Background:Although the usage of combined motor and sensory intraoperative monitoring has been shown to improve the surgical outcome of patients with cervical myelopathy, the role of transcranial electric motor evoked potentials (tceMEP) used in conjunction with somatosensory evoked potentials (SSEP) in patients presenting with radiculopathy but without myelopathy has been less clear.Methods:We retrospectively reviewed all patients (n = 57) with radiculopathy but without myelopathy, undergoing anterior cervical decompression and fusion at a single institution over the past 3 years, who had intraoperative monitoring with both tceMEPs and SSEPs.Results:Fifty-seven (100%) patients presented with radiculopathy, 53 (93.0%) with mechanical neck pain, 35 (61.4%) with motor dysfunction, and 29 (50.9%) with sensory deficits. Intraoperatively, 3 (5.3%) patients experienced decreases in SSEP signal amplitudes and 4 (6.9%) had tceMEP signal changes. There were three instances where a change in neuromonitoring signal required intraoperative alteration of the surgical procedure: these were deemed clinically significant events/true positives. SSEP monitoring showed two false positives and two false negatives, whereas tceMEP monitoring only had one false positive and no false negatives. Thus, tceMEP monitoring exhibited higher sensitivity (33.3% vs. 100%), specificity (95.6% vs. 98.1%), positive predictive value (33.3% vs. 75.0%), negative predictive value (97.7% vs. 100%), and efficiency (91.7% vs. 98.2%) compared to SSEP monitoring alone.Conclusions:Here, we present a retrospective series of 57 patients where tceMEP/SSEP monitoring likely prevented irreversible neurologic damage. Though further prospective studies are needed, there may be a role for combined tceMEP/SSEP monitoring for patients undergoing anterior cervical decompression without myelopathy.

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In morbidly obese patients undergoing bariatric surgery, when a ventral hernia is picked up in clinic or intraoperatively is concurrent repair of the hernia better than delayed repair after weight loss with regards to complication rates? Using the reported search, 179 papers were found. 5 studies were deemed to be suitable to answer the question.All 5 studies assessed were non randomised studies either retrospective or prospective and the overall quality of these studies was poor. The outcomes assessed were incidence of complications associated with hernia repair (recurrence, infection) and deferral of repair (small bowel obstruction). The patient's symptoms and anatomy is important in determining the timing of repair.The evidence does not provide a consensus for the optimal timing of ventral hernia repair for patients undergoing bariatric surgery, with some of the selected studies contradicting each other. However, the studies do affirm the risk of small bowel obstruction if hernias are left alone. The reported rate of surgical site infection is low when mesh repair is performed at the same time as weight loss surgery.Until large volume, high quality randomized control trials can be performed, a case by case approach is best, where the patients' symptoms, anatomy, type of bariatric surgery and their personal preferences are considered, and an open discussion on the risks and benefits of each approach is undertaken.

Background:Worldwide, Salmonella enteritidis (SE) is becoming a common cause of gastrointestinal infections by contaminated food products, mainly eggs. Extra-intestinal manifestations such as brain abscess are more commonly associated with Salmonella typhimurium and are rare in adults. We report the clinical features, treatment outcomes and risk factors predisposing our patient to Salmonella enteritidis brain abscess and discuss relevant literature.Case Description:A 57-year-old-man developed SE subdural empyema, abscess and possible ventriculitis following reoperation for progression of a right temporal glioblastoma. He initially presented with rapidly worsening headaches over a few days, with a wound discharge and associated meningeal signs. An emergent wound washout revealed pus in the epidural, subdural space and resection cavity. An external ventricular drain (EVD) was placed and cultures revealed gram negative rods. Timely intervention, EVD, and antibiotics resulted in complete resolution. Nine cases of Salmonella abscess associated with primary brain tumor have been reported in literature, most frequently caused by SE in association with glioblastoma multiforme (GBM). We describe our management and outcome in addition to discussing neurosurgical literature on the reported cases.Conclusions:Re-operative tumor surgery has a higher incidence of post-operative infections, with Gram positive cocci being the most common pathogens. Predisposing factors reported for intracranial salmonellosis include compromised immunity, diabetes, HIV, and recent travel. Chronic corticosteroid use, multiple regimens of chemotherapy, and regions of tumor necrosis likely potentiate this rare infection in GBM patients.