Neurosurgery
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Intracranial pressure (ICP) monitoring is recommended for patients with traumatic brain injury (TBI) with a Glasgow Coma Scale (GCS) <9 on admission and revealing space-occupying lesions or swelling on computed tomography. However, previous studies that have evaluated its effect on outcome have shown conflicting results. ⋯ ICP monitoring in patients with severe TBI within 24 hours after injury following strict and extended criteria was associated with a decreased in-hospital mortality. The identification of patients with a higher risk of an unfavorable outcome might be useful to better select cases that would benefit more from ICP monitoring.
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Early ambulation is considered a key element to Enhanced Recovery After Surgery protocol after spine surgery. ⋯ Ambulation within 8 hours after surgery is associated with significant improved outcome after elective cervical and lumbar spine surgery.
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Intraoperative neuromonitoring is crucial for facial nerve preservation in cerebellopontine angle (CPA) surgery. Among the available techniques, the role of intraoperative corticobulbar facial motor evoked potentials (FMEPs) is unclear. ⋯ Our study confirmed that FMEPs are reliable predictors of early and late postoperative FNF in CPA surgery and could be easily integrated with standard intraoperative neuromonitoring techniques.
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Neurosurgical complications are unfortunately unavoidable events in our field. Notwithstanding the potentially devastating effect they can have on patients' lives, young neurosurgeons may equally feel devastated by their occurrence and find themselves poorly equipped emotionally to handle them. ⋯ This special article, written in essay format, is simply a brief overview of the seasoned author's personal approach to complication avoidance and management, with an emphasis on the behavioral aspects and humane dimensions of our profession. The younger trainee may find value in the ideas and emotions expressed here, and the seasoned neurosurgeon may well identify with the author's thoughts.