Neurosurgery
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Choroid plexus tumors (CPT) are rare epithelial tumors of the choroid plexus. Gross total resection (GTR) may be curative, but it is not always possible. ⋯ GKSRS represents a minimally invasive alternative management strategy for imaging defined or surgically recurrent low- and high-grade CPT.
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Hypopituitarism is the most frequent complication after pituitary adenoma stereotactic radiosurgery (SRS) and is correlated with increasing radiation to the pituitary gland. Biological effective dose (BED) is a dosimetric parameter that incorporates a time component to adjust for mechanisms of deoxyribonucleic acid repair activated during treatment. ⋯ BED predicted hypopituitarism more reliably than mean gland dose after pituitary adenoma SRS, but additional studies are needed to confirm these results.
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Over the last decade, strict duty hour policies, pressure for increased work related value units from faculty, and the apprenticeship model of education have coalesced to make opportunities for intraoperative teaching more challenging. Evidence is emerging that graduating residents are not exhibiting competence by failing to recognize major complications, and perform routine operations independently. In this pilot study, we combine Vygotsky's social learning theory with a modified version of the competency-based scale called TAGS to study 1 single operation, anterior cervical discectomy and fusion, with 3 individual residents taught by a single faculty member. ⋯ In this pilot study, the time required to complete an independent 2-level anterior cervical discectomy and fusion by the residents correlated with the number of cases to reach competence. We demonstrate the Surgical Autonomy Program's ability to track neurosurgical resident's educational progress and the feasibility of using the Surgical Autonomy Program (SAP) to teach residents in the operating room and provide immediate formative feedback. Ultimately, the SAP represents a paradigm shift towards a modern, scalable competency-focused subspecialty teaching, evaluation and assessment tool that provides increases in resident's autonomy and metacognitive skills, as well as immediate formative feedback.
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Secondary to the complex care, involved specialty providers, and various etiologies, chronic pelvic pain patients do not receive holistic care. ⋯ Eleven percent of patients were offered neuromodulation. There were more responders in the neuromodulation cohort than the conservatively managed neuropathic pain cohort. Neuromodulation patients showed significant improvement at 29 mo in NRS best and worst pain, disability, and rumination. We share our algorithm for patient management.
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Case Reports
Using Smartphone-Based Accelerometer Data to Objectively Assess Outcomes in Spine Surgery.
In order to deliver optimal patient care, spine surgeons must integrate technological changes to arrive at novel measures of functional outcomes. Historically, subjective patient-reported outcome (PRO) surveys have been used to determine the relative benefit of surgical treatments. Using smartphone-based accelerometers, surgeons now have the ability to arrive at objective outcome metrics. ⋯ We demonstrated a valuable supplement to traditional PROs by using smartphone-based activity data. This methodology yields a rich data set that has the potential to augment our understanding of patient recovery.