World Neurosurg
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Cerebral revascularization has been used in treating difficult skull base tumors when the preservation of the involved native arteries is deemed challenging, and the patients are at risk of developing vascular complications. We aimed to evaluate a recent series of patients who needed high flow cerebral bypasses as part of the surgical treatment strategies for their difficult skull base tumors; to assess current indications and the results of such treatments. ⋯ High flow bypass for cerebral revascularization is a good surgical option for treating certain difficult skull base tumors. High rate of graft patency and low risk of perioperative stroke can be achieved in experienced hands with concurrent high rate of gross total resection of the tumor and good clinical outcome of the patients.
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In July 2011, the UCLA Health System released its current time-out process protocol used across the Health System. Numerous interventions were performed to improve checklist completion and time-out process observance. This study assessed the impact of the current protocol for the time-out on healthcare providers' safety attitude and operating room safety climate. ⋯ The time-out process favorably impacted team members' safety attitudes and perception as well as overall safety climate in neurosurgical ORs. Survey responses identified leadership training and teamwork training as two avenues for future improvement.
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Bedside external ventricular drain (EVD) placement is less than perfect and often requires multiple passes to achieve cerebrospinal fluid flow. We conducted this prospective study to understand why multiple passes are necessary and whether this affects the incidence of hemorrhage. ⋯ Multiple passes are inherent to the bedside EVD procedure, but did not increase the rate of intracranial hemorrhage.
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To clarify microsurgical anatomic features of the cerebellomedullary fissure (CMF), the natural cleavage plane between the cerebellum and the medulla, and its relationship to the cerebellomedullary cistern (CMC) and to describe a surgical technique that uses the unilateral trans-CMF approach for CMC surgeries. ⋯ Combined unilateral trans-CMF/lateral foramen magnum approaches provide a wide and close surgical field in the CMC, allowing easy and safe CMC surgery.
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The aim of this study was to determine the utility of an intraoperative magnetic resonance imaging (i-MRI) system (Polestar N-10, 20, 30) in achieving maximal resection of intra-axial brain lesions. ⋯ The Polestar (N-10, 20, 30) proved useful for evaluating residual intra-axial brain lesions and achieving the maximal extent of resection in 42.3% of the total cases and in 43.3% of cases in which complete resection was achieved. Intraoperative MRI led to extended resection in 46.9% of patients for whom the initial intent was to perform an incomplete resection. Nonenhancement was the only independent variable predicting the usefulness of intraoperative MRI for additional lesion resection.