World Neurosurg
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Quality Improvement (QI) is essential for improving health care delivery and is now a required component of neurosurgery residency. However, neither a formal curriculum nor implementation strategies have been established by the Accreditation Council for Graduate Medical Education. ⋯ A formal didactic curriculum and practical application of QI methodologies adds value to resident training. Further, it has the potential to positively impact practice. Consideration should be given to adopting a formal QI curriculum by other neurosurgery departments and perhaps standardization on national level.
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Spinal dural arteriovenous fistula (DAVF) occurs at any spinal level; however, a sacral location of fistula is extremely rare, and the clinical characteristics of sacral DAVF have not been well described. This study aimed to document the clinical features of sacral DAVF and review the existing literature. ⋯ Sacral DAVFs are extremely rare and are easily missed by spinal angiography. Clinicians should be aware of the possibility of the occurrence of sacral DAVFs, and spinal angiography for the complete assessment of spinal vasculature should be carried out.
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Prospective patient-reported outcomes (PROs) registries are central to emerging evidence-driven reform models. These registries entail significant operator and responder burden to capture PROs data. It is important to limit the number of PROs administered. We sought to determine whether the anxiety/depression domain of EQ-5D could be used to define preoperative psychological distress in patients undergoing elective spine surgery. ⋯ The anxiety/depression domain of EQ-5D could be used to categorize preoperative psychological distress. Spine registries could use this information to potentially limit the number of validated PROs administered.
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The parieto-occipital artery (PoA) is the terminal posterior cerebral artery branch, which typically runs in the parieto-occipital sulcus. Previous studies have highlighted variation in the PoA origin and branching pattern and their clinical implications. Nevertheless, PoA anastomoses have not been systematically investigated. The present study aimed to assess whether putative variation in PoA origin and its branching as well as anastomotic pattern is associated with differences in demographic/anthropometric variables. ⋯ Although the PoA invariably supplies the precuneus and almost always the cuneus, its direct contribution to the former seems inferior to PAc. Nevertheless, the PoA frequently shows putative collateral supply networks to the precuneus and cuneus via anastomoses with the PAc and calcarine artery, respectively. The distance between PoA origin and OP varies with an individual's height; the frequency of intrahemispheric PoA anastomoses varies with its site of origin.
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Acromegaly caused by Rathke cleft cyst (RCC) mimicking a plurihormonal pituitary adenoma (PA) is rare. ⋯ We reported a rare case of acromegaly caused by RCC mimicking a plurihormonal PA. This case suggests that inflammation associated with RCC might be involved in the development of adenomatous cells. Postoperative clinical symptoms and elevated fibrinogen and IGF-1 levels later improved. This outcome suggested that the transient increase in IGF-1 2 months after surgery might reflect RCC-induced inflammation.