Coexistent Vestibular Schwannoma and Creutzfeldt-Jakob Disease: Recognition and Infection Control.

Objectives: We describe the first known case of coexistent vestibular schwannoma (VS) and Creutzfeldt-Jakob disease (CJD). Our objectives are to use this case as a general lesson for the subspecialist otolaryngologist to remain vigilant to alternative diagnoses, and to specifically improve understanding of the diagnosis and management of CJD as relevant to the practice of otolaryngology and skull base surgery.

Methods: Retrospective case review performed in June 2016 at an academic, tertiary, referral center.

What Is the Safety and Efficacy of Chemical Venous Thromboembolism Prophylaxis Following Vestibular Schwannoma Surgery?

Objective: The benefit of routine chemical prophylaxis use for venous thromboembolism (VTE) prevention in skull base surgery is controversial. Chemical prophylaxis can prevent undue morbidity and mortality, however there are risks for hemorrhagic complications.

Study Design: Retrospective case-control.

Validation of the unruptured intracranial aneurysm treatment score: comparison with real-world cerebrovascular practice.

OBJECTIVE The purpose of this study was to compare the unruptured intracranial aneurysm treatment score (UIATS) recommendations with the real-world experience in a quaternary academic medical center with a high volume of patients with unruptured intracranial aneurysms (UIAs). METHODS All patients with UIAs evaluated during a 3-year period were included. All factors included in the UIATS were abstracted, and patients were scored using the UIATS.

The Use of Semitranslucent Rubber Pledgets During Microsurgical Dissection of Cerebellopontine Angle Tumors: Technical Note.

Background And Importance: Dissection of cerebellopontine angle (CPA) tumors that abut or adhere to the brainstem or cranial nerves can be a challenging surgical endeavor. We describe the use of semitranslucent latex rubber pledgets in the tumor-brain interface as a method to improve visualization and protection of vital tissue during microsurgical dissection of CPA masses. The rubber pledgets are fashioned by cutting circular discs out of the cuff portion of talc-free, partially opaque latex gloves.

Computer-aided design/computer-aided manufacturing skull base drill.

The authors have developed a simple device for computer-aided design/computer-aided manufacturing (CAD-CAM) that uses an image-guided system to define a cutting tool path that is shared with a surgical machining system for drilling bone. Information from 2D images (obtained via CT and MRI) is transmitted to a processor that produces a 3D image. The processor generates code defining an optimized cutting tool path, which is sent to a surgical machining system that can drill the desired portion of bone.

C2-C3 Anterior Cervical Fusion: Technical Report.

Study Design: Retrospective review of patients at a university hospital.

Objective: To describe the anterior approach for cervical discectomy and fusion (ACDF) at C2-C3 level and evaluate its suitability for treatment of instability and degenerative disease in this region.

Summary Of Background Data: The anterior approach is commonly used for ACDF in the lower cervical spine but is used less often in the high cervical spine.

Rerupture of a Blister Aneurysm After Treatment With a Single Flow-Diverting Stent.

Background And Importance: As the use of flow-diverting stents (FDSs) for intracranial aneurysms expands, a small number of case reports have described the successful treatment of blister aneurysms of the internal carotid artery with flow diversion. Blister aneurysms are uncommon and fragile lesions that historically have high rates of morbidity and mortality despite multiple treatment strategies. We report a case of rebleeding after treatment of a ruptured blister aneurysm with deployment of a single FDS.

Factors influencing management of unruptured intracranial aneurysms: an analysis of 424 consecutive patients.

OBJECTIVE The choice between treating and observing unruptured intracranial aneurysms is often difficult, with little guidance on which variables should influence decision making on a patient-by-patient basis. Here, the authors compared demographic variables, aneurysm-related variables, and comorbidities in patients who received microsurgical or endovascular treatment and those who were conservatively managed to determine which factors push the surgeon toward recommending treatment. METHODS A retrospective chart review was conducted of all patients diagnosed with an unruptured intracranial aneurysm at their institution between January 1, 2013, and January 1, 2016.

Surgical Treatment of Vestibular Schwannoma: Does Age Matter?

Objective: For older patients (>65 years) who undergo surgical treatment of vestibular schwannoma (VS), the reported rates of facial nerve preservation, hearing preservation, and complications are inconsistent. Many surgeons believe that older patients have worse outcomes than their younger counterparts and advise against surgical treatment. We analyzed a consecutive series of patients with VS treated with surgery to determine whether age was a factor in outcome.

Executive Summary: 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis.

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis.

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

Middle Fossa Approach for Vestibular Schwannoma: Good Hearing and Facial Nerve Outcomes with Low Morbidity.

Objective: The middle fossa approach (MFA) is not used as frequently as the traditional translabyrinthine and retrosigmoid approaches for accessing vestibular schwannomas (VSs). Here, MFA was used to remove primarily intracanalicular tumors in patients in whom hearing preservation is a goal of surgery.

Methods: A retrospective chart review was performed to identify consecutive adult patients who underwent MFA for VS.

Bedside Treatment of Chronic Subdural Hematoma: Using Radiographic Characteristics to Revisit the Twist Drill.

Background And Study Aims: Conventional treatment strategies for the management of symptomatic chronic subdural hematoma (cSDH) in the elderly include observation, operative burr holes or craniotomy, and bedside twist drill drainage. The decision on which technique to use should be determined by weighing the comorbidities and symptoms of the patient with the potential risks and benefits. The goal of this study was to identify radiographic characteristics on computed tomography scan that might be used to guide surgical decision making in terms of operative versus bedside removal of cSDH.

Epidemiology of Traumatic Brain Injury After Small-Wheeled Vehicle Trauma in Utah.

Background: Recreational use of small-wheeled vehicles (SWVs), which include skateboards, longboards, nonmotorized scooters, ice skates, and roller skates or rollerblades, results in numerous injuries in the United States.

Objective: To describe the nature and severity of traumatic brain injuries (TBIs) that result from the use of SWVs in Utah.

Methods: Patients who were admitted to any Utah hospital after a SWV-related injury from 2001 through 2010 were identified from the Utah State Trauma Registry.

Comparison of ferromagnetic induction and bipolar electrosurgery and suction in corticotomies in pig cerebrum.

Introduction: The effects of newer energy-based surgical dissection and coagulation modalities on cerebral tissue have not been investigated. Several instruments have been developed to address the limitations of traditional electrosurgical instruments in the nervous system. We compared the effects of standard bipolar electrocautery and suction (BPS) with those of a new ferromagnetic induction (FMI) device in corticotomies of pig cerebral tissue as assessed by magnetic resonance imaging (MRI) and histological analysis.

Comparison of tissue effects in rabbit muscle of surgical dissection devices.

While some energy-based surgical dissection and coagulation modalities may offer excellent cutting and coagulation abilities, the impact on healing may differ among devices. We compared the tissue effects of three of these modalities with those of the standard surgical scalpel in rabbit muscle at 24 h and 14 days after surgery by evaluating radiographic and histological data. Linear incisions were made with each device in the dorsal lumbar musculature of rabbits using monopolar electrocautery in cut mode (MPE-Cut) and coagulation mode (MPE-Coag), a ferromagnetic induction loop (FMI), and a traditional scalpel.

Comparison of the effects of surgical dissection devices on the rabbit liver.

Purpose: Multiple energy-based surgical dissection and coagulation modalities are available to facilitate surgical dissection and hemostasis, but there is limited information regarding the acute tissue effects of these devices. Our objective was to compare the functional characteristics and tissue effects of four energy-based surgical dissection and coagulation modalities on the rabbit liver.

Methods: Linear incisions were created in the rabbit liver using monopolar electrocautery, a harmonic scalpel, a PlasmaBlade and a new ferromagnetic induction loop device.

Complete resection of the cavernous sinus-indications and technique.

Objective: To describe surgical management with complete resection of patients with recurrent benign or malignant lesions involving the cavernous sinus after standard therapy with an emphasis on surgical indications and surgical technique.

Methods: Patients who underwent complete resection of the cavernous sinus for recurrent or progressive tumors or progressive infection were retrospectively identified.

Results: Of 8 patients who fit the inclusion criteria, 7 had recurrent or progressive tumor after previous surgery or radiation therapy or both, and 1 had progressive fungal infection (mucormycosis) despite medical treatment.

Technique for steering spinal cord stimulator electrode.

Background: Spinal cord stimulation is an established technology for management of chronic low back and leg pain when other surgical options have failed or are not feasible. Precise placement of the paddle-style electrode relative to the patient's distribution of pain can be difficult because of anatomic variation and the inherent limitations of electrode design.

Objective: To describe a surgical technique for adjustment of spinal cord stimulator epidural electrode location during placement or revision to optimize stimulation coverage.