World Neurosurg
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Traditionally, lumbar discectomy has involved overnight hospital admission. Recent literature supports the shift to same-day lumbar discectomy because of improved outcomes and better patient satisfaction scores. A successful protocol for outpatient lumbar discectomies was proposed and implemented at a single institution. The aim of this study is to perform a quantitative and qualitative analysis of this institutional model. ⋯ Our data demonstrate that a collaborative protocol for outpatient discectomy can be implemented in a safe and effective manner despite a statistical increase in hospital readmissions. The percentage rates of readmissions and ED visits accounted for a very small percentage of the overall number of cases after protocol implementation. Improvements in perioperative pain management and ensuring that outpatient lumbar discectomies are scheduled early in the day may further decrease the number of admissions. Future studies should examine the societal and financial impact of same-day discectomy versus overnight hospital stays.
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The use of "withdrawal of care" and impact upon outcomes among patients with subarachnoid hemorrhage (SAH) is not well studied. ⋯ Although "withdrawal of care" was effective in limiting hospital charges and resource use, caution is needed to avoid disproportionately high mortality. The prominent relationship between race/ethnicity, insurance status, and hospital location with "withdrawal of care" raises concerns that factors other than severity of disease influence decision making.
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When resecting gliomas, extra-axial tumors, or their overlying cortex, cortical veins may become suspended over the resection cavity and ultimately prolapse and kink into the cavity, promoting venous thrombosis. To prevent this, we describe a technique to secure a Gelfoam scaffold beneath the cortical vein at the edge of the resection cavity to prevent kinking and possible thrombosis from taking place after tumor removal. Depending on the diameter of the resection cavity, this can be done at 1 or both edges of the resection cavity to prevent prolapse of the vein into the cavity. In our experience with this technique, during the past 10 years, there have been no cases of venous thrombosis after tumor removal on postoperative imaging or clinical examination.
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Biography Historical Article
From the cell of Schwann to schwannoma--a century's fruition.
The word "schwannoma" is pervasive throughout the neurosurgical community. However, little is known about the origin of the cell of "Schwann cell," the manifestation of the tumor's nomenclature, or the prominent physicians who studied its etiopathogenesis. Schwann was a founding father of cellular theory and one of the greatest scientists of the 19th century. ⋯ He believed that these tumors have a non-nerve cell, non-Schwann cell origin. He classified the tumors arising from the Schwann cell sheath as peripheral gliomas and articulated, "If any tumors are to be called schwannomas, these should be." The neurofibroma of von Recklinghausen was recognized as a separate entity, as described by von Recklinghausen himself. Murray and Stout proposed that schwannomas are essentially benign in nature clarifying the abstruseness of the benign or malignant nature of schwannoma.