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Background and Objectives: Over the course of their career, 66% of neurosurgeons will witness someone accidentally dropping a bone flap on the floor during a craniotomy procedure. Although this event is rare, it can have significant consequences for the patient, and little literature is available to guide management of this complication. Our objective was to compare 5 bone flap decontamination protocols for efficacy in reducing bacterial load, with the goal of safely reimplanting the dropped flap., Methods: Cadaveric human bone flaps were contaminated with common operating room (OR) contaminant bacteria. The bone flaps were then subject to 1 of 5 decontamination protocols: washing in saline, mechanical debridement, washing in antibiotics, washing in alcoholic chlorhexidine antiseptic, and flash decontamination in autoclave. Inoculum from the flaps was then used to grow bacteria in petri dishes, and bacterial load after decontamination was assessed. Some flaps were physically dropped on an OR floor to simulate and evaluate a real-life contamination., Results: The observed contamination from a flap dropped on an OR floor can be significant (up to 1070 colony-forming units cultured per flap). All protocols tested decreased bacterial load of the bone flaps to different degrees: saline by 95.7%, mechanical debridement by 97.5%, antibiotic bath by 99.5%, alcoholic chlorhexidine by 99.9%, and flash sterilization by 100.0%. Flash sterilization led to significant alterations in the flap's physical appearance., Conclusion: In the event of the accidental fall of a bone flap, decontamination by rinsing in an alcohol-chlorhexidine solution followed by 3 successive washes in saline seemed to provide the best balance between effectiveness, safety, and complexity of the method., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.)

Introduction: Essential tremor (ET) is the most frequent movement disorder, affecting up to 5% of adults > 65 years old. In 30-50% of cases, optimal medical management provides insufficient tremor relief and surgical options are considered. Thalamotomy is a time-honored intervention, which can be performed using radiofrequency (RF), stereotactic radiosurgery (SRS), or magnetic resonance-guided focused ultrasounds (MRgFUS). While the latter has received considerable attention in the last decade, SRS has consistently been demonstrated as an effective and well-tolerated option., Areas Covered: This review discusses the evidence on SRS thalamotomy for ET. Modern workflows and emerging techniques are detailed. Current outcomes are analyzed, with a specific focus on tremor reduction, complications and radiological evolution of the lesions. Challenges for the field are highlighted., Expert Opinion: SRS thalamotomy improves tremor in > 80% patients. The efficacy appears comparable to other modalities, including DBS, RF and MRgFUS. Side effects result mostly from idiosyncratic hyper-responses to radiation, which occur in up to 10% of treatments, are usually self-resolving, and are symptomatic in < 4% of patients. Future research should focus on accumulating more data on bilateral treatments, collecting long-term outcomes, refining targeting, and improving lesion consistency.

Objective: Peripheral nerve field stimulation (PNFS) is a tool in the armamentarium of treatment options for trigeminal pain. The efficacy of this modality in mitigating trigeminal pain remains unclear. The aim of this study was to examine the existing literature on PNFS and elucidate pain score outcomes associated with its use in patients with trigeminal pain., Methods: A systematic review and meta-analysis was performed in accordance with the PRISMA framework. The PubMed, Web of Science, and Scopus databases were queried on June 10, 2020. Studies reporting pain outcomes in more than 5 adult patients treated with PNFS for facial pain were included. The primary outcome of the study was the mean difference in the visual analog scale (VAS) score from the last follow-up to baseline, and it was analyzed by an inverse-variance, random-effect model. The risk of bias was assessed using the Newcastle-Ottawa Scale and a funnel plot., Results: Of the 4597 studies screened for inclusion, 46 relevant full-text articles were assessed for eligibility. Eleven observational cohort studies from the 46 articles were found to be eligible, and reported on a total of 109 patients. In 86% (94/109) of cases, trial stimulation was successful and followed by a permanent system implantation. VAS scores improved by 75% (mean difference 6.32/10 points, 95% CI 5.38-7.27 points) compared to baseline. Seventy-six percent (42/55) of patients became medication free or required lower doses of medications. The complication rate necessitating surgical revision was estimated at 32% per procedure., Conclusions: These findings support the belief that PNFS provides effective, long-term pain control for trigeminal pain. Statistical heterogeneity was considerable across all studies. Future work should be aimed at conducting double-blind randomized controlled trials to determine the utility of PNFS for treating various forms of trigeminal pain for which limited therapeutic options exist.

Long term (1999 to 2014) flow and water quality data from a rock drain located at the base of a coal waste rock dump constructed in the Elk Valley, British Columbia was used to characterize the release of three solutes (NO 3 - , Cl - and SO 4 2- ) from the dump and obtain whole dump estimates of net percolation (NP). The concentrations of dump derived solutes in the rock drain water were diluted by snowmelt waters from the adjacent natural watershed during the spring freshet and reached a maximum concentration during the winter baseflow period. Historical peak baseflow concentrations of conservative ions (NO 3 - and Cl - ) increased until 2006/07 after which they decreased. This decrease was attributed to completion of the flushing of the first pore volume of water stored within the dump. The baseflow SO 4 2- concentrations increased proportionally with NO 3 - and Cl - to 2007, but then continued to slowly increase as NO 3 - and Cl - concentrations decreased. This was attributed to ongoing production of SO 4 2- due to oxidation of sulfide minerals within the dump. Based on partitioning of the annual volume of water discharged from the rock drain to waste rock effluent (NP) and water entering the rock drain laterally from the natural watershed, the mean NP values were estimated to be 446±50mm/a (area normalized net percolation/year) for the dump and 172±71mm/a for the natural watershed. The difference was attributed to greater rates of recharge in the dump from summer precipitation compared to the natural watershed where rainfall interception and enhanced evapotranspiration will increase water losses. These estimates included water moving through subsurface pathways. However, given the limitations in quantifying these flows the estimated NP rates for both the natural watershed and the waste rock dump are considered to be low, and could be much higher (e.g. ~450mm/a and ~800mm/a)., (Copyright © 2017 Elsevier B.V. All rights reserved.)