Post-craniotomy leptomeningeal cyst: a new presentation of an old problem.

Leptomeningeal cyst (LMC) is a known complication of pediatric head injury but has not been described following a craniotomy other than for craniosynostosis. We present the case of a 20-month-old boy who underwent craniotomy for a traumatic epidural hematoma. There was an inadvertent tear of the dura which was repaired with a pericranial patch and dural sealant. The patient presented with a progressive surgical site swelling 5 months post-surgery and a CT scan revealed an LMC with elevation of the bone flap. He underwent re-exploration with watertight repair of the dural defect and rigid fixation of the bone flap. This iatrogenic LMC provides an opportunity to compare and confirm the pathogenesis vis a vis the more common spontaneous post-traumatic LMC. Our report highlights the importance of proper dural closure and bone fixation after craniotomy in children whose skulls are still growing.

Pott's puffy tumor: An unusual complication of rhino-orbito-cerebral mucormycosis.

Objective: To describe clinicoradiological features and surgical outcomes in a series of nine patients with rhino-orbito-cerebral mucormycosis (ROCM) who presented with Pott's puffy tumor (ROCM-PPT). Methods: The records of nine patients with ROCM-PPT seen between March 2020 and December 2021 were analysed. Clinical features, radiology, histopathology, operative findings, management and outcome were noted. Frontal sinus pneumatisation and outflow tract configuration was compared between patients and controls with ROCM and no PPT. Results: ROCM-PPT was diagnosed in 9 of 284 (3.2 %) patients with ROCM seen during the study period. There were six (66.7 %) males and the median age was 54 (IQR 46-60) years. Eight (88.9 %) patients had diabetes mellitus and seven (77.8 %) had been COVID-19 positive. Radiological features of osteomyelitis, subperiosteal abscess formation and dural enhancement were seen in all patients. No significant differences in pneumatisation or frontal sinus outflow tract configuration were noted between patients and controls. All patients underwent a craniectomy with frontal bone debridement and frontal sinus exteriorisation. All patients were treated with anti-fungal agents for several months. All patients had symptomatic improvement at a median follow-up of 21 (IQR 18-23) months. Repeat CT/MRI scans showed disease regression/resolution in six out of eight (75 %) patients with follow-up imaging, and stable disease in two others. Conclusions: ROCM-PPT is a rare, delayed complication of mucormycosis that was seen in larger numbers during the recent COVID-19 pandemic. Aggressive debridement of osteomyelitic bone and antifungal therapy results in a good outcome.

Quantitative Assessment of Brain Expansion After Evacuation of Chronic Subdural Hematoma as a Predictor of Recurrence.

BACKGROUND: A lack of brain expansion is considered a risk factor for recurrence after evacuation of a chronic subdural hematoma (CSDH). To the best of our knowledge, no studies have reported on objective measurement of brain expansion after evacuation of a CSDH. METHODS: We performed a retrospective analysis of prospectively collected data of patients undergoing 2 burr hole evacuation of a CSDH. We measured the depth of the brain surface from the frontal burr hole dural opening after hematoma evacuation using a specially devised measuring tool. Other predictors analyzed for recurrence of hematoma were age, gender, a history of hypertension, the use of anticoagulant and/or antiplatelet agents, Glasgow coma scale score at presentation, unilateral or bilateral hematoma, computed tomography appearance, and hematoma thickness. RESULTS: Among 88 patients who underwent hematoma evacuation, 3 (3.4%) underwent surgery for recurrence. The significant factors associated with recurrence were the presence of bilateral hematoma (P = 0.001), hematoma width >2.3 cm (P = 0.04), gradation type of hematoma on the computed tomography scan (P = 0.03), and the depth of the brain after hematoma evacuation (P = 0.02). The brain expanded less in those with recurrence, with a mean depth of the brain of 18 ± 6 mm versus 7.27 ± 7.8 mm in those without recurrence. CONCLUSIONS: Evacuation of a CSDH through 2 burr holes, along with copious irrigation and bed rest for 3 days, resulted in a very low recurrence rate without the use of a drain. A lack of brain expansion might be a predictor of recurrence. To the best of our knowledge, this is the first study to quantitatively measure the depth of the brain at surgery in patients undergoing surgery for CSDH.

Adding Ketamine to Epidural Morphine Does Not Prolong Postoperative Analgesia After Lumbar Laminectomy or Discectomy.

BACKGROUND: Epidural opioids provide effective postoperative analgesia after lumbar spine surgery. Ketamine has been shown to reduce opioid-induced central sensitization and hyperalgesia. We hypothesized that adding ketamine to epidural opioids would prolong the duration of analgesia and enhance analgesic efficacy after lumbar spine surgery. METHODS: American Society of Anesthesiologists physical status class I to II patients aged between 18 and 70 years with normal renal function undergoing lumbar laminectomy were recruited into this single-center randomized trial. Patients were randomized to receive either single-dose epidural morphine (group A) or epidural morphine and ketamine (group B) for postoperative analgesia. The primary objective was to compare the duration of analgesia as measured by time to the first postoperative analgesic request. Secondary objectives were the comparison of pain scores at rest and movement, systemic hemodynamics, and the incidence of side effects during the first 24 hours after surgery. RESULTS: Fifty patients were recruited (25 in each group), of which data from 48 were available for analysis. The mean±SD duration of analgesia was 20±6 and 23±3 hours in group A and group B, respectively (P=0.07). There were 12/24 (50%) patients in group A and 17/24 (71%) patients in group B who did not receive rescue analgesia during the first 24-hour postoperative period (P=0.07). Pain scores at rest and movement, systemic hemodynamics, and postoperative complications were comparable between the groups. CONCLUSIONS: The addition of ketamine to epidural morphine did not prolong the duration of analgesia after lumbar laminectomy.

Risk Factors for Postoperative Brain Contusion and Early Outcomes in Patients with Anterior Skull Base Meningiomas Undergoing Unifrontal Surgery: Single Center Experience with 110 Patients.

Background: Though frontal lobe contusion is a major cause for morbidity and prolonged hospitalization following excision of anterior skull base meningiomas, there is only limited literature on this complication. This study aimed to find out the incidence of postoperative frontal lobe contusion, identify the risk factors for its development and its impact on early postoperative outcome. Methods: Data from 110 patients who underwent excision of anterior skull base meningiomas through a unilateral supraorbital craniotomy from 2001 to 2018 were retrospectively analyzed. The risk factors analyzed for development of postoperative contusion were tumor location, size, volume, peritumoral edema, tumor consistency, extent of resection, tumor grade and type of retraction used. Results: Simpson grade II excision was achieved in ninety-two patients (83.6%). There was no frontal lobe contusion in eighty-two patients (74.5%). Frontal lobe contusion was noted in twenty-eight patients (25.5%), but was severe in only four patients (3.6%). On multivariate analysis, fixed retractor use (OR 11.56 [1.21-110.03]; P =0.03) and WHO grade II tumor (OR 3.29 [1.11-9.77]; P =0.03) were independently associated with postoperative frontal lobe contusion. Patients with higher contusion grade had significantly longer postoperative hospitalization (P =.02) and lower KPS score at discharge (P =.01). Conclusions: Unilateral supraorbital craniotomy and lateral subfrontal approach is an excellent procedure for excision of anterior skull base meningiomas with minimal postoperative complications related to frontal lobe retraction. Frontal lobe contusion should be avoided with the use of dynamic retraction, since postoperative contusion prolongs hospitalization and worsens the functional outcome at discharge.

Posterior fossa morphometry in 170 South Asian children and adults with Chiari malformation and its correlation with tonsillar descent.

AIM: Patients with Chiari I malformations (CM1) have posterior fossa hypoplasia with crowding of the neural structures. We aimed to study the posterior fossa measurements to analyse the posterior fossa morphology, presence of basilar invagination (BI) and correlated the measurements with the degree of tonsillar descent. METHODS: We retrospectively reviewed data in170 patients who underwent foramen magnum decompression (FMD) for CM1. The posterior fossa measurements were compared with 30 controls. Patients were divided into those with and without BI. The variables measured included clival length, posterior fossa height, supraocciput length, posterior fossa diameter, foramen magnum width, Boogard's angle, clival angle, clival slope and the newly introduced foramen magnum (FM) angle. RESULTS: The average clivus length and posterior fossa height were significantly shorter with a significant increase in the Boogard's and FM angle in the patient groups. Tonsillar descent showed a negative correlation with posterior fossa height (r = -0.498, p ≤ 0.001) and clivus length (r = -0.325, p ≤ 0.001) and a positive correlation with Boogard's angle (r = 0.469, p ≤ 0.001) and FM angle (r = 0.330, p ≤ 0.001). Patients with BI had statistically significant reduced posterior fossa height (p ≤ 0.001) and increased extent of tonsillar herniation (p = 0.001) compared to patients without BI. CONCLUSION: Patients with CM1 have significantly shorter clival length and posterior fossa height with smaller posterior fossa in support of published data. The presence of BI shortens the posterior fossa height and worsens the extent of tonsillar herniation. An increased Boogard's angle and FM angle result in a more horizontally placed suboccipital bone compared to a slanting bone in normal persons.

A pragmatic diagnostic approach to primary intracranial germ cell tumors and their treatment outcomes.

Background: Primary intracranial germ cell tumors (ICGCT) are often diagnosed with tumor markers and imaging, which may avoid the need for a biopsy. An intracranial germ cell tumor with mild elevation of markers is seldom stratified as a distinct entity. Methods: Fifty-nine patients were stratified into three groups: pure germinoma (PG), secreting germinoma (SG) and non-germinomatous germ cell tumors (NGGCTs). Results: At 5 years, progression-free survival and overall survival of the three groups (PG vs SG vs NGGCT) were 91% versus 81% versus 59%, and 100% versus 82% versus 68%, respectively. There was no statistically significant difference in outcome among histologically and clinically diagnosed germinomas. Conclusion: A criterion for clinical diagnosis when a biopsy is not feasible is elucidated, and comparable outcomes were demonstrated with histologically diagnosed germinomas.

Lay abstract Intracranial germ cell tumors (ICGCTs) are rare brain tumors, which often require markers in blood or cerebrospinal fluid, imaging and a tissue biopsy to establish a diagnosis. However, when tissue sampling is not possible, tumor markers can sometimes be used to diagnose ICGCTs. The authors propose guidelines for a diagnosis and a novel subtype of ICGCT called secreting germinoma, which is also described. Fifty-nine patients were separated into three groups: pure germinoma (PG), secreting germinoma (SG) and non-germinomatous germ cell tumors (NGGCTs). At 5 years, progression-free survival and overall survival of the three groups (PG vs SG vs NGGCT) were 91% versus 81% versus 59%, and 100% versus 82% versus 68%, respectively. There was no significant difference in outcome among tumors diagnosed with markers in blood or cerebrospinal fluid and those diagnosed with a biopsy. The proposed guidelines for diagnosis need to be evaluated in future studies. SGs may not warrant aggressive treatment protocols as used in NGGCT, and their outcome as a distinct group needs to be explored in future studies.

Feasibility and diagnostic accuracy of intra-operative monitoring of motor evoked potentials in children <2 years of age undergoing tethered cord surgery: results in 100 children.

OBJECTIVE: This study documents the monitorability using different anesthesia regimes and accuracy of muscle motor evoked potentials (mMEPs) in children ≤2 years of age undergoing tethered cord surgery (TCS). METHODS: Intraoperative mMEP monitoring was attempted in 100 consecutive children, ≤2 years of age, undergoing TCS. MEP monitoring was done under 4 different anesthetic regimes: (Total intravenous anesthesia (TIVA); balanced anesthesia with sevoflurane and ketamine; balanced anesthesia with isoflurane and ketamine; and balanced anesthesia with sevoflurane). Factors analyzed for their effect on monitorability were: age, neurological deficits, type of anesthesia, and the number of pulses used for stimulation. RESULTS: Baseline mMEPs were obtained in 87% children. Monitorability of mMEPs was similar in children ≤1 year and 1-2 years of age (85.7% and 87.5%). In multivariate analysis, anesthesia regime was the only significant factor predicting presence of baseline mMEPs. Children undergoing TIVA (p=0.02) or balanced anesthesia with a combination of propofol, sevoflurane, and ketamine (p=0.05) were most likely to have baseline mMEPs. mMEPs had a sensitivity of 97.4%, specificity of 96.4%, negative predictive value of 98.2% and accuracy of 96.8%. CONCLUSIONS: Baseline mMEPs were obtained in >85% of children ≤2 years of age including those who had motor deficits. TIVA and balanced anesthesia with sevoflurane and ketamine are ideal for mMEP monitoring. mMEPs have a high accuracy although, false positive and false negative results can occasionally be experienced.

Functional Outcomes and Temporal Profile of Recovery in Patients with Intradural Extramedullary Spinal Cord Tumors with Poor Nurick Grade.

BACKGROUND: Patients with spinal intradural extramedullary (IDEM) tumors usually have a good functional outcome after tumor excision. However, the literature is sparse on the functional outcome in patients with poor Nurick grade (NG 4 and 5). METHODS: A retrospective review of 81 patients with IDEM tumors presenting with a poor NG was performed to determine postoperative functional outcome and the temporal pattern of recovery. The following risk factors were analyzed: preoperative NG, duration of symptoms, tumor location, peritumoral edema, presence of syrinx, and tumor type. RESULTS: Neurologic function started recovering soon after surgery, with >80% of the patients improving by ≥1 grade at the end of 1 week after surgery. Of the 66 patients available for follow-up of >6 months after surgery, 63 (95.5%) improved to NG 0-2 and 51 (77.2%) became asymptomatic (NG 0 or 1). Three patients had a poor functional outcome on follow-up of >31 months; 2 had improved from NG 5 to NG 4, whereas 1 patient continued to be in NG 4. Factors associated with a poor outcome were an upper thoracic location (P = 0.025) and presence of a syrinx (P = 0.004). None of the patients had bladder dysfunction at follow-up of >6 months. CONCLUSIONS: After excision of spinal IDEM tumors, in patients who present with a poor neurologic function (NG 4 and 5), good functional outcome (NG 0-2) can be expected in >95% of patients. No recovery can be anticipated beyond 1 year after surgery.

An observational case-control study comparing the recovery profile in patients receiving additional dose of anticonvulsant vs. regular dose during supratentorial craniotomy.

BACKGROUND AND AIMS: Anticonvulsants are used routinely for seizure prophylaxis in patients with supratentorial tumour who present with/without seizures. Excessive use of prophylactic anticonvulsant may delay the recovery from anaesthesia. We have studied the recovery profiles of patients who received an additional dose of anticonvulsant in comparison with those who received only the regular dose. METHODS: In this prospective observational study, patients were anaesthetised using standard anaesthesia protocol. An additional dose of anticonvulsant was administered in one group, while the other group received only the regular dose. Time taken for extubation, eye opening, obeying commands and orientation were compared between the two groups. Haemodynamics, depth of anaesthesia, the plasma anticonvulsant levels and the incidence of seizures were compared between the two groups. RESULTS: A total of 36 patients were studied, of which 19 received regular dose and 17 received an additional dose. There was no significant difference in recovery time between the two groups. Subgroup analysis was performed for phenytoin and sodium valproate. There was a clinically significant delay in recovery in patients who received an additional phenytoin compared to those who received regular dose (time to obey commands >15 min and orientation time >1hour) but, it was not statistically significant. Administration of an additional dose of valproate did not prolong the recovery time. CONCLUSION: An additional dose of sodium valproate did not cause a delay in recovery both, clinically and statistically. However, the administration of an additional dose of phenytoin caused a clinically significant delay in recovery but was not statistically significant.

Frontal sinus cholesteatoma: a masquerading diagnosis.

Cholesteatoma of the paranasal sinus is a very rare condition. As in the tympanomastoid region where cholesteatomas are a common entity, the paranasal sinus cholesteatomas also tend to erode the surrounding bony structures. Because of the extensive bony erosion, this condition often masquerades as a chronic granulomatous or a malignant lesion. Clinical presentation can be quite varied like facial deformities, visual and neurological deficits. Radiological findings are also non-specific making a preoperative diagnosis challenging. Histopathological examination is the only confirmatory investigation. We present a patient with frontal cholesteatoma who presented with forehead swelling of 1 month duration. Since the diagnosis could be obtained only intraoperatively, the patient required multiple surgeries. Frontal sinus cholesteatomas often require a combined endoscopic and external approach to ensure complete disease clearance. Periodic follow-up is essential to rule out recurrence.

Changing trends of presentation of central nervous system tuberculosis: Relative prevalence of cranial and spinal tuberculosis and drug resistance patterns.

OBJECTIVE: Inappropriate use of antituberculosis drugs and a poor compliance has led to an increase in the prevalence of resistant Mycobacterium tuberculosis. The aim of this study was to document the changing trends in clinical presentation and drug resistance in patients with tuberculosis (TB) of the brain and the spine. MATERIALS AND METHODS: The authors retrospectively analyzed data from 243 patients admitted in a neurosurgical unit for surgical management of TB of the brain and spine from 2000 to 2013. To establish changes in trends, the patient population was arbitrarily divided into two groups based on their years of admission: 2000-2006 (Group A; n = 121) and 2007-2013 (Group B; n = 122). RESULTS: In the second era (Group B), there were 14.5% more patients with TB spine [from 42/121 (34.7%) in Group A to 60/122 (49.2%) in Group B; P = 0.02] with a corresponding reduction in the proportion of patients with TB brain. The number of cerebrospinal fluid (CSF) diversion procedures remained the same in both the groups, but there was significant reduction in other surgical procedures for patients with TB brain in Group B (P = 0.0004). In patients with TB brain, the culture yield was 10/50 (20%) from tissue and 8/72 (11%) from CSF and there was no significant difference between the groups. In patients with TB spine, the culture yield was higher in Group B patients but was not statistically significant [7/35 (20%) in Group A versus 18/57 (31.6%) in Group B (P = 0.27)]. In Group A, nine patients with TB brain grew Mycobacterium tuberculosis in culture and none was resistant to first-line antituberculosis therapy (ATT), while in Group B, nine patients grew the bacilli and five had resistance to first-line ATT (P = 0.03). Among patients with a positive culture of resistant TB, all had received prior ATT (100% secondary resistance). None of the seven patients with TB spine in Group A with a positive culture had resistant organisms, but in Group B, 5 of 18 (27.8%) with a positive culture had resistant organisms (P = 0.27). Of these, five patients with TB spine with resistance, three of five (60%) patients had secondary resistance, and two of five (40%) patients had primary resistance. Overall, 10 of 27 (37%) patients with a positive culture had resistant organisms in Group B, while none of 16 patients in Group A with a positive culture had resistant organisms (P = 0.007). CONCLUSION: The most significant finding of our study is an alarming increase in the number of patients with TB brain and spine who have resistant disease (from 0% to 37%) with most of the resistance being secondary in nature. There was an increase in the number of in-patients with spinal TB relative to those with TB brain, though the cause for this is unclear.

Factors Predicting the Need for Prolonged (>24 Months) Antituberculous Treatment in Patients with Brain Tuberculomas.

BACKGROUND: Patients with brain tuberculomas are generally managed with 12-18 months of antituberculous treatment (ATT) with or without surgery. However, a subset of these patients may require ATT for longer periods. We studied the factors that were associated with the need for prolonged ATT (>24 months) in patients with brain tuberculomas. METHODS: This retrospective study included patients with intracranial tuberculomas managed from January 2000 to December 2015 if they were followed up until completion of therapy and resolution of the tuberculoma/s. The predictive factors analyzed were the number of lesions (solitary vs. multiple), location (infratentorial vs. supratentorial and infratentorial), previous ATT treatment (yes vs. no), surgery (yes vs. no), and size of the lesion (≤2.5 cm vs. >2.5 cm). RESULTS: Of the 86 patients, 19 (22%) received ATT for >2 years. On multivariate analysis, multiple lesions were significantly associated with the need for prolonged ATT (P = 0.02). Size of the tuberculoma showed a trend toward significance (P = 0.06), with tuberculomas >2.5cm having a 3.68 times increased risk of requiring prolonged ATT. CONCLUSIONS: Although 78% of brain tuberculomas resolve with 12-24 months of ATT, 22% required >24 months of ATT. Multiple tuberculomas had significant association with prolonged ATT, with a median duration of resolution of 36 months. Because tuberculomas >2.5 cm were likely to need longer duration of ATT, brain tuberculomas that require surgery should be excised totally or reduced in size to <2.5 cm to enable early resolution.

An Adult with Atrial Septal Defect Presenting with a Brain Abscess.

The common heart diseases resulting in a brain abscess are associated with a right to left shunt and include tetralogy of Fallot and transposition of great vessels. Atrial septal defect (ASD) is almost always associated with the left to right shunt and therefore is not a commonly considered risk factor for brain abscess. We report the case of a 29-year-old male, with no symptoms of cardiac disease, who presented with the left posterior frontal pyogenic abscess which led to the detection of a silent ASD. Our case emphasizes the need for a careful evaluation of the source of infection in patients with a brain abscess.

Primary Intradural Extramedullary Cervical Spinal Cysticercosis.

BACKGROUND: Spinal cysticercosis has been reported in 0.7%-3.0% of patients with neurocysticercosis. Most patients with spinal cysticercosis have a coexisting intracranial disease. Most often this intracranial disease manifests as intradural extramedullary lesions involving thoracic and lumbar regions or intramedullary lesions. Intradural extramedullary primary spinal cysticercosis manifesting as cervical myelopathy is extremely rare and has not been reported to date. CASE DESCRIPTION: A 56-year-old man from the northeastern part of India presented with progressive spastic quadriparesis. Magnetic resonance imaging showed a ventrally located intradural extramedullary multiloculated cyst with an enhancing wall in the upper cervical region. Enzyme-linked immunoelectrotransfer blot performed to detect cysticercal antibodies in serum was positive. The patient underwent total excision of the cysts, which were confirmed histologically to be cysticercal cysts. He was also treated with 2 weeks of albendazole therapy after surgery. He had recovered fully 1 year later. CONCLUSIONS: Cysticercosis should be considered in the differential diagnosis in a patient with multiloculated cysts in the spinal subarachnoid space. Surgical exploration and excision of the cysts should be performed not only to establish a diagnosis but also to decompress the cord before medical therapy.

Importance of fibrinogen in dilutional coagulopathy after neurosurgical procedures: A descriptive study.

BACKGROUND AND AIMS: The routine management of coagulopathy during surgery involves assessing haemoglobin, prothrombin time (PT), activated partial thromboplastin time (aPTT) and platelets. Correction of these parameters involves administration of blood, fresh frozen plasma and platelet concentrates. The study was aimed at identifying the most common coagulation abnormality during neurosurgical procedures and the treatment of dilutional coagulopathy with blood components. METHODS: During 2 years period, all adult patients undergoing neurosurgical procedures who were transfused two or more units of red cells were prospectively evaluated for the presence of a coagulopathy. PT, aPTT, platelet count and fibrinogen levels were estimated before starting a component therapy. RESULTS: After assessing PT, aPTT, platelet count and fibrinogen levels following two or more blood transfusions, thirty patients were found to have at least one abnormal parameter that required administration of a blood product. The most common abnormality was a low fibrinogen level, seen in 26 patients; this was the only abnormality in three patients. No patient was found to have an abnormal PT or aPTT without either the fibrinogen concentration or platelet count or both being low. CONCLUSION: Low fibrinogen concentration was the most common coagulation abnormality found after blood transfusions for neurosurgical procedures.

Complications following central corpectomy in 468 consecutive patients with degenerative cervical spine disease.

OBJECTIVE This study was performed to describe the incidence and predictors of perioperative complications following central corpectomy (CC) in 468 consecutive patients with cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL). METHODS The authors performed a retrospective review of a cohort of patients who had undergone surgery for CSM (n = 338) or OPLL (n = 130) performed by a single surgeon over a 15-year period. All patients underwent uninstrumented CC with autologous iliac crest or fibular strut grafting. Preoperative clinical and imaging details were collected, and the type and incidence of complications were studied. Univariate and multivariate analyses were performed to establish risk factors for the development of perioperative complications. RESULTS Overall, 12.4% of patients suffered at least 1 complication following CC. The incidence of major complications was as follows: C-5 radiculopathy, 1.3%; recurrent laryngeal nerve injury, 0.4%; dysphagia, 0.8%; surgical-site infection, 3.4%; and dural tear, 4.3%. There was 1 postoperative death (0.2%). On multivariate analysis, patients in whom the corpectomy involved the C-4 vertebral body (alone or as part of multilevel CC) were significantly more likely to suffer complications (p = 0.004). OPLL and skip corpectomy were risk factors for dural tear (p = 0.015 and p = 0.001, respectively). No factors were found to be significantly associated with postoperative C-5 palsy, dysphagia, or acute graft extrusion on univariate or multivariate analysis. Patients who underwent multilevel CC were predisposed to surgical-site infections, with a slight trend toward statistical significance (p = 0.094). The occurrence of a complication after surgery significantly increased the mean duration of postoperative hospital stay from 5.0 ± 2.3 days to 8.9 ± 6 days (p < 0.001). CONCLUSIONS Complications following CC for CSM or OPLL are infrequent, but they significantly prolong hospital stay. The most frequent complication following CC is dural tear, for which a diagnosis of OPLL and a skip corpectomy are significant risk factors.