المؤلفون: Houlihan, Lena Mary, Meeke, James, Dunlea, Orla, O'Sullivan, Michael G. J., Lim, Chris, Kaar, George

المصدر: Surgical Neurology International; 10/15/2020, Vol. 12, p1-4, 4p

مصطلحات موضوعية: DISCECTOMY, QUALITY of life

مستخلص: Background: Lumbar microdiscectomy is one of the most frequently performed neurosurgical procedures. In this review, we ask why patients' outcomes vary so widely even within the same unit, with the same surgeon performing the procedure and utilizing the technique? Methods: In a cohort of 87 patients, we investigated how/whether multiple patient variables impacted outcomes following single-level lumbar microdiscectomy. We studied whether early surgical intervention improved the patients' quality of life (QOL) versus late intervention. Furthermore, we assessed other variables that could influence patient-perceived improvement. Preoperatively and postoperatively, we additionally utilized the following internationally standardized questionnaires (EQ-5D, Oswestry, and Core Outcome Measures Index [COMI]). Results: A generalized substantial improvement in QOL was identified throughout the cohort population (<0.05). There was no difference in health measurement scores for those undergoing early versus late surgery. However, there was a statistically significant improvement in all QOL scores for privately insured patients versus publicly insured patients (e.g., on COMI, EQ-5D, and ODI Scores). Conclusion: There was no objective statistically significant difference in QOL health scores between patients undergoing early versus late surgical lumbar microdiscectomy. This would suggest that the length of time patients is symptomatic before surgery did not significantly impact postoperative outcome. Of interest, however, was the difference in QOL health scores for private versus public patients suggesting that there are more subjective, complex, and psychosocial issues that influence outcome. [ABSTRACT FROM AUTHOR]

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المؤلفون: Houlihan, Lena Mary, Marks, Charlie

المصدر: Surgical Neurology International; 8/10/2020, Vol. 11, p1-8, 8p

مصطلحات موضوعية: ARACHNOID cysts, INTRACRANIAL hypertension, CEREBROSPINAL fluid, HYDRODYNAMICS, MEDICAL records

مستخلص: Background: A clear connection has been established between arachnoid cysts (ACs) and the evolution of idiopathic intracranial hypertension (IIH), a connection, which is presently not well understood. Cerebrospinal fluid (CSF) is an integral element of this condition. Little is known about either the influence of AC on CSF hydrodynamics or the specific nature of CSF, which contributes to the complex pathology of IIH. Case Description: This study aimed to chronicle in detail four patients with previously treated intracranial ACs, who developed persistent IIH. This series and review aims to identify and qualitatively analyze the multiple constituents, which could possibly elucidate the intrinsic relationship between arachnoid cyst-induced IIH and CSF hydrodynamics. A retrospective analysis of the medical records of four patients admitted to the institution's neurosurgery department during the period of 1994-2013 was completed. This study investigated discernible aspects linking CSF pathophysiology with the development of IIH in AC patients. Four male patients, ranging from 3 to 44 years of age at presentation, had a left-sided arachnoid cyst treated surgically. All four patients subsequently developed IIH. Three patients remain persistently symptomatic. Conclusion: IIH associated with AC is a hydrodynamic disorder. The full discovery of its fluctuant pathophysiology is the only way to identify an effective standard for the management and treatment of this condition. [ABSTRACT FROM AUTHOR]

: Copyright of Surgical Neurology International is the property of Scientific Scholar LLC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)