Neurosurgery
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Review Meta Analysis
Diagnostic Value and Safety of Brain Biopsy in Patients With Cryptogenic Neurological Disease: A Systematic Review and Meta-analysis of 831 Cases.
The role of brain biopsy in patients with cryptogenic neurological disease is uncertain. ⋯ Brain biopsy in cryptogenic neurological disease was associated with the highest diagnostic yield in patients with suspected PACNS. The greatest clinical impact was seen in children with cryptogenic neurological disease. The presence of a radiological target was associated with a higher diagnostic yield.
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Surgical site infection (SSI) is an expensive complication associated with spine surgery. The application of intrawound vancomycin is rapidly emerging as a solution to reduce SSI. The impact of intrawound vancomycin has not been systematically studied in a well-designed multicenter study. We determine whether intrawound vancomycin application was associated with reduced risk of SSI in patients after spine surgery. ⋯ Intrawound application of vancomycin after elective spine surgery was associated with reduced risk of SSI and return to OR associated with SSI, even after controlling for confounding variables.
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Clinical prediction and decision rules use evidence-based medicine to assist clinicians in diagnosing and treating illness. Although widespread in modern medical practice, there are relatively few clinical rules for neurosurgical conditions. ⋯ It also summarizes a list of clinical rules published for neurosurgical illnesses and analyzes each rule for how it was derived and whether it was validated and/or evaluated compared with similar rules. It reports on whether the implementation of each rule was studied and grades the overall quality of each report.
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The comparative efficacy of microscopic and fully endoscopic transsphenoidal surgery for pituitary adenomas has not been well studied despite the adoption of fully endoscopic surgery by many pituitary centers. We compared the extent of tumor resection (EOR) and the endocrine outcomes of 1 very experienced surgeon performing a microscopic-transsphenoidal surgery technique (1800 independent cases) with those of a less experienced surgeon using a fully endoscopic-transsphenoidal surgery technique (100 independent cases) for nonfunctioning pituitary adenomas in a concurrent series of patients. ⋯ A less experienced surgeon using a fully endoscopic technique was able to achieve similar outcomes compared with a very experienced surgeon using a microscopic technique in a cohort of patients with nonfunctioning tumors. These data suggest that certain advantages afforded by the fully endoscopic technique help address the learning curve in pituitary surgery.
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Patient satisfaction metrics are emerging as determinants of quality of care and reimbursement after spine surgery. Identifying modifiable factors that improve satisfaction is of utmost importance. ⋯ Patient satisfaction with outcome may accurately represent the effectiveness of surgical spine care in terms of 1-year improvement in pain and disability. However, healthcare stakeholders relying on satisfaction as a proxy of overall quality or effectiveness of care need to account for Medicaid/uninsured payer status and worse baseline pain and disability scores as confounders.