World Neurosurg
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Endoscopic third ventriculostomy (ETV) remains the mainstay of treatment for noncommunicating hydrocephalus these days. However, there has been no adequate clue for the intraoperative assessment of ETV efficacy until now. This time, we propose a newly defined finding, "folding sign," which is visible and enables us to confirm penetration of both the third ventricle floor and the Liliequist membrane (LM) during operation. In this report, we describe consecutive ETV cases and discuss the mechanism of folding sign and its clinical meanings. ⋯ The folding sign is a newly defined sign to predict the success of ETV during operation. This optimal finding appears only when the LM is sufficiently opened; therefore, it could be a good candidate for an intraoperative assessment tool.
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Nonlethal cervical spine injuries in skydiving are rare due to the associated high mortality. Here, we report an unusual pathomechanism leading to a Hangman fracture in a semiprofessional parachute athlete. ⋯ Excessive deceleration during canopy deployment may pose a risk for life-threatening cervical spine injuries in skydiving.
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This video (Video 1) demonstrates bilateral posterior communicating artery (PCoA) aneurysms that were treated through a unilateral supraorbital approach. A 53-year-old woman presented with a Hunt-Hess grade I subarachnoid hemorrhage. Computed tomography scan showed subarachnoid hemorrhage in the left sylvian fissure and basal cistern. ⋯ The patient recovered well without any complications. Postoperative angiography confirmed complete obliteration of these 2 aneurysms. For selected bilateral PCoA aneurysms with non-low-lying and posteromedial projection of the contralateral aneurysm, surgical clipping of all aneurysms via a unilateral approach is a feasible alternative.
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Programs that address overall wellbeing early in residency are necessary to prevent physician burnout and promote physician mental health to improve patient outcomes and ensure long and productive careers. A wellness initiative was implemented at our institution 3 years ago. We present feedback from participating residents across all levels of training. ⋯ Participating resident perceptions of the wellness program are highly favorable. The survey results, combined with the perspectives across training levels, provide insight for other programs wishing to implement program of their own.