Journal of neurosurgery
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Journal of neurosurgery · Jul 2019
Daniel Ruge: the first neurosurgeon to serve as physician to the president.
The role of chief White House physician has traditionally been held by an individual with a background in a broad medical field, such as emergency medicine, family medicine, or internal medicine. Dr. Daniel Ruge, who served as the director of the Spinal Cord Injury Service for the Veterans Administration and was appointed during President Ronald Reagan's first term, was the first neurosurgeon to become the chief White House physician. ⋯ Dr. Ruge's actions after the assassination attempt on President Reagan resulted in the rapid, smooth recovery of the then-president. Daniel Ruge's background, his high-profile roles and heavy responsibilities, and his critical decision-making are characteristics that make his role in the history of medicine and of neurosurgery unique.
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Journal of neurosurgery · Jul 2019
Development of a performance model for virtual reality tumor resections.
Previous work from the authors has shown that hand ergonomics plays an important role in surgical psychomotor performance during virtual reality brain tumor resections. In the current study they propose a hypothetical model that integrates the human and task factors at play during simulated brain tumor resections to better understand the hand ergonomics needed for optimal safety and efficiency. They hypothesize that 1) experts (neurosurgeons), compared to novices (residents and medical students), spend a greater proportion of their time in direct contact with critical tumor areas; 2) hand ergonomic conditions (most favorable to unfavorable) prompt participants to adapt in order to optimize tumor resection; and 3) hand ergonomic adaptation is acquired with increasing expertise. ⋯ The study results confirm the experts' (neurosurgeons) greater capacity to adapt their hand ergonomics during simulated neurosurgical tasks. The proposed hypothetical model integrates the study findings with various human and task factors that highlight the importance of learning in the acquisition of hand ergonomic adaptation.
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Journal of neurosurgery · Jul 2019
ReviewRisk of de novo aneurysm formation in patients with a prior diagnosis of ruptured or unruptured aneurysm: systematic review and meta-analysis.
De novo aneurysms are rare entities periodically discovered during follow-up imaging. Little is known regarding the frequency with which these lesions form or the time course. This systematic review and meta-analysis was undertaken to estimate the incidence of de novo aneurysms and to determine risk factors for aneurysm formation. ⋯ This systematic review demonstrates that formation of de novo aneurysms is rare. Overall, routine screening for de novo aneurysms is likely to be of low yield and could be performed at time intervals of at least 5 to 10 years.
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Journal of neurosurgery · Jul 2019
Long-term and delayed functional recovery in patients with severe cerebrovascular and traumatic brain injury requiring tracheostomy.
Data on long-term functional recovery (LFR) following severe brain injury are essential for counseling of surrogates and for appropriate timing of outcome assessment in clinical trials. Delayed functional recovery (DFR) beyond 3-6 months is well documented following severe traumatic brain injury (sTBI), but there are limited data on DFR following severe cerebrovascular brain injury. The objective of this study was to assess LFR and DFR in patients with sTBI and severe stroke dependent on tracheostomy and tube feeding at the time of discharge from the intensive care unit (ICU). ⋯ Among patients with severe brain injury requiring tracheostomy and tube feeding at ICU discharge, 46% regained the ability to walk and 37% performed B-ADLs 2-3 years after injury. DFR beyond 1-3 and 6-12 months was seen in over 30% of survivors, with no significant difference between sTBI and severe stroke.