Neurosurgery
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Transient neurological symptoms (TNS) are frequent in patients with subdural hematomas (SDH) and many will receive a diagnosis of epilepsy despite a negative workup. ⋯ We describe NESIS as a syndrome experienced by SDH patients with specific prognostic and therapeutic implications. Independent validation of this new entity is now required.
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Observational Study
Simulating Episode-Based Bundled Payments for Cranial Neurosurgical Procedures.
Episode-based bundled payments were introduced by Medicare in 2013 as the Bundled Payments for Care Improvement (BPCI) in order to improve care coordination and cost efficiency. BPCI has not yet been applied to cranial neurosurgical procedures. ⋯ For the first time, to our knowledge, we project the values of episode-based bundled payments for common vascular and tumor cranial operations. As previously identified in orthopedic procedures, there is significant variability in total bundle payments within each cranial procedure. Compared to spine and orthopedic procedures, postdischarge care significantly impacts total bundle payments in cranial neurosurgery.
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A range of opinions exist in the literature regarding obstetric management of pregnant women with Chiari malformation type I (CM-I). ⋯ A diagnosis of CM-I prior to delivery is associated with a higher rate of C-section and a lower rate of epidural analgesia. Rates of serious maternal morbidity among women with CM-I were similar to those for normal controls. The data suggest a predelivery diagnosis of CM-I may influence obstetric decisions despite no evidence of substantially increased delivery risk in this group.