Cushing's Disease Clinical Phenotype and Tumor Behavior Vary with Age: Diagnostic and Perioperative Implications.

Context: Little is known about presenting clinical characteristics, tumor biology, and surgical morbidity of Cushing's disease (CD) with aging.

Objective: Using a large multi-institutional dataset, we assessed diagnostic and prognostic significance of age in CD through differences in presentation, laboratory results, tumor characteristics, and postoperative outcomes.

Design: Data from the Registry of Adenomas of the Pituitary and Related Disorders (RAPID) were reviewed for patients with CD treated with transsphenoidal tumor resection at 11 centers between 2003 and 2023.

A retrospective analysis of quality of life domains impacted by distal radius fracture and ulnar neuropathy.

Background: Distal radius fractures (DRF) and ulnar neuropathy (UNE) present with reduced motor function, restricted range of motion, pain, and reduced grip strength that may lead to similar treatment approaches. With rapid and insidious onset for DRF and UNE, respectively, the contextual factors impacting an individuals' experience with the condition can vary.

Purpose: The aim of this secondary analysis is to compare ratings of quality of life (QoL) domains prior to treatment and 3 months post treatment for DRF and UNE.

Does Improved Resection Plane Coverage During Shoulder Arthroplasty Influence Proximal Humeral Bone Stress? A Comparison of Circular vs. Elliptical Humeral Heads.

Introduction: Stress shielding remains a concern following total shoulder arthroplasty using press-fit short humeral stems. While the effect of alterations in implant geometry, positioning, and sizing on stress shielding have been investigated, the effects of coverage of the cortical boundary of the resection plane have not yet been fully explored. The purpose of this study was to quantify the effect of improved cortical coverage using elliptical vs.

Combined Solid Organ Transplant and Transfusion-Associated Graft-Versus-Host Disease in a Lung Transplant Recipient: An Uncertain Culprit With Lethal Complications.

Although graft-versus-host disease (GVHD) is a common complication of hematopoietic stem cell transplantation, it is rare after solid organ transplantation (SOT) or blood transfusion. We present a rare case of SOT-derived and/or transfusion-associated graft-versus-host disease (TA-GVHD) in a 66-year-old man with interstitial lung disease who underwent bilateral lung transplantation (LT) from a 12-year-old female donor and required three units of packed red blood cells intraoperatively. He presented with signs and symptoms consistent with GVHD, and a bone marrow biopsy revealed an XX karyotype.

Non-HFE Hemochromatosis in the Context of β-Thalassemia Trait: A Case Study on Iron Overload Dysregulation.

Thalassemia and hemochromatosis are two distinct conditions that involve dysregulation of iron metabolism, though their origin, clinical presentations, and treatments differ. This case represents a patient with incidentally discovered microcytic anemia due to β-thalassemia trait and non- hemochromatosis. It discusses the potential synergistic effect of these two diseases on iron overload and highlights the need for further testing to determine hereditary versus secondary causes of hemochromatosis.

Perioperative morbidity after primary hiatal hernia repair increases as hernia size increases.

Background: Minimally invasive hiatal hernia (HH) repair is the gold standard for correcting mechanical defects of the crural diaphragm due to its safety and favorable clinical outcomes (i.e., relief of patient symptoms).

A Roadmap for Implanting Electrode Arrays to Evoke Tactile Sensations Through Intracortical Stimulation.

Intracortical microstimulation (ICMS) is a method for restoring sensation to people with paralysis as part of a bidirectional brain-computer interface (BCI) to restore upper limb function. Evoking tactile sensations of the hand through ICMS requires precise targeting of implanted electrodes. Here we describe the presurgical imaging procedures used to generate functional maps of the hand area of the somatosensory cortex and subsequent planning that guided the implantation of intracortical microelectrode arrays.

Protocol for bacterial filtration efficiency evaluations of facemask materials using viable bacteria-laden aerosol droplets.

Here, we present a protocol for determining the bacterial filtration efficiencies of facemask materials according to the American Society for Testing and Materials (ASTM) standard F2101-19. We describe steps for reproducibly generating, collecting, and enumerating viable bacteria-laden aerosols containing the bacterial pathogen Staphylococcus aureus. The optimized operating parameters generate 1,700 to 3,000 viable bacteria-laden aerosol droplets between 2.

Natural history of dolichoectatic vertebrobasilar aneurysms: a multinational study.

Objective: Dolichoectatic vertebrobasilar aneurysms (DVBAs) are expansions of arterial tissue leading to aneurysmal formations without an obvious neck. Their natural history is poorly understood; usually patients are admitted with thromboembolic complications and/or neurological symptoms from the mass effect. There have not been international collective data, and correct timing for highly risky treatments has been under discussion.

Clinical Experience of Dissolvable Calcium Sulfate (Stimulan) Carrier for Antibiotic Delivery in Orthopedic Surgery: A Study of 143 Patients.

Prosthetic bone and joint infections are difficult to treat with varying levels of success with standard therapy. Synthetic calcium sulfate carrier, to which specific antibiotics can be added, can be utilized as an alternative drug delivery system in these cases. We have reviewed clinical outcomes using commercially available pure synthetic calcium sulfate dissolvable beads (Stimulan) loaded with antibiotics in 143 patients undergoing orthopedic surgery for prevention and treatment of joint infection.

Optimization of 3D-printed titanium interbody cage design. Part 1: in vitro biomechanical study of subsidence.

Background Context: Cage subsidence is a complication of interbody fusion associated with poor clinical outcomes. 3D-printed titanium interbody cages allow for the alteration of features such as stiffness and porosity. However, the influence of these features on subsidence and their biological effects on fusion have not been rigorously evaluated.

Collision of a Pancreatic Neuroendocrine Tumor and Intra-ampullary Carcinoma: A Case Report and Review of the Literature.

This manuscript reports the case of a 75-year-old patient presenting with a collision tumor consisting of a pancreatic neuroendocrine tumor and intra-ampullary adenocarcinoma, which manifested with obstructive jaundice and was treated with primary surgical cytoreduction. Additionally, a bibliographic search of original articles was performed in the Medical Literature Analysis and Retrieval System Online (MEDLINE; via PubMed) and the Latin American and Caribbean Literature on Health Sciences (LILACS) databases to review the literature on pancreaticobiliary collision tumors. Currently, information regarding pancreatic and bile duct collision tumors is limited due to their very low incidence.

Flow diverter versus stent-assisted coiling treatment for managing dissecting intracranial aneurysms: A systematic review and meta-analysis.

Background: Dissecting intracranial aneurysms (DIAs) have been treated through endovascular reconstructive manners, such as flow diverters (FDs) and stent-assisted coiling (SAC). Notably, no robust evidence has compared both approaches. Hence, the authors conducted a meta-analysis to compare their outcomes.

Complications: skull base and cerebrovascular.

Neurosurgical complications are a rich source for learning, but they are grossly underutilized for the purpose of surgeon education. Details of the complications, which make them all the more powerful as teaching tools, are restricted to morbidity and mortality conferences behind closed doors, and open discussions of the topic are blurred by hypotheticals in order to shield the presenters from medicolegal risks. In this issue of Neurosurgical Focus, 9 neurosurgeons were invited to present complications they encountered along with the details and specific lessons they learned.

Front-to-Back Arthroscopic Repair of Complete Lunotriquetral Ligament Injuries: A Case Presentation and Algorithm for Arthroscopic Management of Intercarpal Ligament Injuries.

The lunotriquetral intercarpal ligament (LTIL) is an important structure that equalizes the forces on the lunate imparted through the scapholunate intercarpal ligament. The extension moment of the triquetrum balances the flexion force of the scaphoid, positioning the lunate for efficient load transfer from the hand to the wrist. In contrast to the scapholunate intercarpal ligament, the LTIL is strongest volarly, with the most critical region being associated with the volar ulnocapitate ligament.

Ultrahigh-resolution 7-Tesla anatomic magnetic resonance imaging and diffusion tensor imaging of formalin-fixed human brainstem-cerebellum complex.

Introduction: Brain cross-sectional images, tractography, and segmentation are valuable resources for neuroanatomical education and research but are also crucial for neurosurgical planning that may improve outcomes in cerebellar and brainstem interventions. Although ultrahigh-resolution 7-Tesla (7T) magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) reveal such structural brain details in living or fresh unpreserved brain tissue, imaging standard formalin-preserved cadaveric brain specimens often used for neurosurgical anatomic studies has proven difficult. This study sought to develop a practical protocol to provide anatomic information and tractography results of an human brainstem-cerebellum specimen.

Optimization of 3D-printed titanium interbody cage design. Part 2: An in vivo study of spinal fusion in sheep.

Background Context: 3D-printed titanium cage designs can incorporate complex, porous features for bone ingrowth and a greater surface area for minimizing subsidence. In a companion study (Part 1), we determined that increased surface area leads to decreased subsidence; however, it remains unclear how increasing the cage surface area, resulting in a smaller graft aperture, influences fusion.

Purpose: We evaluated the effects of surface area of 3D-printed titanium cages and the use of autologous bone grafts on spinal fusion in sheep.

Early experience with the Aristotle Colossus 0.035' macrowire for mechanical thrombectomy in 30 consecutive cases.

Introduction: Recent literature continues to demonstrate the successful role of large-bore aspiration catheters in thrombus ingestion during mechanical thrombectomy. However catheter-to-microwire step-off and distal navigation are ongoing challenges in thrombectomy. A new to market 0.

Is There an Association Between Spine Surgeon Academic Productivity and Patient Satisfaction Ratings?

Background And Objectives: Physician rating websites (PRWs) are increasingly used by patients to find health care providers. This study explores spine neurosurgeon PRW ratings and their relationship with academic productivity.

Methods: A retrospective study was conducted from November 2022 to May 2023 that included 1990 neurological surgeons listed in the American Association of Neurological Surgeons database with a subspecialty in spine.

Lung transplant outcomes in recipients of advanced age: Are two always better than one?

Background: Lung transplantation has become more common in patients aged 65 years and older. We aimed to examine outcomes across age groups and identify risk factors for decreased survival.

Methods: United Network for Organ Sharing data for all primary lung transplants from January 1, 2006, to March 8, 2023, were retrospectively reviewed.