World Neurosurg
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Observational Study
Thromboelastography Parameter Predicts Outcome After Subarachnoid Hemorrhage: An Exploratory Analysis.
Hypercoagulability after subarachnoid hemorrhage (SAH) is well described and may be platelet mediated. Thromboelastography (TEG) provides a global assessment of coagulation. We sought to determine whether the maximum amplitude (MA) parameter of TEG, a measure of platelet strength and function, is associated with outcome after SAH. ⋯ TEG indices are associated with poor outcome after SAH and may identify a platelet-mediated hypercoagulable state. The association between MA and outcome was stronger than that between traditional biomarkers and was independent of age and Hunt Hess grade.
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The evolution of the surgical treatment of petroclival meningiomas (PMs) has led to a tendency to abandon complex petrous approaches and return to "less-aggressive" skull base approaches. ⋯ For each PM group, the most suitable approach was identified in terms of surgical radicality and low postoperative morbidity. CSIPR can be considered the approach of choice for the most frequent group of PMs in our series. We believe that the CSIPR remains a valuable option for the treatment of PMs.
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Constrains on neurosurgical residents' work hours demand innovative teaching models to complement the traditional "in the operating room" model. Stratathane ST-504 (Strata-Tech, Inc., Des Moines, Iowa, USA) has been proposed as a useful artificial neurosurgical tumor model. The consistency, dissectability, and radio-opacity of this model strongly depend on its preparation and storage. However, little work has addressed the interplay of these properties. Hence our study was undertaken to explore the properties of ST-504, its preparation, and storage and how these interactions affect its radio-opacity and consistency. ⋯ For any given ratio of ST-504/water, the time sequence after polymer solidification and the storage method determine the computed tomography appearance and consistency of the tumor block/model. When taking these properties into consideration, ST-504-based artificial tumor models can be customized for different dissection practices, from more solid (meningioma-like) to less solid (schwannoma-like) models.
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There is high variability in neurosurgical costs, and surgical supplies constitute a significant portion of cost. Anecdotally, surgeons use different supplies for various reasons, but there is little understanding of how supply choices affect outcomes. Our goal is to evaluate the effect of patient, procedural, and provider factors on supply cost and to determine if supply cost is associated with patient outcomes. ⋯ A combination of patient, procedural, and provider factors underlie the significant variation in neurosurgical supply costs at our institution. Surgical supply costs are not correlated with 30-day readmission or mortality.
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In an era of continued advancements in endovascular treatment of cerebral aneurysms, novel developments concerning microsurgical clipping are sparse. The Lazic aneurysm clip system represents such an advancement. The applier has a malleable shaft and is designed to minimally obstruct the view of the surgical field. The purpose of this study was to illustrate the transition to this new aneurysm clip system in an established cerebrovascular practice. ⋯ In the largest series to date, the Lazic clip system proved to be safe and efficacious and presents an interesting alternative to established aneurysm clip systems. This study illustrates the transition of an established cerebrovascular practice to the Lazic clip system.