Neurosurgery
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Carotid blowout syndrome (CBS) is a life-threatening emergency resulting from compromise of the carotid artery caused by malignancy in the head and neck. ⋯ The use of covered stents is a simple, safe, and effective method for treating or preventing carotid blowout syndrome in patients with head and neck malignancy. Carotid artery reconstruction with covered stents may minimize the risk of ischemic complications associated with endovascular or surgical carotid sacrifice.
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High-dose or prolonged narcotic use is associated with altered pain perception and response to pain management strategies in patients with chronic pain syndromes. We set out to determine whether the amount of preoperative narcotic use for spine-related pain predicted short-term and 1-year outcomes after spine surgery. ⋯ Increasing levels of preoperative narcotic use were associated with worse short-term and long-term outcome after elective surgery for degenerative spine pathology. Preoperative narcotic use in MEAs may help hospitals and providers more appropriately risk stratify for surgical selection and indications. Efforts should be made to address narcotic dependence before elective spine surgery.
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The authors present the results of Gamma knife stereotactic radiosurgery performed in a series of children with arteriovenous malformations (AVMs). ⋯ Radiosurgery was successful in the majority of patients with minimal morbidity. Gamma Knife radiosurgery for AVMs can be a safe and successful method in pediatric patients.
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Acromegaly is a challenging clinical entity. Despite improvements in microsurgery and medical therapy, acromegaly persists or recurs in many patients. We evaluate the long-term results of stereotactic radiosurgery (SRS) for acromegalic patients. ⋯ SRS affords endocrine remission in the majority of acromegalic patients. Delivering a higher radiation dose portends a greater chance of remission. The most common complication after SRS was hypopituitarism, but this occurs in a minority of patients.
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Newborns with a myelomeningocele are often brought to the operating room for surgical repair within the first few days of life. Wound infection in this population may represent a devastating outcome in the immature nervous system. No studies have evaluated infection as a function of surgical timing at a national level. We hypothesized an increase in wound infection in those patients with delays in myelomeningocele repair when evaluated from a national database. ⋯ Myelomeningocele repair, when delayed more than 1 day after birth, is associated with increased rates of infection. High-volume centers are associated with fewer delays in procedure. Although constrained by limitations of a national coded database, results suggest that appropriate attention to timely myelomeningocele repair decreases the infection rate.