Neurosurgery
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Spine and nonspine skeletal metastases occur in more than 80% of patients with prostate cancer. ⋯ The majority of patients undergoing surgery for prostate cancer metastases to the spine were refractory to hormone therapy, indicating that patients with hormone-sensitive prostate cancer are unlikely to develop symptomatic spinal cord compression or spinal instability. A significant number of HRPC patients presented with neurological deficits attributable to spinal cord compression. Vigilant monitoring for the development of signs and symptoms of epidural spinal cord compression and spinal instability in hormone-refractory patients is recommended. Surgical decision making may be affected by the much shorter postoperative survival for HRPC patients as compared to patients with hormone-sensitive cancer.
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Reducing Surgical Infections and Implant Costs via a Novel Paradigm of Enhanced Physician Awareness.
Studies have demonstrated that physicians are often unaware of prescription drug, laboratory, diagnostic, and surgical supply costs. ⋯ Physician awareness of outcomes and costs resulted in increasing the quality of care, while at the same time reducing the cost.
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The use of "big data" in neurosurgical research has become increasingly popular. However, using this type of data comes with limitations. This study aimed to shed light on this new approach to clinical research. ⋯ Harvard Medical School was the top institution, using this research technique with 59 representations (31 by primary author and 28 by senior). The increasing use of data from non-neurosurgery-specific databases presents a unique challenge to the interpretation and application of the study conclusions. The limitations of these studies must be more strongly considered in designing and interpreting these studies.
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Skull base chordomas in children are extremely rare. Their course, management, and outcome have not been defined. ⋯ Long-term overall and progression-free survival in children harboring skull base chordomas can be achieved with gross surgical resection and proton-beam radiotherapy, despite an advanced stage at presentation. Collins' law does apply to pediatric skull base chordomas, and children with this disease have a high hope for cure.
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Identification of rupture sites in patients with multiple intracranial aneurysms is largely based on aneurysm size, location, and shape. Finding circumferential enhancement along the aneurysm wall (CEAW) on magnetic resonance (MR) vessel wall imaging was recently shown to be indicative of ruptured aneurysm. ⋯ CEAW is associated with rupture of intracranial aneurysm independent of aneurysm size and patient characteristics. Contrast-enhanced MR vessel wall imaging helps to identify the site of rupture in patients with multiple aneurysms.