Acta neurochirurgica
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Acta neurochirurgica · Jun 2020
The impact of COVID-19 on neurosurgeons and the strategy for triaging non-emergent operations: a global neurosurgery study.
The COVID-19 pandemic has disrupted all aspects of society globally. As healthcare resources had to be preserved for infected patients, and the risk of in-hospital procedures escalated for uninfected patients and staff, neurosurgeons around the world have had to postpone non-emergent procedures. Under these unprecedented conditions, the decision to defer cases became increasingly difficult as COVID-19 cases skyrocketed. ⋯ We report on the impact of COVID-19 on neurosurgeons around the world. From their ranking of the nine case scenarios, we deduced a strategic scheme that can serve as a guideline to triage non-emergent neurosurgical procedures during the pandemic. With it, hopefully, neurosurgeons can continue to serve their patients without endangering them either neurologically or risking their exposure to the deadly virus.
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Acta neurochirurgica · Jun 2020
Pituitary surgery's epidemiology using a national inpatient database in Japan.
Between 2010 and 2014, microscopic transsphenoidal surgery (mTSS) was performed more frequently than endoscopic TSS (eTSS) in the USA. However, few epidemiological studies on pituitary surgery are currently available. ⋯ The present study showed that both TSS and eTSS increased on a yearly basis. We believe that the present study will be the basis of future epidemiological investigations of pituitary surgery.
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Acta neurochirurgica · Jun 2020
Predicting post-operative cerebrospinal fluid (CSF) leak following endoscopic transnasal pituitary and anterior skull base surgery: a multivariate analysis.
Post-operative CSF leak is the major source of morbidity following endoscopic transsphenoidal surgery. The purpose of this study was to identify factors associated with post-operative CSF leak in patients undergoing this surgery and facilitate the prospective identification of patients at higher risk of this complication. ⋯ Increasing surgical experience is a strong predictor of a decreased risk of developing post-operative CSF leak following endoscopic transsphenoidal surgery. Patients with Cushing's disease and those who develop an intra-operative CSF leak should be managed with meticulous skull base repair and close observation for signs of CSF leak post-operatively.
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Acta neurochirurgica · Jun 2020
Hybrid antero-lateral transcondylar approach to the clivus: a laboratory investigation and case illustration.
Surgical treatment of lesions involving the ventral craniovertebral junction (CVJ) and the lower clivus, traditionally involved complex lateral or transoral approaches to the skull base. However, mid or upper clivus involvement requires more extensive lateral approaches. Recently, the endoscopic endonasal approach (EEA) has become the standard for upper CVJ lesions and medial clival, and a valuable alternative for those tumors extending in its upper third as well as laterally. However, the EEA is associated with an increased risk of post-operative CSF leakage and infection when the tumor is characterized by an intradural extension. Furthermore, whenever the tumor has significant lateral and/or inferior extension below the odontoid process, the chances for a complete resection decrease. ⋯ The hybrid antero-lateral transcondylar approach is a valuable surgical option for CVJ tumor extending from C2 to the mid and upper clivus.
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Acta neurochirurgica · Jun 2020
Enhanced recovery after spine surgery-a multinational survey assessing surgeons' perspectives.
Enhanced Recovery After Surgery (ERAS) is the object of numerous publications in various surgical fields. Still, its value in spine surgery is not as recognized as it is in other surgical domains. Our aim was to report neurosurgeons' opinions about ERAS in spine surgery. ⋯ Efforts are necessary to promote minimal invasive pre-, intra-, and postoperative workflow to improve patient management and reduce complications or side effects particularly adapted to spinal surgery. Specificities of spine patients, in terms of chronic pain, pre- and postoperative pain management, and psychological issues have to be considered.