World Neurosurg
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Meta Analysis
A novel hybrid endoscopic approach for anterior cervical discectomy and fusion, and a meta-analysis of the literature.
We describe our experience in the endoscopic treatment of cervical spondylosis. We present a "hybrid" technique that is similar to an open anterior cervical discectomy with fusion but is performed endoscopically. We also analyzed data from studies on endoscopic cervical discectomies published in the past 2 decades. ⋯ We described the feasibility and safety of anterior hybrid endoscopic cervical discectomy, overcoming some of the limitations of the previously described percutaneous discectomies and shifting the standard open technique into an endoscopic procedure.
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In the present study, we sought to evaluate the timing and outcomes in patients with hemorrhagic stroke who received tracheostomy. ⋯ In our cohort, early tracheostomy in patients with hemorrhagic stroke may help reduce hospital stays and hospital costs, but not in-hospital mortality. Future prospective multicenter studies are warranted to validate these findings.
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Review Case Reports
Targeted stereotactic radiosurgery for AVM downgrading followed by microsurgical resection: a case report and review of the literature.
An unruptured brain arteriovenous malformation (bAVM) is a complex pathological entity with the potential to lead to disabling or fatal intracranial hemorrhage. The treatment approaches for these lesions have included microsurgical resection, endovascular embolization, stereotactic radiosurgery (SRS), and medical management or any combination of these modalities. However, the optimal treatment approach for unruptured bAVMs has not yet been determined. In the present case, we used SRS strategically to downgrade an AVM to allow for improved resectability. ⋯ We have proposed a protocol of using focused SRS to eliminate the portions of the AVM that confer an increased surgical risk. SRS, followed by microsurgical resection, could represent an optimal treatment strategy for high-grade AVMs with difficult surgical anatomy.
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In this video, we present the case of a 61-year-old female who was brought to the emergency department after she had partial complex seizures. Computed tomography and magnetic resonance imaging of the brain revealed a right temporal lobe mass, which was initially thought to be a tumor. The patient was therefore referred to us for further management. ⋯ A strategy was then devised, which consisted of cutting the dome of the aneurysm and clearing the distal two thirds of the clot ("tulip technique") and then completing thrombus resection under temporary occlusion. Once clot removal was completed, the aneurysm was clipped using the "shingle clip cut clip" technique (Video 1). The patient's postoperative course was uneventful, and the patient remained seizure free.
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Multicenter Study
Current training status of neurosurgical residents in South Korea: A Nationwide multicenter survey.
In South Korea, special legislation was introduced in December 2016 to limit residents' training time to a maximum of 80 hours per week. The aim of this study was to survey the current training system and environment of neurosurgical residents and to find ways to improve the quality of neurosurgical training. ⋯ The major reason that neurosurgical residents are dissatisfied with the current training system and environment is the excessive time spent on it. These survey results are expected to be used as the basis for improvement of the residents' training system and work environment in South Korea.