Standardizing postoperative pain control for decompression of pediatric Chiari type I malformation by limiting narcotic usage.

Objective: The aim of this study was to assess the effectiveness of a postoperative multimodal pain control protocol on perioperative pain scores in children undergoing decompression for Chiari type I malformation (CM-I).

Methods: This retrospective matched cohort study included patients < 21 years of age who underwent elective suboccipital craniectomy and C1 laminectomy for CM-I with or without duraplasty at a single center from January 2020 to July 2023. A standardized, multimodal postoperative pain protocol was implemented in August 2021 that did not use narcotic patient-controlled analgesia.

Safety and accuracy of stereoelectroencephalography for pediatric and young adult patients with prior craniotomy.

Objective: The authors assessed the safety and accuracy of stereoelectroencephalography (SEEG) electrode implantation in pediatric patients who had previously undergone craniotomy compared to those without prior cranial surgery.

Methods: The authors performed a retrospective analysis of patients under 25 years of age with medically refractory epilepsy at a single institution who underwent SEEG electrode placement between March 2016 and July 2023. Surgical history and demographic characteristics were collected from the electronic medical records.

Vasospasm and subsequent stroke from paraneoplastic syndrome in a pediatric patient with an intracranial mature teratoma: a case report.

Teratomas account for 18-20% of all intracranial germ cell tumors and mostly occur in the pineal region with only a few cases of pediatric sellar and suprasellar teratomas described in the literature. Here, we present a case of a child with an intracranial mature teratoma with pancreatic features causing vasospasm and subsequent stroke, found to be positive for CDKN2A-an independent variant associated with malignancy and small vessel disease leading to stroke.

Recurrent petit mal seizures in Erdheim-Chester disease mimicking an intra-axial brain tumor: illustrative case.

Background: Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis characterized histologically by foamy histiocytes and Touton giant cells in a background of fibrosis. Bone pain with long bone osteosclerosis is highly specific for ECD. Central nervous system involvement is rare, although dural, hypothalamic, cerebellar, brainstem, and sellar region involvement has been described.

Primary thoracic intramedullary spinal cord tumor with likely metastases of glial origin to the lumbosacral vertebrae: Illustrative case.

Background: Metastasis of systemic neoplasms to the spine is common; however, the metastasis of primary spinal cord tumors to other regions in the body is an infrequent occurrence. A few case reports have described the metastasis of primary spinal cord tumors, and in most cases, patients were younger than 30 years of age.

Case Description: We present an illustrative case of a 47-year-old female with metastatic lesions to the lumbosacral vertebrae years after the initial diagnosis of an intradural, intramedullary spinal cord tumor (IMSCT).

Acute aortic occlusion leading to spinal cord ischemia in a 73-year-old: A case report.

Background: Cauda equina syndrome (CES) is typically caused by a compressive etiology from a herniated disk, tumor, or fracture of the spine compressing the thecal sac. Here, we report a CES mimic - acute aortic occlusion (AAO), a rare disease that is associated with high morbidity and mortality. AAO can compromise spinal cord blood supply and leads to spinal cord ischemia.

Indolent multicentric chordoma - A previously undescribed entity: A Case report and literature review.

Background: Chordomas are rare neuraxial tumors arising from remnants of primitive notochord. They are generally slow-growing malignant neoplasms. Only four adult cases of multicentric chordomas have been reported, all with aggressive and rapid growth.

Educational impact of early COVID-19 operating room restrictions on neurosurgery resident training in the United States: A multicenter study.

Background: The coronavirus (COVID-19) pandemic has caused unprecedented suspensions of neurosurgical elective surgeries, a large proportion of which involve spine procedures. The goal of this study is to report granular data on the impact of early COVID-19 pandemic operating room restrictions upon neurosurgical case volume in academic institutions, with attention to its secondary impact upon neurosurgery resident training. This is the first multicenter quantitative study examining these early effects upon neurosurgery residents caseloads.

Hijacking Sexual Immuno-Privilege in GBM-An Immuno-Evasion Strategy.

Regulatory T-cells (Tregs) are immunosuppressive T-cells, which arrest immune responses to 'Self' tissues. Some immunosuppressive Tregs that recognize seminal epitopes suppress immune responses to the proteins in semen, in both men and women. We postulated that GBMs express reproductive-associated proteins to manipulate reproductive Tregs and to gain immune privilege.

Feasibility and Efficacy of Low-profile Visual Intraluminal Support Device: A Single Center Five-year Experience.

Introduction: The Low-Profile Visualized Intraluminal Support (LVIS) devices are a new generation of self-expandable, high-porosity stents approved for the treatment of large to giant wide-necked intracranial aneurysms via stent-assisted coiling. Here we report the radiographic and clinical outcomes seen with LVIS, LVIS Jr. and LVIS Blue from a single institution over a fiveyear period.

Microsurgical Clipping of a Posterior Inferior Cerebellar Artery Aneurysm Following Failed Pipeline Stent.

Aneurysms of the posterior inferior cerebellar artery (PICA) are rare, with limited consensus on appropriate management. These aneurysms have been noted to have a faster growth rate and are more prone to rupture. Accessing these aneurysms for microsurgical clipping is challenging, and has traditionally required significant removal of the occipital condyle, putting the patient at risk for future complications.

Multiple Anterior and Posterior Circulation Intracranial Fenestrations presenting With Aneurysmal Subarachnoid Hemorrhage.

: Intracranial artery fenestrations are very rare, however, when found, there is a high association with cerebral aneurysms. : This report describes a patient with multiple anterior and posterior circulation intracranial artery fenestrations and an anterior communicating artery aneurysm presenting with a thunderclap headache found to have a subarachnoid hemorrhage (SAH). The patient was treated with open surgery via clipping after a diagnostic angiography and did very well.

Ventriculoperitoneal shunt complications in an adult population: A comparison of various shunt designs to prevent overdrainage.

Background: Overdrainage after cerebrospinal fluid diversion remains a significant morbidity. The hydrostatic, gravitational force in the upright position can aggravate this. Siphon control (SC) mechanisms, as well as programmable and flow regulating devices, were developed to counteract this.

Stereotactic laser ablation for subependymal giant cell astrocytomas: personal experience and review of the literature.

Purpose: Subependymal giant cell astrocytomas (SEGAs) are rare tumors typically found in tuberous sclerosis patients. They typically grow in the region of the foramen of Monro and can occlude it, leading to hydrocephalus. Currently, gross total resection is the standard of care, with low rates of recurrence but high rates of complication, especially with larger lesions.

Operative Treatment of a Superior Cerebellar Artery Perforator Dissecting Aneurysm.

Background And Importance: Superior cerebellar artery (SCA) perforator aneurysms are extremely rare, with only one other case published in the literature. There is no conclusive management strategy for these aneurysms, although endovascular treatment, open surgical treatment with clipping, and antifibrinolytic administration with spontaneous thrombosis have all been discussed.

Clinical Presentation: A 61-yr-old male presented with intraventricular hemorrhage (IVH) primarily in the posterior fossa.

Contemporary Management of Increased Intraoperative Intracranial Pressure: Evidence-Based Anesthetic and Surgical Review.

Increased intracranial pressure (ICP) is frequently encountered in the neurosurgical setting. A multitude of tactics exists to reduce ICP, ranging from patient position and medications to cerebrospinal fluid diversion and surgical decompression. A vast amount of literature has been published regarding ICP management in the critical care setting, but studies specifically tailored toward the management of intraoperative acute increases in ICP or brain bulk are lacking.

Correction: Lumbosacral Osteomyelitis and Discitis with Phlegmon Following Laparoscopic Sacral Colpopexy.

[This corrects the article DOI: 10.7759/cureus.671.

Higher Rate of Intracerebral Hemorrhage in Hispanic Patients with Cerebral Cavernous Malformation.

Unlabelled: Cerebral cavernous malformations (CCM) are vascular malformations prone to intracerebral hemorrhage and epilepsy. Studies about the natural history and clinical presentation in the Hispanic population are lacking [7]. Retrospectively, we identified demographics and clinical features of Hispanic patients with CCM in our neurology clinic.