Journal of neurosurgery
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Journal of neurosurgery · Jul 2020
Multicenter StudyThe limited influence of neurosurgeons' behavior on inpatient satisfaction: a retrospective multihospital analysis.
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a survey that assesses patient satisfaction, which is an important measure of the quality of hospital care and ultimately the overall hospital rating (OHR). However, the survey covers several elements of patient satisfaction beyond the patient-surgeon interaction. In this study, authors investigated which admission and experience factors had the highest impact on the OHR. ⋯ The study findings demonstrated that there are several nonmodifiable factors (i.e., specialty, experience) and items that are not under the direct purview of the neurosurgeon (e.g., nursing communication, hospital environment) that are significant influences on overall inpatient satisfaction on the HCAHPS survey. Furthermore, components of the survey that ultimately influence the OHR vary across different hospitals. Hence, HCAHPS survey results should be broadly interpreted as a way to make health systems more aware of the overall hospital factors that can improve quality of care and patient experience.
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Journal of neurosurgery · Jul 2020
Multicenter StudyPlasma extracellular vesicles as a source of biomarkers in traumatic brain injury.
The objective of this study was to isolate extracellular vesicles (EVs) from plasma in a cohort of patients with traumatic brain injury (TBI) and analyze their contents for novel biomarkers that could prove useful for rapid diagnosis and classification of brain injury during initial evaluation. ⋯ Isolating plasma EVs in patients with TBI is feasible. Increased GFAP concentration-a validated plasma TBI marker-in EVs from TBI patients with altered consciousness, along with differential expression of multiple miRNAs targeting TBI-relevant pathways, suggests that EVs may be a useful source of TBI biomarkers. Additional evaluation in larger patient cohorts is indicated.
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Journal of neurosurgery · Jun 2020
Multicenter StudyDevelopment and external validation of a clinical prediction model for functional impairment after intracranial tumor surgery.
Decision-making for intracranial tumor surgery requires balancing the oncological benefit against the risk for resection-related impairment. Risk estimates are commonly based on subjective experience and generalized numbers from the literature, but even experienced surgeons overestimate functional outcome after surgery. Today, there is no reliable and objective way to preoperatively predict an individual patient's risk of experiencing any functional impairment. ⋯ Functional impairment after intracranial tumor surgery remains extraordinarily difficult to predict, although machine learning can help quantify risk. This externally validated prediction tool can serve as the basis for case-by-case discussions and risk-to-benefit estimation of surgical treatment in the individual patient.
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Journal of neurosurgery · Jun 2020
Randomized Controlled Trial Multicenter Study Comparative StudyRECO Flow Restoration Device Versus Solitaire FR With the Intention for Thrombectomy Study (REDIRECT): a prospective randomized controlled trial.
The RECO flow restoration (FR) device is a new stent retriever designed for rapid flow restoration in acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Here, the authors compared the efficacy and safety of the RECO device with the predicate Solitaire FR stent retriever. ⋯ The RECO stent retriever is effective and safe as a mechanical thrombectomy device for AIS due to LVO. Clinical trial registration no.: NCT01983644 (clinicaltrials.gov).
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Journal of neurosurgery · Jun 2020
Multicenter StudyOptimal indications and limitations of endoscopic transorbital superior eyelid surgery for spheno-orbital meningiomas.
Spheno-orbital meningiomas (SOMs) are complicated tumors that involve multiple structures at initial presentation, such as the orbit, temporalis muscle, sphenoidal bone, cavernous sinus, and temporal or infratemporal fossa. The infiltrative growth and complexity of this type of meningioma make total resection impossible. In this study, the authors evaluated the surgical outcome of the endoscopic transorbital approach (eTOA) for SOM. In addition, they identified optimal indications for the use of eTOA and analyzed the feasibility of this approach as a minimally invasive surgery for SOMs of varying types and locations at presentation. ⋯ The en plaque type of SOM remains a challenge despite advances in technique such as minimally invasive surgery. Overall, clinical outcome of eTOA for SOM was comparable to the transcranial surgery. To achieve GTR, eTOA is recommended, with additional lateral orbital rim osteotomy for globulous-type tumors, without involving the floor of the temporal and infratemporal fossa.