World Neurosurg
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Patient blood management (PBM) is defined as treatment of a patient who is at risk of transfusion to minimize the need for transfusion and improve the probability of an optimal clinical outcome. We performed the present study to examine the effects of PBM in spinal fusion surgery. ⋯ Implementation of PBM is an effective strategy for reducing the rate of transfusion in patients undergoing lumbar spinal fusion surgery without significant complications.
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We are inevitably faced with the need to perform coil embolization immediately after diagnostic cerebral digital subtraction angiography (DSA) for economic reasons, patient convenience, fear of rupture, and other reasons. Here we report the advantages of coil embolization performed immediately after diagnostic cerebral DSA for unruptured intracranial aneurysms (UIAs) from the patients' perspective. ⋯ Our findings indicate that coil embolization performed immediately after diagnostic cerebral DSA can be a relatively safe alternative approach to treating patients with UIAs.
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Quality assurance (QA) is a way to prevent mistakes in advance. Although it has been previously reported for surgical setup, there is no effective approach for minimizing microsurgical technical errors before an operation is done. Neurosurgery resident operative errors during brain aneurysm surgery could be foreseen by practicing in an ex vivo hybrid simulator with microscopic fluorescein vessel flow image. ⋯ There was a left-shift on the quality assurance line with residents who practiced brain aneurysm microsurgical errors in an ex vivo model. A multicentric prospective study is necessary to confirm the hypothesis that real operative error could be reduced after training in a realistic simulator.
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Undesirable events in the neurosurgery operating theater have less often been the result of a technical error than of a dysfunction linked to nontechnical skills (NTSs). The essential aim of our study was to perform a systematic review of the reported data on NTS in neurosurgery. Our secondary objective was to identify the NTSs more specific to neurosurgery to define the training needs of neurosurgery trainees. ⋯ Very few studies have been performed concerning neurosurgical NTSs, despite the increasing the number of studies during the past few years on NTSs in other domains of surgery. Society has been concentrating more and more on the quality and safety of medical care. The development and application of NTS assessment tools is, therefore, essential to provide assistance in the training of future neurosurgeons.
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Stereotactic radiosurgery is a modern discipline that emerged after World War II. It represents a synthesis of an approach to patient care that was not immediately embraced by either neurosurgeons or radiation oncologists, but which has been shown, time and again, to be advantageous for the treatment of intracranial pathology. ⋯ Any examination of the individuals, devices, and technological advances that permitted stereotactic radiosurgery to become a preferred approach for patient care cannot be absolutely comprehensive but can provide insights into the evolution of the specialty and potential future prospects for further improvements in patient care. As Shakespeare wrote in The Tempest, "What's past is prologue."