Objective The COVID-19 pandemic poses major risks to healthcare workers in neurocritical care. Recommendations are in place to limit medical personnel attending to the neurosurgical patient as a protective measure and to conserve personal protective equipment. However, the complexity of the neurosurgical patient proves to be a challenge and an opportunity for innovation. The goal of our study was to determine if telemedicine delivered through smart glasses was feasible and effective in an alternative method of conducting ward round on neurocritical care patients during the pandemic. Methods A random pair of Neurosurgery resident and specialist conducted consecutive virtual and physical ward rounds on neurocritical patients. A virtual ward round was first conducted remotely by a specialist who received real-time audiovisual information from a resident wearing smart glasses integrated with telemedicine. Subsequently, a physical ward round was performed together by the resident and specialist on the same patient. The management plans of both ward rounds were compared and the intrarater reliability was measured. On study completion a qualitative survey was performed. Results Ten paired ward rounds were performed on 103 neurocritical care patients with excellent overall intrarater reliability. Nine out of ten showed good to excellent internal consistency and one showed acceptable internal consistency. Qualitative analysis indicated wide user acceptance and high satisfaction rate with the alternative method. Conclusions Virtual ward rounds using telemedicine via smart glasses on neurosurgical patients in critical care were feasible, effective and widely accepted as an alternative to physical ward rounds during the COVID-19 pandemic.

Transpedicular screw fixation is generally feasible in our population except for 8 % with at least one PW < 4.00 mm. However, in view of significant sex and ethnic morphometric variability, pre-operative CT evaluation together with image-guided screw placement is highly advised to ensure safety and accuracy.

o drain, or not to drain, that is the question." Chronic subdural hemorrhage (SDH) or hematoma is a predominantly neurological condition usually resulting from trauma and affecting elderly individuals. 2,3,14,19 Chronic SDH is not a benign condition and is regarded as a sentinel health event because of its high morbidity and mortality rates in older people.9,18 The treatment of choice for managing chronic SDHs is surgical drainage. 12,23 Large studies have shown that older age independently contributes to increased mortality and morbidity rates after the surgical drainage of chronic SDHs. 10,22,24 As the world's elderly population increases because of adabbreviatioNs CCI = Charlson Comorbidity Index; GCS = Glasgow Coma Scale; KPS = Karnofsky Performance Scale; LOS = length of stay; SDH = subdural hemorrhage. submitted September 5, 2014. accepted December 18, 2014. iNclude wheN citiNg Published online July 10, 2015; DOI: 10.3171/2014.12.JNS142053. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJective Chronic subdural hemorrhage (SDH) or hematoma is a condition that affects elderly individuals. With advances in medical care, the number of nonagenarians and centenarians will increase. However, surgical treatments in this age group are associated with high rates of morbidity and mortality. Because no data are available on the rates of survival among elderly patients with chronic SDHs who undergo surgical drainage or receive only conservative care, the goal of this study was to determine survival rates in patients 90 years of age or older with symptomatic chronic SDHs. methods The authors conducted a retrospective analysis of patient data that were collected at 3 hospitals over a 13-year period (from January 2001 to June 2013). The data from patients 90 years or older with symptomatic chronic SDHs and who were offered surgical treatment were included in the analysis. Patients who underwent surgical treatment were included in the surgical group and patients who declined an operation were included in the conservative care group. The patients' Charlson Comorbidity Index score, Karnofsky Performance Scale score, dates of death, presenting symptoms, Glasgow Coma Scale score, length of stay in the hospital, discharge location, side of the SDH, and neurological improvements at 30-day and 6-month follow-ups were recorded. Data were statistically analyzed with Fisher exact test, Kaplan-Meier curves, and logistic regression. results In total, 101 patients met the inclusion criteria of this study; 70 of these patients underwent surgical drainage, and 31 received conservative care. Patients in the surgical group had statistically significantly (p < 0.001) higher survival at both the 30-day and 6-month follow-ups, with 92.9% and 81.4% of the patients in this group surviving for at least 30 days and 6 months, respectively, versus 58.1% and 41.9%, respectively, in the conservative care group. Moreover, the mean overall length o...

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Primary central nervous system lymphoma (PCNSL) is a rare form of Non-Hodgkin’s lymphoma (NHL) confined to the central nervous system, which continues to be a challenging malignancy to treat. The reason behind this lies in the fact that its systemic counterpart carries a more favourable prognosis with a cure rate of approximately 70%, whereas the prognosis of PCNSL remains poor in the immunocompetent and even poorer in HIV-associated PCNSL. Fortunately, the median overall survival has nearly doubled since the 1970s reflecting a better understanding, and more effective management of this disease. In this chapter, we will explore the many reasons behind this increased survival as well as current management options from a neurosurgical perspective.

Subdural empyema is a rare but serious intracranial infection that warrants prompt management to reduce morbidity and avoid mortality. However, clinical and radiologic features may be subtle or ambivalent. Thus a diagnosis of subdural empyema should not be discounted, especially in a patient with a history of head trauma. Treatment consists of surgery to establish bacteriologic identification and subsequently guide antibiotic therapy. Here we present a case of delayed Escherichia coli subdural empyema following a head injury in an elderly patient without significant risk factors. Computed tomography imaging was equivocal for subdural empyema. The patient underwent surgery and was treated with intravenous antibiotic therapy. Although initial improvement in the patient's clinical condition was observed, he eventually succumbed to nosocomial pneumonia. In this article, we discuss the presentation, diagnostic tools, and treatment options for subdural empyema with an emphasis on the challenges. The management conundrum that follows prompted us subsequently to review the literature.

Cranial infections continue to be an important cause of mortality and morbidity worldwide. To understand cranial infections, knowledge of anatomy is important because the pathogenesis and sequelae vary according to anatomical location and their functional relevance. Microorganisms, owing to their intrinsic properties and distinct characteristics, produce relatively specific clinical syndromes in cranial infections. Definitive treatment depends on prompt microbial identification and antimicrobial treatment, reduction of microbial load, relief of excessive pressure or mass effect and modulation of the host’s immune response to allow successful microbial clearance while minimizing inflammation and oedema. In this chapter, we will discuss the management of common cranial infections and their associated clinical conundrums from a neurosurgical perspective.