Neurosurgery practice最新文献

{"title":"Analysis of Surgical Smoke Generated by Electrocautery in a Simulated Neurosurgical Operating Room Using a Postmortem Porcine Model for Laminectomy and Craniotomy Exposures: A Preliminary Study.","authors":"Bennett R Levy, Andre Monteiro, Vinay Jaikumar, Brianna M Donnelly, David E Smolar, Jaims Lim, Jeffrey P Mullin, Elad I Levy","doi":"10.1227/neuprac.0000000000000066","DOIUrl":"10.1227/neuprac.0000000000000066","url":null,"abstract":"<p><strong>Background and objectives: </strong>Electrocautery is a widely used tool to coagulate and separate tissue during neurosurgical procedures. Surgical smoke generated by electrocautery has harmful properties if inhaled over long-term. To our knowledge, no efforts have been made within the neurosurgery field to investigate the air quality of operating rooms (ORs) where neurosurgical procedures are being performed. We analyzed the presence and quantitation of volatile organic compounds and respirable dust in surgical smoke generated by electrocautery use during a neurosurgical OR simulation for laminectomies and craniotomies and evaluated whether surgical masks can adequately prevent inhalation of such substances.</p><p><strong>Methods: </strong>Two laminectomy exposures and two bicoronal exposures were performed in two freshly euthanized pigs using electrocautery in a simulated neurosurgical OR. In each of the four neurosurgical procedure models, air sampling media and pumps were connected to a 3D-printed human face model. In two of these models, the face was covered with a standard surgical mask; in the other two models, no masks were placed. The models were positioned at a distance of 40 cm from the surgical field. Air samples were analyzed by an independent laboratory. Analyses of total amounts of respirable dust and 31 organic volatile compounds were conducted. The mean total amounts of the samples obtained from the masked and nonmasked models were compared.</p><p><strong>Results: </strong>In the two masked and two nonmasked models, all 31 organic volatile compounds were below the levels of quantitation. The total amounts of respirable dust were higher in the two nonmasked models than in the two masked models.</p><p><strong>Conclusion: </strong>The total amount of organic volatile compounds seems to be low at the distance measured regardless of mask use; however, further studies are needed to determine whether even small amounts can be harmful over time. Standard surgical masks reduced the amounts of inhalable respirable dust.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 4","pages":"e00066"},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scalp Incisions With Stairstep Pericranial Edges to Minimize Sequalae from Poor Wound Healing in Supratentorial Brain Tumor Surgery: A Technical Note With Early Results.","authors":"Nicholas Popp, Ishan Singhal, Brandon Laing, Kate B Krucoff, Max O Krucoff","doi":"10.1227/neuprac.0000000000000052","DOIUrl":"10.1227/neuprac.0000000000000052","url":null,"abstract":"<p><strong>Background and objectives: </strong>Wound healing problems are especially prevalent in craniotomies for intra-axial brain tumors as patients often require radiation, chemotherapy, and chronic steroids. Although newer techniques such as minimally invasive approaches and routine vancomycin powder use have helped overall complication rates, poor skin healing remains a frustratingly persistent cause of morbidity. Therefore, here we describe the novel technique of elevating and closing a stairstep pericranial edge offset from the skin incision to protect hardware and support wound healing, and we report early outcomes using this technique.</p><p><strong>Methods: </strong>Ninety-one consecutive patients underwent supratentorial, intra-axial brain tumor surgery with a single surgeon at a single institution using this technique. Patient demographics, pathology, adjuvant interventions, and other independent risk factors were analyzed.</p><p><strong>Results: </strong>No wound-related complications requiring readmission, intravenous antibiotics, or reoperation were encountered at a median 3-month follow-up. There were also no surgical site infections, dehiscences, or cerebrospinal fluid leaks. Fifty-one patients (57.3%) had postoperative radiotherapy, 85 patients (93.4%) had perioperative steroids, and 56 patients (61.5%) had postoperative chemotherapy. Six patients (6.5%) were placed on a short course of oral antibiotics perioperatively due to concerns with initial scalp healing (ie, excessive scabbing at follow-up), none of whom progressed to infection or required further intervention. These are the cases where this technique is felt to have been most helpful by potentially preventing worse sequelae. One patient developed a shunt infection during this interval that required removal unrelated to the craniotomy site.</p><p><strong>Conclusion: </strong>Here we outline in detail the principles, design, and execution of incisions and closures with stairstep pericranial edges in supratentorial brain surgery. This technique was designed in consultation with plastic surgeons to provide an intact, vascularized layer of pericranium beneath the healing skin and over the bone graft/hardware to optimize wound healing conditions and prevent morbid sequelae in inevitable cases of poor initial healing. Early results are promising.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 4","pages":"e00052"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-Dosed Stereotactic Radiosurgery for the Treatment of Cerebral Arteriovenous Malformations: An Early Institution Experience and Case Series.","authors":"Akal Sethi, Keanu Chee, Gregoire P Chatain, Blake Wittenberg, Joshua Seinfeld, Sarah Milgrom, Brian Kavanagh, Robert Breeze","doi":"10.1227/neuprac.0000000000000060","DOIUrl":"10.1227/neuprac.0000000000000060","url":null,"abstract":"<p><strong>Background and objectives: </strong>Stereotactic radiosurgery (SRS) is an effective treatment modality used by neurosurgeons to treat cerebral arteriovenous malformations (AVMs), particularly for treating AVMs <10 cm³. Current strategies include single-staged, dose-staged, and volume-staged SRS, all of which demonstrate varying effectiveness for treating large-volume AVMs (>10 cm³). We introduce a novel refinement called time-dosed SRS for the treatment of large-volume AVMs or AVMs located in eloquent areas. This study aims to detail treatment parameters, outcomes, and complications associated with time-dosed SRS in our early experience study.</p><p><strong>Methods: </strong>We retrospectively reviewed all patients treated using time-dosed SRS at our institution. Data, including AVM location, history of hemorrhage, history of intervention, AVM volume, Spetzler-Martin grade, presence of residual disease, and occurrence of postprocedural complications, were collected.</p><p><strong>Results: </strong>Sixteen patients were included. The median total AVM volumes treated were 9.64 cm³ (0.92-46.2 cm³) and 13.2 cm³ (3.0-42.2 cm³) in adults and children, respectively. The median margin doses for adults and children at each of the 3 stages were 10 Gy, 10 Gy (8-10 Gy) and 9 Gy (8-10 Gy), and 10 Gy, 10 Gy (9-10 Gy), and 10 Gy (8-10 Gy), respectively. The median total dose delivered was 29 Gy (27-30 Gy) in adults and 30 Gy (28-30 Gy) in children. The median radiological follow-up length was 35 months (9-62 months) in adults and 31 months (4-72 months) in pediatric patients. Complete obliteration was confirmed by cerebral angiogram in 6 adult patients and 1 pediatric patient. One adult patient and 2 pediatric patients suffered radiation-related toxicity. No patients suffered postprocedural hemorrhage.</p><p><strong>Conclusion: </strong>Time-dosed SRS seems to be effective for treating large AVMs or those in highly eloquent areas, with a low rate of complications.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 4","pages":"e00060"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topical Vancomycin as a Tool for the Prevention of Surgical Site Infections in Cranial Neurosurgery: A Retrospective Cohort Study.","authors":"Juan Pablo Leal-Isaza, Luis Garcia Rairan, Andrés David Ramírez-Sanabria, Isabella Mejía-Michelsen, Julian Camargo, Yessid Araque, María Camila Pedraza, Juliana Mendoza, Pierre Fonseca, Ericka Ramírez-Arquez, Teo Nicolas Campo, Gabriel Alexander Quiñones-Ossa, M Salvador Mattar, Juan Sebastian Davidson, Diego Fernado Gómez-Amarillo, Juan Armando Mejía Cordovez, Fernando Hakim Daccach, Juan Fernando Ramon Cuellar, Enrique Jimenez Hakim","doi":"10.1227/neuprac.0000000000000061","DOIUrl":"10.1227/neuprac.0000000000000061","url":null,"abstract":"<p><strong>Background and objectives: </strong>Surgical site infections (SSI) in neurosurgery result in prolonged hospitalizations, readmissions, poor outcomes, and even death. Prevention of SSI remains paramount to mitigate the risk of this complication. In this study, we aimed to evaluate the effect of topical use of vancomycin powder during surgical closure in cranial surgery for the reduction of SSI.</p><p><strong>Methods: </strong>This is a retrospective cohort study of cranial neurosurgical patients from 2016 to 2022 in Fundación Santa Fe de Bogotá. Baseline clinical and surgical characteristics were collected, as well as vancomycin powder use. The primary outcome of interest was SSI within 90 days after surgery. A <i>P</i> value of .05 was considered significant.</p><p><strong>Results: </strong>We found a total of 1395 patients, of which 1108 met the selection criteria. Surgical site infection was seen in 32 patients (2.9%). Topical use of vancomycin powder during surgical closure was associated with a lower frequency of SSI in cranial surgery n = 10 (2.3%) relative to those who did not use vancomycin n = 22 (3.3%), and it was found to be a protective factor in the multinomial regression, with a statistically significant result (relative risk = 0.397, <i>P</i> = .034).</p><p><strong>Conclusion: </strong>The evidence supporting the use of vancomycin powder during surgical closure is currently weak, as the association did not reach statistical significance in the primary analysis. However, a <i>P</i> value of less than 0.05 was obtained in the multivariate analysis. To further assess the efficacy of this intervention, additional randomized prospective studies are needed.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 4","pages":"e00061"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Significance of Venous Outflow Obstruction in Dural Arteriovenous Fistulas.","authors":"Lachlan R Evans, Visnu Khanijou, Andrew J Gauden, Bhadrakant Kavar, Andrew S Davidson, Bernard Yan, Steve Bush, Richard Dowling, John D Laidlaw, Peter J Mitchell, Alexios A Adamides","doi":"10.1227/neuprac.0000000000000057","DOIUrl":"10.1227/neuprac.0000000000000057","url":null,"abstract":"<p><strong>Background and objectives: </strong>The association between venous outflow obstruction (VOO) and cranial dural arteriovenous fistulas (DAVF) is well established; however, its impact on the natural history remains unclear. This article aims to characterize its clinical significance and further describe the natural history of DAVF.</p><p><strong>Methods: </strong>A retrospective cohort study was performed at a tertiary neurosurgical center. Cohort characteristics were described with a focus on patients with VOO. Annualized event rates and risk factors for hemorrhage and nonhemorrhagic neurological events (NHNE) were also investigated.</p><p><strong>Results: </strong>The cohort consisted of 108 patients, 74 of which had follow-up greater than 1 month including 24 low-grade (Cognard I-IIa) fistulas (21.7 lesion-years) and 50 high-grade (Cognard IIb-V) fistulas (60 lesion-years). 18 patients with concurrent VOO were identified; most (83.3%) were high-grade DAVF and had obstruction of the direct draining sinus. Annualized rates of hemorrhage and NHNE for high-grade DAVF were 4.6% and 10.6%, respectively. Those high-grade lesions presenting with hemorrhage had a 10.9% annual rate of recurrent hemorrhage, while those presenting with NHNE had a 22.3% annual rate of subsequent NHNE. Fifteen high-grade DAVF with VOO (15.7 lesion-years) had annualized hemorrhage and NHNE rates of 6.4% and 31.9%, respectively. High radiological grade, an aggressive index presentation, and the presence of VOO were the predictors of hemorrhage and NHNE (<i>P</i> < .05).</p><p><strong>Conclusion: </strong>This study reports a novel association between VOO and a more aggressive clinical course. DAVF with high-grade angiographic features, an aggressive index presentation, or VOO should be considered for early treatment.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 4","pages":"e00057"},"PeriodicalIF":0.0,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mini-Craniotomy With Endoscopic Approach for Acute Subdural Hematoma Evacuation in a Patient With Complex Scalp Flap Defect: A Case Report.","authors":"Adam Joseph Kundishora, Vinaik Mootha Sundaresan, Sam Boroumand, Sarah E Hodges, Sacit Bulent Omay","doi":"10.1227/neuprac.0000000000000056","DOIUrl":"10.1227/neuprac.0000000000000056","url":null,"abstract":"<p><strong>Background and importance: </strong>Acute subdural hematoma (aSDH) is one of the most common pathologies resulting from head trauma. Surgical management often involves a large craniotomy for hematoma evacuation. Prior complex cranial reconstructive surgery can complicate incision planning or limit craniotomy size.</p><p><strong>Clinical presentation: </strong>In this report, we describe a 61-year-old woman with a history of squamous cell carcinoma of the scalp, which previously required complex flap reconstruction and left a residual skull defect, who presented with an aSDH after a fall. Prior surgery and poorly vascularized skin significantly limited the available area for craniotomy. We used a mini-craniotomy with endoscopic adjunct to achieve appropriate visualization and complete evacuation of the hematoma.</p><p><strong>Conclusion: </strong>In cases of aSDH in which a mini-craniotomy is desirable and the potential location of the incision is limited, an endoscopic approach should be considered.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 4","pages":"e00056"},"PeriodicalIF":0.0,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explantation and Simultaneous Explantation-Reimplantation of Spinal Cord Stimulation Paddle Electrodes: Complication Rate and Predisposing Factors.","authors":"Xenia Kuparinen, Abdirisak Ahmed Haji Omar, Nuutti Vartiainen, Johan Marjamaa, Joonatan Gröndahl, Riku Kivisaari, Julio Resendiz-Nieves","doi":"10.1227/neuprac.0000000000000055","DOIUrl":"10.1227/neuprac.0000000000000055","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spinal cord stimulation (SCS) is an effective treatment for chronic pain that does not respond to conservative treatment. Nonetheless, up to 38% of all implanted SCS electrodes are explanted, and while the risks involved in the surgical implantation of SCS paddle electrodes are well documented, there is scarce information about SCS explantations and their associated complications. We aimed to document the complication rate and identify their predisposing factors in SCS paddle electrode explantations and simultaneous explantation-reimplantations.</p><p><strong>Methods: </strong>We retrospectively reviewed the outcomes and the characteristics of all patients who underwent explantation of surgically implanted SCS paddle electrodes at the Helsinki University Hospital Department of Neurosurgery between February 2005 and October 2020.</p><p><strong>Results: </strong>One hundred thirty-one explantations were performed on 106 patients. The complication rate was 18.3% (24 operations). Major complications occurred during 5 operations (3.8%). No permanent neurological deficits were recorded. Smoking predisposed patients to postoperative complications (<i>P</i> = .023). On average, patients who suffered complications required a day longer hospitalization (2.22 vs 2.92, <i>P</i> = .011). Patients who had repeated explantations (3 or more) suffered significantly more complications than patients who had only 1 or 2 operations (62.5% vs 15.4%, <i>P</i> = .005).</p><p><strong>Conclusion: </strong>Our results suggest that the explantation of the SCS paddle electrode is a relatively safe surgical procedure. Although severe complications occurred, they were successfully managed. Repeated explantations should be treated cautiously as they seem to increase the complication rate considerably.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 3","pages":"e00055"},"PeriodicalIF":0.0,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lateral Compression is the Strongest Independent Predictor of Aneurysm Occlusion After Endovascular Treatment of Intracranial Aneurysms With the Woven EndoBridge Device.","authors":"Josser E Delgado Almandoz, Yasha Kayan, Alexander Z Copelan, Ashley M Ertelt, Jill M Scholz","doi":"10.1227/neuprac.0000000000000054","DOIUrl":"10.1227/neuprac.0000000000000054","url":null,"abstract":"<p><strong>Background and objectives: </strong>The effect of lateral compression (LC) of the Woven EndoBridge (WEB) device on intracranial aneurysm (IA) occlusion and retreatment has not been studied in depth. This study aims to determine the effect of LC on aneurysm occlusion and retreatment after endovascular treatment with WEB.</p><p><strong>Methods: </strong>We retrospectively reviewed IAs treated with WEB at our institution between February 5th, 2019, and March 31st, 2022. LC was determined in the immediate postdetachment angiogram by measuring the mean implanted WEB width at the equator in two orthogonal projections and subtracting it from the nominal WEB width. LC was then converted to the percentage of nominal WEB width (percent LC [%LC]). Independent predictors of complete and adequate aneurysm occlusion at follow-up and retreatment were determined using multivariate logistic regression analysis. Optimal %LC thresholds were determined using receiver operating characteristic analysis.</p><p><strong>Results: </strong>One hundred and fifty-five IAs were included, with a mean size of 6.4 mm, a mean neck of 3.6 mm, and a mean time to last follow-up of 15.5 months. At last follow-up, complete and adequate aneurysm occlusion was present in 98 (63.2%) and 139 (89.7%) IAs, respectively. Twelve IAs were retreated (7.7%). %LC was the strongest independent predictor of complete and adequate aneurysm occlusion at first and last follow-up and an independent predictor of aneurysm retreatment. Optimal %LC thresholds for complete and adequate aneurysm occlusion at first follow-up were >17.1% and >15.7%, respectively. Compared with IAs in which these thresholds were not attained, IAs in which these thresholds were attained had significantly higher rates of complete (31% vs 68%, <i>P</i>-value <.0001) and adequate occlusion (81% vs 96%, <i>P</i>-value .004) at first follow-up. The optimal %LC threshold for aneurysm retreatment was ≤15.6%. IAs with ≤15.6% LC had a significantly higher rate of retreatment (15%) than IAs with >15.6% LC (4%, <i>P</i>-value .025).</p><p><strong>Conclusion: </strong>LC is the strongest independent predictor of aneurysm occlusion in IAs treated with WEB.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 3","pages":"e00054"},"PeriodicalIF":0.0,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rupture of a Spinal Dural Arteriovenous Fistula as a Differential Diagnosis of a Coronary Syndrome: Case Report.","authors":"Juan Fernando Ramón, Luis Garcia Rairan, Yessid Araque, Santiago Fuentes, Nicolas Useche","doi":"10.1227/neuprac.0000000000000050","DOIUrl":"10.1227/neuprac.0000000000000050","url":null,"abstract":"<p><strong>Background and importance: </strong>Spinal dural arteriovenous fistulas (SDAVFs) are the most common vascular malformation of the spine and can lead to progressive paraplegia if left untreated. However, because of their nonspecific clinical presentation, they are often misdiagnosed as other pathologies, such as discopathies or degenerative neuropathies, which can result in delayed diagnosis and treatment.</p><p><strong>Clinical presentation: </strong>A case of a 73-year-old female with a history of acute coronary syndrome who presented to the emergency department with sudden onset chest pain suggestive of an acute myocardial infarction is presented. Further evaluation revealed a subdural hematoma at T2-T5 and T8-L5, caused by a ruptured SDAVF at the T12-L1 level. The patient required emergency decompression surgery, but because of late diagnosis, she suffered a spinal cord injury with an ASIA-A classification.</p><p><strong>Conclusion: </strong>SDAVF is a disease with nonspecific initial symptoms, which can easily be mistaken for other pathologies. However, early recognition of the presence of the fistula, especially in cases of rupture, can improve prognosis and increase the chance of better outcomes. It is important to keep this condition in mind when evaluating patients with unexplained neurological symptoms and consider SDAVF as a differential diagnosis of acute coronary syndrome.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 3","pages":"e00050"},"PeriodicalIF":0.0,"publicationDate":"2023-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagonal Earlobe Crease (Frank's Sign): a New Clinical Sign to Look for in Patients With Ruptured and Unruptured Intracranial Aneurysms? Patient Series.","authors":"Victor Ramzes Chavez-Herrera, Joel Abraham Velazquez-Castillo, Flavio Hernandez-Gonzalez, Josue Alejandro Cervantes-Gonzalez, Juan Luis Cruz-Rosales, Bayron Alexander Sandoval-Bonilla, Diego Tonathiu Soto-Rubio, Cristian Alberto Perez-Carrillo, Rabindranath Garcia-Lopez","doi":"10.1227/neuprac.0000000000000053","DOIUrl":"10.1227/neuprac.0000000000000053","url":null,"abstract":"<p><strong>Background and importance: </strong>Diagonal earlobe crease (DELC, Frank's sign) and intracranial arterial aneurysms (IAA) have a pronounced association with atherosclerosis. Therefore, detecting DELC in patients with IAA could be potential for clinical and research use.</p><p><strong>Clinical presentation: </strong>During a 2-month period, we diagnosed 20 patients with intracranial arterial aneurysms. Sixteen (80%) were positive for DELC, 12 were female, and 4 were male (ages ranging from 32 to 68 years and a mean of 52 years). Eleven were unruptured and 5 were ruptured. We highlight cases 1, 7, and 8.</p><p><strong>Conclusion: </strong>The interesting tight association of DELC and IAAs to atherosclerosis and the overwhelming presence of DELC in patients with IAAs could lead to potentially associated DELC with the development, growth, and rupture of IAAs. As a result, important clinical and research information could be found.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 3","pages":"e00053"},"PeriodicalIF":0.0,"publicationDate":"2023-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}