Journal of neurosurgery
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Journal of neurosurgery · Aug 2019
Surgeon specialty and patient outcomes in carotid endarterectomy.
The goal of this study was to compare outcomes of carotid endarterectomy performed by neurological, general, and vascular surgeons. ⋯ Patients who undergo carotid endarterectomy performed by a neurosurgeon tend to have a greater preoperative disease burden than do those treated by a general or vascular surgeon, which contributes significantly to more morbid postoperative courses. In patients matched carefully on the basis of health status at the time of surgery and intraoperative variables that affect results, patients' outcomes after carotid endarterectomy do not appear to depend on the attending surgeon's primary specialty.
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Journal of neurosurgery · Aug 2019
Nervus intermedius and the surgical management of geniculate neuralgia.
Geniculate neuralgia (GN) is an uncommon craniofacial pain syndrome attributable to nervus intermedius (NI) dysfunction. Diagnosis and treatment can be challenging, due to the complex nature of ear sensory innervation, resulting in clinical overlap with trigeminal neuralgia (TN) and glossopharyngeal neuralgia (GPN). ⋯ GN is rare, and diagnosis is confounded by symptomatic overlap with TN/GPN. Directed treatment of all possible neuralgias improved pain control in almost all primary operations. Repeat surgery seems a risk factor for an unfavorable outcome. NI is adherent to superomedial VIII at the brainstem; the intermediate/cisternal portion is optimal for visualization and sectioning.
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Journal of neurosurgery · Aug 2019
Multimodal management of arteriovenous malformations of the basal ganglia and thalamus: factors affecting obliteration and outcome.
Arteriovenous malformations (AVMs) of the basal ganglia and thalamus are particularly difficult lesions to treat, accounting for 3%-13% of all AVMs in surgical series and 23%-44% of malformations in radiosurgery series. The goal of this study was to report the results of multimodal management of basal ganglia and thalamic AVMs and investigate the factors that influence radiographic cure and good clinical outcomes. ⋯ Good outcomes are possible with multimodal treatment in these complex patients. Increasing size and, by extension, higher Spetzler-Martin grade are associated with worse outcomes. Inclusion of multiple modalities of treatment as indicated could improve the chances of radiographic cure and good outcomes.
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Journal of neurosurgery · Aug 2019
Assessment of costs in open surgery and stereotactic radiosurgery for vestibular schwannomas.
Microsurgical resection and radiosurgery remain the most widely used interventions in the treatment of vestibular schwannomas. There is a growing demand for cost-effectiveness analyses to evaluate these two treatment modalities and delineate the factors that drive their total costs. Here, the authors evaluated specific cost drivers for microsurgical and radiosurgical management of vestibular schwannoma by using the Value Driven Outcomes system available at the University of Utah. ⋯ This analysis identified the fact that facility utilization constitutes the majority of total costs for both microsurgery and SRS treatment modalities of vestibular schwannomas. LOS, discharge disposition, nonserviceable hearing, and complications contributed significantly to the total costs for the microsurgical group, whereas none of the factors could be identified as driving total costs for the SRS group. This information may be used to establish policies and protocols to reduce facility costs, with the goal of decreasing the total costs without jeopardizing patient care.
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Journal of neurosurgery · Aug 2019
Case ReportsTotal improvement after surgery for obstructive sleep apnea syndrome in a patient with concurrent malignant idiopathic intracranial hypertension.
The association between idiopathic intracranial hypertension (IIH) and obstructive sleep apnea syndrome (OSAS) constitutes an interesting point of discussion regarding clinical approaches as well as the underlying pathophysiological mechanisms. Here, the case of a 42-year-old female with malignant IIH and OSAS is illustrated. ⋯ The authors point out the importance of identifying OSAS as a crucial causative agent in some IIH subtypes. Future studies are warranted to clarify this underestimated association.