Journal of neurointerventional surgery
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Physician spending is complex and intrinsically related to national health care spending, government regulations, health care reform, private insurers, physician practice and patient utilization patterns. Consequently, since the inception of Medicare programs in 1965, several methods have been used to determine the amounts paid to physicians for each covered service. The sustainable growth rate (SGR) was enacted in 1997 to determine physician payment updates under Medicare part B with an intent to reduce Medicare physician payment updates to offset the growth and utilization of physician services that exceeds the gross domestic product growth. ⋯ Payments were cut by 4.8% in 2002. Since then, Congress has intervened on 13 separate occasions to prevent additional cuts from being imposed. This manuscript describes certain important aspects of the 2012 physician fee schedule.
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The use of simulators in medical training has been on the rise over the past decade as a means to teach procedural skills to trainees in a risk free environment. The goal of this study was to pilot a simulator based skills course for inexperienced neurosurgical residents to teach the fundamentals of cervicocerebral catheterization and angiography, with the ultimate goal of defining a universal simulator based curriculum that could be incorporated into neurosurgical resident training in the future. ⋯ Participant angiography skills, based on both faculty and simulator assessments, as well as participant knowledge, improved after this didactic, hands-on simulator course. Neuroendovascular simulator training appears to be a viable means of training inexperienced neurosurgery residents in the early learning stages of basic endovascular neurosurgery. Further studies evaluating the translation of procedural skills learned on the simulator to actual clinical skills in the angiography suite is necessary.
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Brain arteriovenous malformations (AVM) account for a significant percentage of brain hemorrhages in pregnant patients. There is general consensus that ruptured AVMs in pregnant women should be managed based on neurosurgical rather than obstetric considerations. Since the risk of re-hemorrhage is significantly higher in the pregnant patient with a ruptured AVM, aggressive treatment during pregnancy must be considered if this can be accomplished with acceptable risk. Recent advances in endovascular technology have increased the potential for successful treatment of previously inoperable high-grade AVMs. ⋯ Extensive endovascular Onyx embolization is feasible in the setting of a ruptured high-grade AVM during pregnancy. The rationale for proceeding with treatment is the perceived higher likelihood of re-hemorrhage from such a lesion.
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Case Reports
Over-the-catheter retrieval of a retained microcatheter following Onyx embolization: a technical report.
Brain arteriovenous malformations are vascular lesions that are increasingly being treated with endovascular embolization. A potential complication with endovascular embolization is microcatheter entrapment within the embolic material. In the present report, a novel technique for the retrieval of microcatheters retained during Onyx embolization of intracranial lesions is described. ⋯ A novel technique, which may be useful in the removal of retained microcatheters during Onyx embolization of Brain arteriovenous malformations, is presented.