World Neurosurg
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Traumatic high-grade cervical spinal dislocations are rare injuries, generally associated with severe neurological compromise. In particular, cervical spondyloptosis (>100% subluxation) is rarely reported. The object of our study is to present a case series describing presentation, management, and outcome in traumatic high-grade cervical spinal dislocations. ⋯ In this series, 26.7% of patients had improvement in their AIS grade postoperatively, and the majority of patients (60%) maintained their preoperative AIS grade. In 57% of patients placed in traction, reduction was possible. Likely due to the severity of these injuries, there was a high incidence of complications. However, review of patient outcomes reveals that these patients can have improvement of neurological function. We recommend aggressive reduction and surgical stabilization. Our preference is either a combined anterior-posterior approach or a posterior-only approach.
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Validity of prognostic grading indices for brain metastasis patients undergoing repeat radiosurgery.
We tested the validity of 5 prognostic indices, Recursive Partitioning Analysis (RPA), Score Index for Radiosurgery (SIR), Basic Score for Brain Metastases (BSBM), Graded Prognostic Assessment (GPA), and Modified-RPA, for patients who underwent repeat stereotactic radiosurgery (re-SRS). ⋯ Among the 5 systems, based on patient number proportions, MST separation among the 3/4 groups, and/or detailed reflection of status changes, the Modified-RPA system was shown to be most applicable to re-SRS patients.
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Craniopharyngiomas represent one of the major challenges of neurosurgery. Surgical management of craniopharyngiomas classically required various transcranial approaches with the transsphenoidal route reserved for very selected cases. With the widespread use of endoscopes in endonasal surgery in the past decade, the extended endoscopic endonasal transtuberculum and transplanum approaches have been proposed as an alternative surgical route for removal of different types of suprasellar tumors, including solid craniopharyngiomas in patients with normal pituitary function and small sella. ⋯ The endoscopic endonasal approach offers advantages in the management of craniopharyngiomas that historically have been approached via the transsphenoidal route (i.e., purely intrasellar or intra-suprasellar infradiaphragmatic, preferably cystic lesions in patients with panhypopituitarism). Use of the "extended" endoscopic endonasal approach overcomes the limits of the transsphenoidal route to the sella enabling the management of different purely suprasellar and retrosellar cystic/solid craniopharyngiomas, regardless of the sellar size or pituitary function.
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To examine the experiences of volunteers of the Foundation for International Education in Neurological Surgery. ⋯ Volunteers demonstrated wide-ranging contributions. Successful strategies included continuity and collaboration with other organizations. Challenges were overwhelmingly related to equipment or infrastructure. Common suggestions for future directions included institutional collaboration and subspecialty development.
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Comparative Study
A comparative analysis of online education resources for patients undergoing endoscopic transsphenoidal surgery.
Endoscopic transsphenoidal surgery has become the most commonly performed surgical procedure for pituitary tumor removal. As such, there are many patient-oriented educational materials on the technique available online for members of the public who desire to learn more about the surgery. It has been recommended that educational resources be written to the national average reading level, which in the United States is between sixth and seventh grade. This study assesses the reading level of the educational materials currently available online for endoscopic transsphenoidal surgery and determines whether these resources are written at a suitable comprehension level for most readers. ⋯ The online educational resources written for patients about endoscopic transsphenoidal surgery are above the recommended reading level for patient education materials. Further revisions to simplify these resources on endoscopic transsphenoidal surgery are needed to ensure that most patients can comprehend this important material and make informed decisions about their health care.