Acute complications following gamma knife radiosurgery are rare.

BACKGROUND: Gamma knife radiosurgery (GKR) is a safe and effective alternative to surgery for intracranial lesions. Most studies evaluating toxicity after GKR have concentrated on the delayed radiation effects. METHODS: We retrospectively reviewed 835 consecutive GKR cases for early (within 7 days) neurological complications or death. RESULTS: We identified a total of 18 patients (2.2%) who had a neurological event or death. Five (0.6%) patients developed new focal deficits, 12 (1.4%) patients experienced a seizure and there were three (0.4%) deaths. Two deaths were related to development of seizures and neurological deterioration. One death was caused by a respiratory arrest related to the patient's primary cancer. Of the five patients with neurological deficits, none had a persistent deficit. In two cases the neurological deficits were due to an increase in edema. Whether this occurred as a result of the gamma knife treatment or was the natural progression of the tumor is unclear. CONCLUSIONS: Complications after GKR are uncommon and the risk of a permanent deficit arising from an acute neurological event is exceedingly low.

Anticoagulation in neurosurgical patients.

OBJECTIVE: Few recommendations have been outlined in the neurosurgical literature regarding when it is safe to initiate postoperative or posthemorrhage anticoagulation (AC), or for what duration it is safe to discontinue AC therapy in patients with clear indications for AC therapy. Our objective was to formulate guidelines for managing AC in neurosurgical patients, based on patients' needs for AC and the risk of complications. METHODS: We conducted a systematic review of the neurosurgical and general surgical literature pertaining directly to postoperative or posthemorrhage management of AC. In addition, we surveyed the general medical, cardiology, cardiothoracic surgery, general surgery, vascular surgery, and neurology literature to determine the risk of thromboembolic complications when AC is stopped in specific patient groups. RESULTS: Postoperative bleeding complications occurred more frequently when correction of coagulation abnormalities was inadequate in the preoperative period, when AC was reinstituted in the early (24-48 h) postoperative period, and when AC was supratherapeutic in the postoperative period. Risk of significant thromboembolic complications while off AC varied significantly depending on the primary disease process necessitating AC. CONCLUSION: Adequate preoperative correction of coagulation abnormalities and strict regulation of coagulation to avoid supratherapeutic AC is essential. Reintroduction of AC after an intracranial hemorrhage treated without surgery, or after a neurosurgical procedure, particularly an intracranial procedure, can be guided by determining whether the patient is at high, moderate, or low risk for thromboembolic complications. On the basis of experimental studies, the patient's thromboembolic risk, and the experience of other surgeons, we propose therapeutic options for use of AC in neurosurgical patients undergoing intracranial procedures.

Growth factors in central nervous system development and tumorigenesis.

Growth factors play an important role in the development of the normal central nervous system as well as in the genesis of central nervous system tumors. Some of the more important growth factors and growth factor receptors, as they pertain to neurooncology, are reviewed in this article.

Vertical fracture of the odontoid process: case report.

Fifteen percent of cervical spine fractures involve the odontoid process. Most odontoid fractures can be classified as Types I through III according to the scheme developed by Anderson and D'Alonzo. We report a case of a vertically oriented fracture through the odontoid process that does not fit into any of these categories. Only two such cases have been described in the literature. Our patient is an 18-year-old man who sustained an axial loading injury to his cervical spine. Plain lateral cervical tomography and computed tomography were performed to characterize the fracture and to evaluate the instability. The patient was placed in a rigid orthosis for 12 weeks, and at 6-month follow-up, he had full range of motion and showed no evidence of abnormal movement, as revealed by flexion-extension studies. This case demonstrates the shortcomings of the current classification system for odontoid fractures and value of plain tomography and computed tomography in evaluating odontoid fractures.

Latissimus dorsi rupture: an unusual complication of anterior spine surgery.

Anterior spinal surgery is a common part of the treatment for spinal trauma and deformity. Two cases of an unusual postoperative complication of the surgical exposure for anterior spinal fusion with rib strut grafts are herein reviewed. In each case, the patient presented 3-6 months postoperatively with a large, painful mass along the posterior axillary line near the surgical incision. The mass was diagnosed as a rupture of the latissimus dorsi. The cause of this disruption is unclear, but it appears to be a complication of the surgical approach; therefore, surgeons performing transthoracic and thoracoabdominal approaches should be aware of it.