Neurosurgery
-
The optimal site for placement of tissue oxygen probes following traumatic brain injury (TBI) remains unresolved. We studied brain tissue oxygen tension (PbtO2) at the sites of contusion, proximal and distal to contusion, and in the contralateral hemisphere to determine the effect of probe location on PbtO2 and to assess the effects of physiological interventions on PbtO2 at these different sites. ⋯ PbtO2 measurements are strongly influenced by the distance from the site of focal injury. Physiological alterations, including hyperoxia, hyperventilation, and hypoventilation substantially affect PbtO2 values distal to the site of injury, but have little effect in and around the site of contusion.
-
Operative management of adult spinal deformity (ASD) repeatedly demonstrates improvements in health-related quality of life over nonoperative treatment. However, little is reported regarding the quality-adjusted life-year (QALY) improvements following surgical correction of ASD. The purpose of this study was to evaluate the QALY increases following the operative treatment of ASD compared with nonoperative treatment. ⋯ The operative treatment of ASD results in significant increases in QALYs gained at minimum 2 years postoperatively as well as at the 1-, 2-, and 3-year time points compared with nonoperative management.
-
Surgical costs are very high, but most surgeons have little knowledge of their operating room (OR) costs. A recent study of orthopedic surgeons found that their cost estimates for commonly used orthopedic devices ranged from 1.8% to 24.6 times the actual price. The goal of OR SCORE is to determine whether a price transparency initiative will reduce costs in the surgical departments at University of California San Francisco (UCSF). ⋯ To the best of our knowledge, there are no publications demonstrating cost reduction through a price transparency initiative directed at surgeons, and our work represents one of the first attempts to do this.
-
The spine surgeon often encounters patients with a foot drop. It is the task of spine physicians to be able to determine the etiology and responsible pathological process based upon history, physical examination, electrophysiological testing, and radiographic studies. A detailed knowledge of the musculoskeletal anatomy of the lower extremity and of the peripheral nervous system is beneficial to interpret the aforementioned findings in order to arrive at an accurate diagnosis. Specifically, the spine surgeon needs to be able to identify whether a "foot drop" is the result of a central, radicular, or neuropathic etiology. Peroneal neuropathy must be differentiated from L5 radiculopathy, because the treatment strategies for each of the pathologies differ. ⋯ There may be a lack of knowledge among spine surgeons of the lumbosacral plexus and lower extremity anatomy. Medical education dedicated to the musculoskeletal system and neuroanatomy may be necessary so that gaps in knowledge may be minimized.
-
Surgery for cerebrospinal fluid diversion is the most common procedure performed by pediatric neurosurgeons. The failure rates for shunts remain frustratingly high, resulting in a negative burden to patients, families, providers, and health care systems. The goal of this study was to quantify the risk of a shunt malfunction in patients with an existing shunt who undergo an elective intradural operation. ⋯ This is the first study to quantify the risk of a shunt malfunction after elective intradural surgery. The 90-day all-cause shunt failure rate (per procedure) was 10% with nearly half of the failures occurring within the first 5 postoperative days. Possible risk factors for shunt malfunction after elective intradural surgeries are intraventricular surgical approach, shorter time since last shunt-related surgery, and young age.