Neurosurgery
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The focus of this article is the early recognition and emergent treatment of severe or catastrophic traumatic brain injury. The pathophysiology and management of mild traumatic brain injury are reviewed extensively in other sections. Classification of head injuries can be based on anatomic location (epidural, subdural, intraparenchymal), mechanism of injury (coup, contrecoup, linear, rotational), distribution (focal or diffuse), and clinical presentation. ⋯ Physicians and other healthcare professionals have become integral members of organized sport and must advocate for the players' best interest. Once a neurological injury has been identified on field, it is imperative that prompt management and prevention of secondary injury occur. The goal of this article is to help provide a clear plan of action that is well thought out and rehearsed and that will lead to improved outcomes for the players, particularly those with severe or catastrophic brain injury.
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There are still many unanswered questions about postconcussion syndrome (PCS) in sports and recreation. The predictors of PCS are unknown, although a history of previous concussion has been suspected. ⋯ More than 80% of PCS cases had at least 1 other previous concussion. Half of the athletes with PCS were ≤ 18 years of age. PCS was associated with 7.6 symptoms per athlete. The duration of PCS and the number of symptoms were not related to the number of previous concussions, loss of consciousness, or return to play. Further research on treatment and prevention of PCS is required.
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The risk of radiation-induced optic neuropathy (RION) is the primary limitation of single-fraction stereotactic radiosurgery (SRS) for many patients with parasellar lesions. ⋯ The AVP in patients without prior radiation treatments can safely receive radiation doses up to 12 Gy with a low risk of RION. Although additional studies are needed to better delineate the normal tissue complication probability of the AVP, adherence to the AVP radiation tolerance guidelines developed 20 years ago (8 Gy) limits the applicability and potentially the effectiveness of single-fraction SRS for patients with lesions in the parasellar region.