Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Nov 2020
Burnout and career satisfaction among attending neurosurgeons during the COVID-19 pandemic.
The novel coronavirus SARS-CoV-2 (COVID-19) pandemic has posed significant changes to physician workflow and healthcare delivery. This national survey investigated the impact of the pandemic on burnout and career satisfaction among U.S. attending neurosurgeons. ⋯ Factors related to the novel COVID-19 pandemic have contributed to changes in workflow among U.S. attending neurosurgeons. Despite these changes, we report decreased burnout and high career satisfaction among U.S. neurosurgeons. Understanding modifiable stressors among neurosurgeons during the pandemic may help to identify effective future interventions to mitigate burnout and improve career satisfaction.
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Clin Neurol Neurosurg · Nov 2020
The ratio of facial nerve to facial canal as an indicator of entrapment in Bell's palsy: A study by CT and MRI.
To find out if the ratio of facial nerve to facial canal diameter plays any role in the etiopathogenesis and grade of Bell's palsy. ⋯ FN/FC ratio of labyrinthine segment and geniculate ganglion was found to be increased in patients with Bell's palsy. In addition, a positive correlation was determined between this ratio and grade of Bell's palsy particularly at labyrinthine segment. Basing the current study, if FN decompression is recommended in Bell's palsy patients with objective findings of bad prognosis, conservative surgery targeting the labyrinthine segment and geniculate ganglion alone might be safer.
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Clin Neurol Neurosurg · Nov 2020
Proposal for a new scoring system for spinal degeneration: Mo-Fi-Disc.
We aimed to develop a new scoring system for spinal degeneration including Modic changes, fatty infiltration (fi) in the paraspinal muscles, and intervertebral disc degeneration (IVDD), briefly Mo-fi-disc, using current radiological classification systems. We also aimed to understand whether Mo-fi-disc could predict patients with more intense low back pain (LBP). ⋯ Patients with more intense LBP had higher 'Mo-fi-disc' scores. This scoring system suggests an easy and objective classification to evaluate the spinal degeneration.
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Clin Neurol Neurosurg · Nov 2020
Facial nerve outcomes following gamma knife radiosurgery for subtotally resected vestibular schwannomas: Early versus delayed timing of therapy.
Initially treating vestibular schwannomas (VSs) with subtotal resection (STR) followed by Gamma Knife radiosurgery (GKRS) for progression of tumor residual is a strategy that balances maximal tumor resection with preservation of neurological function. The effect of timing of GKRS for residual and recurrent VSs remains poorly defined. We developed a simple and practical treatment algorithm for the timing of GKRS after STR of VSs and reviewed our follow-up results to determine outcomes between patients treated with early vs. late GKRS. ⋯ GKRS of residual or recurrent tumor is safe following STR of VS and appears to carry a low risk of worsening facial nerve function when performed for progressive tumor growth.
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Clin Neurol Neurosurg · Oct 2020
ReviewTranssphenoidal surgery using robotics to approach the sella turcica: Integrative use of artificial intelligence, realistic motion tracking and telesurgery.
While full integration of robotic surgery has been achieved in other surgical domains, its transition into neurosurgery has been more prolonged, especially with respect to pituitary surgery. The confined working space and precise maneuvers required in endoscopic endonasal surgery makes development of an efficacious and safe robotic system difficult. Nevertheless, preclinical studies have attempted to demonstrate the feasibility of the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) in both transnasal and transoral approaches. ⋯ The possible role of concentric tube robotics surgery in skull base pathologies has been explored, and the novel use of telesurgery incorporated into robotic neurosurgery is discussed. An endoscopic endonasal transsphenoidal surgical system has also been developed, integrating computational methods to create a presurgical reconstructive model for surgical planning and automating the line of dissection for an enhanced approach to the sphenoid sinus. While surgical robotics for transsphenoidal surgery remain in its nascency, these preliminary findings are promising and suggest a role for robotic pituitary surgery.