Neurosurgery
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Contemporary surgical approaches to pituitary pathologies include transsphenoidal microsurgical and, more recently, endoscopic techniques. Data reporting direct costs in transsphenoidal pituitary surgery are limited. ⋯ Higher overall total and hospital/facility costs are associated with endoscopic transsphenoidal pituitary surgery compared to microsurgery. In contrast, physician reimbursements are similar between techniques. Whereas LOS was the strongest predictor of overall total and hospital/facility costs, health plan was the strongest predictor of differential physician reimbursements.
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Although empiric treatment of urinary tract colonized patients remains a frequent practice in neurosurgery, the value of this practice remains debatable. ⋯ The routine use of urinalysis and empiric urinary antibiotics for bacteriuria in neurosurgical trauma patients without urinary symptoms increases risk of exposure to antibiotics does not decrease rates of wound infection, and is associated with increased rates of C. difficile infection and death.
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Some patients are diagnosed with asymptomatic meningioma(s) after undergoing a screening CT and MRI for minor ailments or postresection. ⋯ GKRS is a reasonable treatment strategy for asymptomatic meningiomas and compares favorably to natural history studies in terms of tumor control and neurological preservation. It results in relatively low morbidity in previously untreated meningiomas and serves as an appealing alternative treatment modality for recurrent meningiomas in asymptomatic patients.