World Neurosurg
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Because peripheral nerve surgery has become more common in recent years, the pressure to increase this procedure's health care safety and cost-effectiveness has increased. Given our limited understanding, we evaluated prospectively identified and randomly sampled patients who underwent peripheral nerve surgery from 2005 to 2014 through the American College of Surgeons National Surgical Quality Improvement Program database. ⋯ Our study confirms that peripheral nerve surgery and nerve graft procedures can be safely performed with low complication risks and low unplanned readmission rates. We also identified the risks associated with perioperative adverse outcomes, and these data may be used as an adjunct for risk stratification for patients under consideration for peripheral nerve surgery. This approach may enable the improved targeting of the most costly and harmful complications of preventive measures.
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Various techniques are available for occipital skull exposure with muscle dissection, as well as different types of skin incisions in the lateral suboccipital approach to vestibular schwannoma (VS) surgery. The skin incisions are generally classified as S-shaped, J-shaped, or C-shaped. In each method, the technique used for muscle dissection differs in terms of cut, single layer, and multiple layers. This study was performed to identify the relationships among muscle dissection method, skin incision type, and muscle atrophy in the lateral suboccipital approach to surgery for VS. ⋯ The C-shaped skin incision with multilayer muscle dissection was associated with significantly reduced postoperative muscle atrophy compared with the other methods.
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We report cases of 4 patients where Goel facet distraction surgery resulted in restoration of herniated disc back into the intervertebral disc space in the immediate postoperative period. Such a fate of herniated disc has not been recorded earlier. ⋯ The indications for facetal distraction surgery, its mechanisms of action and its suitability in the presented cases are discussed.
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Unruptured intracranial aneurysms (UIAs) are being detected and treated with endovascular techniques at an increasing rate, with little evidence on the optimal imaging follow-up protocol. We performed a survey of academic neurovascular centers in the United States to assess imaging follow-up strategies and costs after endovascular treatment of UIAs. ⋯ There is significant heterogeneity in imaging follow-up strategies and their associated costs. Stratification of patients by risk of recanalization and corresponding adjustment of follow-up imaging may be 1 strategy to limit unnecessary imaging and control costs.
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Ocular movement nerve (cranial nerve III, IV and VI) palsy (OMNP) is rarely encountered after mild head trauma. As a result of the inconsistent definition of this specific entity in published studies, it is difficult to offer an accurate management strategy and prognosis assessment to affected patients. ⋯ OMNP after mild head trauma is a rare entity in neurosurgical practice. In patients with no positive intracranial finding, observation and follow-up are the mainstay of management. If any underlying intracranial lesions are identified, the management should be focused on the underlying lesions. From the data available, mild trauma does not mean mild injury or favorable recovery in OMNP after mild head trauma.