDH at the L1-2 level is rare, and preoperative MR/CT studies may not always document their intradural location. Ideally, ventral dural tears attributed to these lesions should be directly repaired and/or managed with additional adjunctive CSF leak repair techniques (i.e. muscle patch grafts, microfibrillar collagen, and fibrin sealants).
IDH at the L1-2 level is rare, and preoperative MR/CT studies may not always document their intradural location. B102 datasheet Ideally, ventral dural tears attributed to these lesions should be directly repaired and/or managed with additional adjunctive CSF leak repair techniques (i.e. muscle patch grafts, microfibrillar collagen, and fibrin sealants).
Dysphagia is one of the most serious complications of occipitocervical fusion (OCF). The previous studies have shown that postoperative cervical alignment, documented with occipito (O)-C2 angles, C2-C6 angles, and pharyngeal inlet angles (PIA), impacted the incidence of postoperative dysphagia in patients undergoing OCF. Here, we investigated the relationship of preoperative versus postoperative cervical alignment on the incidence of postoperative dysphagia after OCF.

We retrospectively reviewed the clinical data/medical charts for 22 patients following OCF (2006- 2019). The O-C2 angles, C2-C6 angles, PIA, and narrowest pharyngeal airway spaces (nPAS) were assessed using plain lateral radiographs of the cervical spine before and after the surgery. The severity of dysphagia was assessed with the functional oral intake scale (FOIS) levels as documented in medical charts; based on this, patients were classified into the nondysphagia (FOIS 7) versus dysphagia (FOIS 1-6) groups.

Seven patients (35%) experienced dysphagia after OCF surgery. Preoperative PIA and nPAS were smaller in the dysphagia group. Spearman rank correlation showed a positive correlation between preoperative PIA and FOIS and between preoperative nPAS and FOIS.

This study suggests that preoperative cervical alignment may best predict the incidence of postoperative dysphagia after OCF.
This study suggests that preoperative cervical alignment may best predict the incidence of postoperative dysphagia after OCF.
This is an updated analysis of the morbidity and mortality of cervical surgery performed in outpatient/same day (OSD) (Postoperative care unit [PACU] observation 4-6 h), and ambulatory surgicenters (ASC PACU 23 h) versus inpatient facilities (IF).

We analyzed 19 predominantly level III (retrospective) and IV (case series) studies regarding the morbidity/mortality of cervical surgery performed in OSC/ASC versus IF.

A "selection bias" clearly favored operating on younger/healthier patients to undergo cervical surgery in OSD/ASC centers resulting in better outcomes. Alternatively, those selected for cervical procedures to be performed in IF classically demonstrated multiple major comorbidities (i.e. advanced age, diabetes, high body mass index, severe myelopathy, smoking, 3-4 level disease, and other comorbidities) and had poorer outcomes. Further, within the typical 4-6 h. PACU "observation window," OSD facilities "picked up" most major postoperative complications, and typically showed 0% mortality rates.IF surgery correlated with poorer results. Although most OSD cervical series report 0% mortality rates, a review of 2 wrongful death suits by just one neurosurgeon prior to 2018 showed there are probably many more mortalities resulting from OSD cervical surgery than have been reported.
Cough is one of the most common symptoms of coronavirus disease 2019 (COVID-19) infection. This relatively benign symptom may lead to serious sequelae, especially in postoperative neurosurgical patients.

Here, we report a case of bone flap displacement, pseudomeningocele formation, and consequent cerebrospinal fluid leak in a patient with COVID-19 infection who recently underwent craniotomy for excision of cerebral metastasis. We highlight the pathophysiologic mechanisms of cough that may cause increased intracranial pressure (ICP), leading to the postoperative morbidity.

Aside from additional risks to the patient's health and increased treatment costs, these complications also lead to subsequent delays in the management of the underlying disease. Symptomatic treatment of cough is advised to prevent complications resulting from increased ICP.
Aside from additional risks to the patient's health and increased treatment costs, these complications also lead to subsequent delays in the management of the underlying disease. Symptomatic treatment of cough is advised to prevent complications resulting from increased ICP.
The treatment of internal carotid artery (ICA) - posterior communicating artery aneurysms (ICPC aneurysms) is challenging when a fetal posterior cerebral artery (PCA) arises from the saccular neck. This complex angioarchitecture renders endovascular approaches difficult. Giant thrombosed IC-PC aneurysms are also hard to treat by endovascular coiling because its flow-diversion effect is insufficient.

We report the first case of a ruptured giant thrombosed IC-PC aneurysm associated with a fetal PCA that was successfully treated by coil embolization with retrograde overlap horizontal stenting using low-profile stents introduced through the contralateral ICA. The aneurysm was completely occluded and follow-up MRI scans demonstrated the reduction of the aneurysmal size.

Our technique is advantageous because low-profile stents can be used to treat lesions not accessible with flow-diverter stents due their presence in complex angioarchitectures, and overlap stenting may have flow-diversion effects that can result in the complete occlusion of giant thrombosed aneurysms.
Our technique is advantageous because low-profile stents can be used to treat lesions not accessible with flow-diverter stents due their presence in complex angioarchitectures, and overlap stenting may have flow-diversion effects that can result in the complete occlusion of giant thrombosed aneurysms.
Coronavirus Disease 2019 (COVID-19) pandemic raised global attention especially due to the severe acute respiratory symptoms associated to it. However, almost one third of patients also develop neurological symptoms. The aim of the present study is to describe the case of a previously health adult that evolved cerebral ventricular empyema in the IV ventricle during COVID-19 infection treatment.

A 49-year-old man with COVID-19 developed pneumonia caused by multidrug-resistant
. After treating adequate treatment, sedation was switched off without showing appropriate awakening. Brain CT was performed with evidence of communicating hydrocephalus. External ventricular shunt (EVD) was implant with intraoperative cerebrospinal fluid suggestive of meningitis with a positive culture for oxacillin-sensitive
. Twenty days after EVD, meningitis treatment was finished and with 2 negative cultures, conversion to ventriculoperitoneal shunt was performed. In the following week, during the evaluation of the patient in intensive care, quadriplegia and absence of spontaneous respiratory movement were evidenced, just maintaining head movement. Brain MRI was performed with a diagnosis of ventriculitis associated with pus collections on the IV ventricle. The patient underwent microsurgical drainage removal of the shunt, with a positive intraventricular collection culture for
carbapenemase and multidrug-resistant
, without improvement in the neurological condition. After 14 weeks of hospitalization, the patient died.

It is well known that COVID-19 has potential to directly attack and cause severe damage to the central nervous system; however, ventricular empyema is an extremely rare life-threatening complication.
It is well known that COVID-19 has potential to directly attack and cause severe damage to the central nervous system; however, ventricular empyema is an extremely rare life-threatening complication.
Major blood loss during neurosurgery may result in a variety of complications, such as potentially fatal hemodynamic instability. Brain tumor and skull base surgery is among the high bleeding risk procedures. Tranexamic acid (TXA) has been found to reduce bleeding events in various fields of medicine.

We searched for all randomized controlled trials published in English or Bahasa which compared the use of TXA with placebo in brain tumor surgery. The studies should include adult patients with intracranial tumor who received TXA before skin incision. The primary and secondary outcomes are intraoperative blood loss and the need of transfusion.

This meta-analysis included a total of 200 patients from three studies. TXA resulted in less blood loss with pooled mean difference of -292.80 (95% CI, -431.63, -153.96,
<0.05). The need of transfusion was not significant between TXA and control group (pooled mean difference -85.36, 95% CI, -213.23 - (42.51), P=0.19).

TXA reduced the volume of blood loss but did not reduce the need of blood transfusion.
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