Jai Deep Thakur

A comparison of lumboperitoneal and ventriculoperitoneal shunting for idiopathic intracranial hypertension: an analysis of economic impact and complications using the Nationwide Inpatient Sample.

OBJECT Complications following lumboperitoneal (LP) shunting have been reported in 18% to 85% of cases. The need for multiple revision surgeries, development of iatrogenic Chiari malformation, and frequent wound complications have prompted many to abandon this procedure altogether for the treatment of idiopathic benign intracranial hypertension (pseudotumor cerebri), in favor of ventriculoperitoneal (VP) shunting. A direct comparison of the complication rates and health care charges between first-choice LP versus VP shunting is presented. METHODS The Nationwide Inpatient Sample database was queried for all patients with the diagnosis of benign intracranial hypertension (International Classification of Diseases, Ninth Revision, code 348.2) from 2005 to 2009. These data were stratified by operative intervention, with demographic and hospitalization charge data generated for each. RESULTS A weighted sample of 4480 patients was identified as having the diagnosis of idiopathic intracranial hypertension (IIH), with 2505 undergoing first-time VP shunt placement and 1754 undergoing initial LP shunt placement. Revision surgery occurred in 3.9% of admissions (n = 98) for VP shunts and in 7.0% of admissions (n = 123) for LP shunts (p < 0.0001). Ventriculoperitoneal shunts were placed at teaching institutions in 83.8% of cases, compared with only 77.3% of first-time LP shunts (p < 0.0001). Mean hospital length of stay (LOS) significantly differed between primary VP (3 days) and primary LP shunt procedures (4 days, p < 0.0001). The summed charges for the revisions of 92 VP shunts (

Comparison of cosmetic outcome between single-incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy: an objective study.

3,453,956) and those of the 6 VP shunt removals (

Creutzfeldt-Jakob disease: updated diagnostic criteria, treatment algorithm, and the utility of brain biopsy.

272,484) totaled

An update on unilateral sporadic small vestibular schwannoma

3,726,352 over 5 years for the study population. The summed charges for revision of 70 LP shunts (

A prospective controlled trial comparing single-incision and conventional laparoscopic cholecystectomy: caution before damage control.

2,229,430) and those of the 53 LP shunt removals (

Is posttraumatic cerebrospinal fluid fistula a predictor of posttraumatic meningitis? A US Nationwide Inpatient Sample database study

3,125,569) totaled

Surgical management of intracranial arachnoid cysts: clinical and radiological outcome.

5,408,679 over 5 years for the study population. CONCLUSIONS The presented results appear to call into question the selection of LP shunt placement as primary treatment for IIH, as this procedure is associated with a significantly greater likelihood of need for shunt revision, increased LOS, and greater overall charges to the health care system.

Do cystic vestibular schwannomas have worse surgical outcomes? Systematic analysis of the literature

BACKGROUND Single-incision laparoscopic cholecystectomy (SILC) has been projected to have better cosmetic outcome compared with conventional laparoscopic cholecystectomy (CLC). However, there are scarce data that have objectively compared the patients perception of cosmetic outcome after SILSC and CLC. METHODS The SILC and CLC patients, who were operated in the last 2 years, were personally interviewed and assessed using the Patient Scar Assessment Questionnaire. A lower score indicated a better patient outcome. The satisfaction with the appearance and the symptoms due to the scars was assessed in all the patients. RESULTS Fifty-two patients were included in the study (25 SILC, 27 CLC). The age and sex distributions and body mass indexes were similar in both groups. The scores of different parameters assessed as per Patient Scar Assessment Questionnaire-appearance (SILC, 1.08 ± 0.4; CLC, 1.14 ± 0.5: P=.57), symptoms (SILC, 1.16 ± 0.5; CLC, 1.18 ± 0.4; P=.83), scar consciousness (SILC, 1.04 ± 0.2; CLC, 1.07 ± 0.3; P=.6), satisfaction with symptoms (SILC, 1.12 ± 0.3; CLC, 1.18 ± 0.4; P=.52), and satisfaction with appearance (SILC, 1.04 ± 0.2; CLC, 1.11 ± 0.3; P=.34)-were similar in both groups. The overall satisfaction scores were also statistically similar in both groups (SILC, 5.44 ± 1.4; CLC, 5.70 ± 1.7; P=.54). Overall, a majority of patients (>80%) in both groups gave the lowest score (1), indicating maximum satisfaction, in all the categories. CONCLUSIONS Patient perception regarding cosmetic outcome after SILC and CLC was similar in both groups. SILC does not seem to offer any significant cosmetic advantage over CLC. This point needs to be assessed in detail by larger studies, as cosmetic benefit is projected as one of the major advantages of single-incision surgery.

Microsurgical resectability, outcomes, and tumor control in meningiomas occupying the cavernous sinus

Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative condition with a rapid disease course and a mortality rate of 100%. Several forms of the disease have been described, and the most common is the sporadic type. The most challenging aspect of this disease is its diagnosis-the gold standard for definitive diagnosis is considered to be histopathological confirmation-but newer tests are providing means for an antemortem diagnosis in ways less invasive than brain biopsy. Imaging studies, electroencephalography, and biomarkers are used in conjunction with the clinical picture to try to make the diagnosis of CJD without brain tissue samples, and all of these are reviewed in this article. The current diagnostic criteria are limited; test sensitivity and specificity varies with the genetics of the disease as well as the clinical stage. Physicians may be unsure of all diagnostic testing available, and may order outdated tests or prematurely request a brain biopsy when the diagnostic workup is incomplete. The authors review CJD, discuss the role of brain biopsy in this patient population, provide a diagnostic pathway for the patient presenting with rapidly progressive dementia, and propose newer diagnostic criteria.

Intrasellar plasmacytoma: An illustrative case and literature review

Advances in neuroimaging have increased the detection rate of small vestibular schwannomas (VSs, maximum diameter < 25 mm). Current management modalities include observation with serial imaging, stereotactic radiosurgery, and microsurgical resection. Selecting one approach over another invites speculation, and no standard management consensus has been established. Moreover, there is a distinct clinical heterogeneity among patients harboring small VSs, making standardization of management difficult. The aim of this article is to guide treating physicians toward the most plausible therapeutic option based on etiopathogenesis and the highest level of existing evidence specific to the different cohorts of hypothetical case scenarios. Hypothetical cases were created to represent 5 commonly encountered scenarios involving patients with sporadic unilateral small VSs, and the literature was reviewed with a focus on small VS. The authors extrapolated from the data to the hypothetical case scenarios, and based on the level of evidence, they discuss the most suitable patient-specific treatment strategies. They conclude that observation and imaging, stereotactic radiosurgery, and microsurgery are all important components of the management strategy. Each has unique advantages and disadvantages best suited to certain clinical scenarios. The treatment of small VS should always be tailored to the clinical, personal, and social requirements of an individual patient, and a rigid treatment protocol is not practical.