World Neurosurg
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In recent years, the number of ventriculoatrial (VA) shunt insertions has decreased worldwide, the major cause being the risk of shunt infection. VA shunts remain as an alternative option to ventriculoperitoneal shunts. We describe our 10-year experience with VA shunts by analyzing the incidence of shunt infections and predisposing cofactors. ⋯ In our patient cohort, the infection rate related to VA shunt insertion is low; the only statistically significant risk factor was the number of revisions. If the VA shunt is applied following a standardized protocol, the infection risk does not represent an argument for reluctance towards the VA draining concept.
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Various complex techniques for depth electrode insertion in refractory epilepsy using preoperative imaging have been investigated. We evaluated a simple, accurate, cost-effective, and timesaving method using intraoperative magnetic resonance imaging (MRI). ⋯ Our frameless technique of depth electrode insertion using intraoperative MRI guidance is an accurate, reliable, cost-effective, and timesaving method for stereo-electroencephalography.
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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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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.