Neurosurgery
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Obesity is a significant comorbidity that can increase the risk and technical difficulty of surgery. Previous studies comparing minimally invasive (MIS) to traditional open spinal surgery in the obese have shown similar clinical outcomes but improved perioperative benefits of decreased estimated blood loss (EBL), length of stay (LOS), and complications with MIS approaches. Similar studies have not been performed for obese patients undergoing surgery for adult spinal deformity (ASD). This study's objective was to compare the impact of obesity in the treatment of ASD with MIS compared with open approaches. ⋯ Similar clinical and radiographic improvements were noted for MIS and open treatment of ASD. Although EBL was less in the MIS group, the frequency of complications and reoperations were similar, suggesting the potential benefit of MIS approaches may be mitigated by obesity. Larger comparative studies are needed to clarify the benefit of MIS in the obese undergoing ASD surgery.
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Several studies have indicated that 30-day morbidity and mortality risk is higher among pediatric and adult patients who are admitted on the weekends. This "weekend effect" has been observed among patients admitted with and for a variety of diagnoses and procedures, respectively, including myocardial infarction, pulmonary embolism, ruptured abdominal aortic aneurysm, stroke, peptic ulcer disease, and pediatric surgery. We sought to compare morbidity and mortality outcomes for emergent pediatric neurosurgical procedures done on the weekend or after-hours with emergent surgical procedures performed during regular weekday "business hours." ⋯ Weekday after-hours and weekend emergent pediatric neurosurgical procedures are associated with significantly increased 30-day morbidity and mortality risk compared with procedures performed during weekday regular hours.
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Multicenter Study
Long-term Auditory Symptoms in Patients With Sporadic Vestibular Schwannoma: An International Cross-Sectional Study.
There are limited data on the long-term auditory symptoms in patients with sporadic small- and medium-sized vestibular schwannoma (VS). The initial treatment strategy for VS is controversial. ⋯ The overall prognosis for hearing in sporadic VS is poor regardless of treatment strategy. Treatment modality was an independent predictor of hearing status; observation was associated with the highest rate of hearing preservation. .
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Comparative Study
Comparison of Stent-Assisted Coiling vs Coiling Alone in 563 Intracranial Aneurysms: Safety and Efficacy at a High-Volume Center.
Stent-assisted coiling has been used in both unruptured and ruptured aneurysms, but the safety and efficacy still remain controversial. ⋯ Compared with coiling alone, stent-assisted coiling may achieve lower recurrence rates, with comparable procedure-related complications and clinical outcomes in both ruptured and unruptured aneurysms.
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Smoking has been associated with worse self-reported outcomes in patients undergoing degenerative lumbar spine surgery. Current focus is on decreasing cost and complications while improving outcomes. This potentially can be accomplished by acting on modifiable preoperative patient characteristics such as smoking. However, the impact of smoking on outcomes following degenerative cervical spine surgery is poorly understood. The aim of the study is to understand impact of smoking on patient-reported outcomes after degenerative cervical spine surgery. ⋯ The smoking population was younger and had a higher preoperative narcotic use. Smoking results in lower absolute scores and these patients have less benefit following surgical intervention compared with the nonsmokers, after controlling for confounding variables. Smoking cessation should be strongly considered before surgical intervention so as to optimize outcome.