World Neurosurg
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With the increasing interest in big data and health services research, use of administrative databases is becoming commonplace in health care studies, including in neurosurgery. Administrative data offer the unique advantage of accessing large amounts of information previously collected from a population-based sample with geographic diversity. When using administrative data sets, researchers can benefit from application of risk adjustment instruments, which help stratify patients and tailor the original sample for specific research questions. ⋯ The Pediatric Medical Complexity Algorithm and Clinical Classification Software are other promising tools. Understanding of these tools may assist neurosurgeons who wish to critically assess research findings relevant to their clinical practice. In this review, an overview is presented of risk adjustment tools commonly used in adult as well as pediatric populations and their history, uses, limitations, and applications in neurosurgical research are summarized.
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The telemedicine program in Albania includes a specialized teleneurotrauma program. There is only 1 national trauma center with neurosurgery capability in the capital city of Tirana. Patients with isolated head or spine injury who require consultation with neurosurgeons located at the National Trauma Center receive telemedicine consultation. The aim of this follow-up study was to evaluate the effectiveness of a nationwide teleneurotrauma network in preventing unnecessary transfers for neurotrauma. ⋯ Structured and coordinated telemedicine for neurotrauma increases access to care for neurosurgery patients in countries that do not have widespread neurosurgery services. Nearly 70% of patients may be treated locally by nonneurosurgeons.
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Brainstem hemorrhage (BSH) is the most dangerous and devastating subtype of intracerebral hemorrhage and is associated with high morbidity and mortality. However, to date, no effective prevention methods or specific therapies have been available to improve its clinical outcomes. We preliminarily explored the efficacy of deferoxamine (DFO), a clinical chelator known for its iron-scavenging activities, in a rat model of BSH induced with collagenase infusion. ⋯ Administration of DFO had limited therapeutic effects on collagenase-induced brainstem hemorrhage in rats. Some potential explanations were proposed, and more preclinical work is required to clarify the controversial curative effect of DFO in ICH.
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Comparative Study
Malignant Cerebral Venous Infarction; Decompressive Craniectomy versus Medical Treatment.
Cerebral venous thrombosis (CVT) is a common type of stroke in young adults and associated with 8% mortality. High intracranial pressure (ICP) and brain herniation are the most common causes of death in these patients. In contrast with malignant arterial middle cerebral infarction, there are few studies reporting the efficacy of decompressive craniectomy (DC) for treatment of high ICP in patients with CVT. In this study, we assess the clinical outcome of patients with CVT with impending brain herniation treated with DC versus medical management. ⋯ The results of our study confirmed that in contrast with DC, medical treatment could not prevent transtentorial herniation. DC is not only lifesaving for patients with CVT with impending brain herniation but also results in favorable outcome in most patients.
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The National Cancer Database (NCDB) and the SEER (Surveillance Epidemiology and End Results) program are the 2 largest cancer registries in the United States. However, considerable differences exist between them regarding the sampling frame as well as the participating facility characteristics. In this study, NCDB and SEER are compared for primary central nervous system (CNS) tumors with the aims of discussing the implications for researchers and evaluating the generalizability of both databases. ⋯ Analysis of 623,361 patients with primary CNS tumors, which are identified using both the NCDB and SEER databases, showed significant differences in age, histopathologic classification of tumors, tumor behavior, and treatment of tumors between 2 databases. Overall, the differences observed between 2 databases provide helpful points for the researchers who would like to use NCDB or SEER. These observations should be taken into account when researchers design studies using these databases and discuss the generalizability of their findings.