Neurosurgery
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Revascularization for moyamoya disease (MMD) effectively prevents future ischemic events. However, small subsets of patients with persistent or new symptoms due to inadequate collateralization require repeat revascularizations. ⋯ Repeat revascularization can safely and effectively prevent future ischemic events. Indirect bypass has a higher rate of repeat revascularization than direct bypass.
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Readmissions are a significant economic burden on the health care system and increasingly being utilized as a metric of quality. Patients discharged to home vs an inpatient facility have different characteristics, which might influence the readmissions following spine surgery. ⋯ Despite the older age and higher comorbidities in patients discharged to an inpatient facility, the proportion of readmissions was comparable to those discharged home. Patients discharged home had a higher proportion of readmissions related to surgical wound complications and those discharged to facility had higher readmissions associated with medical complications. Understanding causes of readmission based on discharge destination may allow targeted intervention to reduce the readmission rates following spine surgery.
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Posterior cranial vault distraction (PCVD) is a technique widely used in surgical treatment of craniosynostosis when cranial expansion is required. It has proven to be safe and to allow a significant increase of intracranial volume. ⋯ PCVD is an effective surgical method to increase intracranial volume in a variety of clinical entities. Volumetric results of this procedure could be easily evaluated using 3-D photogrammetric imaging or plane radiographs that expose the patients to only low ionizing radiation doses.
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The morphological and hemodynamic features differ between middle cerebral artery (MCA) bifurcations with and without aneurysms. ⋯ A larger φ angle was more prevalent in aneurysmal than nonaneurysmal MCA bifurcations, and the higher flow resistance caused by the larger φ angle might be a potential hemodynamic factor associated with MCA aneurysm presence.
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Intraoperative monitoring of brainstem auditory evoked potentials (BAEPs) has been implemented to reduce the risk of hearing impairment during microvascular decompression for hemifacial spasm. ⋯ Intraoperative monitoring of BAEPs evaluated through our scoring system was valuable in predicting hearing impairment after surgery.