Does the COVID-19 Screening Test Affect the Postoperative Prognosis of Patients Who Undergo Emergency Surgery for Cerebral Hemorrhage? / 대한신경손상학회지

Objective@#The coronavirus disease 2019 (COVID-19) pandemic has affected all medical fields, including neurosurgery. Particularly, performing preoperative screening tests has become mandatory, potentially extending the time from admission to the emergency room and operating room, thus possibly affecting patients’ prognosis. This study aimed to determine the influence of COVID-19 screening time on patients’ postoperative prognosis. @*Methods@#From September 10, 2020, to May 31, 2021, we retrospectively evaluated 54 patients with cerebral hemorrhage who underwent emergency surgery in the emergency room after the screening test. The control group included 89 patients with cerebral hemorrhage who underwent emergency surgery between January 2019 and March 2020, i.e., the period before the COVID-19 pandemic. Prognosis was measured using the Glasgow Coma Scale scores, which were obtained preoperatively, postoperatively, and at discharge, and the modified Rankin Scale (mRS). Additionally, unfavorable outcomes (mRS score 3–6) and in-hospital mortality rates were investigated for postoperative prognostic assessments. @*Results@#No remarkable differences were observed in the time to surgical intervention and prognostic evaluation scores between patients with cerebral hemorrhage who underwent COVID-19 screening tests and subjects in the control group. @*Conclusion@#This study confirmed that patient treatment and prognosis were not significantly affected by additional preoperative screening testing times during the pandemic. We believe that our results are informative for the evaluation and performance of emergency neurosurgery during the pandemic.

Learning Curve and Complications Experience of Oblique Lateral Interbody Fusion : A Single-Center 143 Consecutive Cases

Objective@#: Oblique lateral interbody fusion (OLIF) is becoming the preferred treatment for degenerative lumbar diseases. As beginners, we performed 143 surgeries over 19 months. In these consecutive cases, we analyzed the learning curve and reviewed the complications in our experience. @*Methods@#: This was a retrospective study; however, complications that were well known in the previous literature were strictly recorded prospectively. We followed up the changes in estimated blood loss (EBL), operation time, and transient psoas paresis according to case accumulation to analyze the learning curve. @*Results@#: Complication-free patients accounted for 43.6% (12.9%, early stage 70 patients and 74.3%, late stage 70 patients). The most common complication was transient psoas paresis (n=52). Most of these complications occurred in the early stages of learning. C-reactive protein normalization was delayed in seven patients (4.89%). The operation time showed a decreasing trend with the cases; however, EBL did not show any significant change. Notable operation-induced complications were cage malposition, vertebral body fracture, injury to the ureter, and injury to the lumbar vein. @*Conclusion@#: According to the learning curve, the operation time and psoas paresis decreased. It is important to select an appropriately sized cage along with clear dissection of the anterior border of the psoas muscle to prevent OLIF-specific complications.

A case of an unruptured duplicated middle cerebral artery aneurysm–An unusual presentation of the distal internal carotid artery aneurysm

The duplicated middle cerebral artery (DMCA) is an anatomic variation that arises from the distal internal carotid artery (ICA) and supplies blood to the middle cerebral artery (MCA) territory. Aneurysms of the DMCA have been reported in 36 cases in 2020. We also report a case of a 3.7 mm saccular aneurysm originating from the DMCA. A 52-year-old woman visited our hospital with worsening headache. She had no neurological abnormalities. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) revealed a right distal ICA aneurysm at the anterior choroidal artery. Cerebral angiography was performed to confirm the shape and the size of the aneurysm. Cerebral angiography revealed that the vessel that was originally identified as the anterior choroidal artery by the MRA was actually the duplicated MCA that was originating from the aneurysm neck and was supplying the MCA territory. The patient’s aneurysm was clipped using a transsylvian approach and she recovered without any neurological symptoms. DMCAs are rare and often associated with aneurysms and require preoperative evaluation to confirm the vascular status, aneurysm characteristics, and the shape of the parent artery.

Learning Curve and Complications Experience of Oblique Lateral Interbody Fusion : A Single-Center 143 Consecutive Cases

Objective@#: Oblique lateral interbody fusion (OLIF) is becoming the preferred treatment for degenerative lumbar diseases. As beginners, we performed 143 surgeries over 19 months. In these consecutive cases, we analyzed the learning curve and reviewed the complications in our experience. @*Methods@#: This was a retrospective study; however, complications that were well known in the previous literature were strictly recorded prospectively. We followed up the changes in estimated blood loss (EBL), operation time, and transient psoas paresis according to case accumulation to analyze the learning curve. @*Results@#: Complication-free patients accounted for 43.6% (12.9%, early stage 70 patients and 74.3%, late stage 70 patients). The most common complication was transient psoas paresis (n=52). Most of these complications occurred in the early stages of learning. C-reactive protein normalization was delayed in seven patients (4.89%). The operation time showed a decreasing trend with the cases; however, EBL did not show any significant change. Notable operation-induced complications were cage malposition, vertebral body fracture, injury to the ureter, and injury to the lumbar vein. @*Conclusion@#: According to the learning curve, the operation time and psoas paresis decreased. It is important to select an appropriately sized cage along with clear dissection of the anterior border of the psoas muscle to prevent OLIF-specific complications.

A case of an unruptured duplicated middle cerebral artery aneurysm–An unusual presentation of the distal internal carotid artery aneurysm

The duplicated middle cerebral artery (DMCA) is an anatomic variation that arises from the distal internal carotid artery (ICA) and supplies blood to the middle cerebral artery (MCA) territory. Aneurysms of the DMCA have been reported in 36 cases in 2020. We also report a case of a 3.7 mm saccular aneurysm originating from the DMCA. A 52-year-old woman visited our hospital with worsening headache. She had no neurological abnormalities. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) revealed a right distal ICA aneurysm at the anterior choroidal artery. Cerebral angiography was performed to confirm the shape and the size of the aneurysm. Cerebral angiography revealed that the vessel that was originally identified as the anterior choroidal artery by the MRA was actually the duplicated MCA that was originating from the aneurysm neck and was supplying the MCA territory. The patient’s aneurysm was clipped using a transsylvian approach and she recovered without any neurological symptoms. DMCAs are rare and often associated with aneurysms and require preoperative evaluation to confirm the vascular status, aneurysm characteristics, and the shape of the parent artery.