World Neurosurg
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The cholesterol embolization syndrome (CES) results from the distal embolization of cholesterol crystals from atheromatous plaques in large vessels such as the aorta and results in multiorgan damage. ⋯ Our patient with CES had cutaneous involvement affecting the lower limbs and renal and neurological involvement. High clinical suspicion and early treatment can reduce the mortality and morbidity after endovascular procedures. The neurological symptoms had most likely resulted from delayed cerebral hyperperfusion syndrome resulting in intracerebral hemorrhage.
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Review Meta Analysis
Meta-analysis with Trial Sequential Analysis on the Efficacy and Safety of Erythropoietin in Traumatic Brain Injury: A New Paradigm.
Erythropoietin (EPO) has been shown to be beneficial in traumatic brain injury (TBI). We have attempted to quantitatively synthesize the findings of current randomized controlled trials (RCTs) in this meta-analysis and analyzed the need for further trials using trial sequential analysis (TSA). ⋯ EPO seems to be beneficial in terms of reducing 6-month mortality, however, its effect on in-hospital mortality, neurologic outcomes, and risk of deep vein thrombosis fails to reach statistical significance. TSA suggests a need for large trials to evaluate the role of EPO in patients with TBI in a more systematic way.
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Comparative Study Observational Study
Revision strategy of symptomatic lumbar adjacent-segment degeneration: full-endoscopic decompression versus extended posterior interbody fusion.
We evaluated the clinical and imaging outcomes of full endoscopic lumbar decompression (FELD) compared with extended posterior lumbar interbody fusion (PLIF) for adjacent segment degeneration (ASD) after fusion surgery and developed a revision strategy. ⋯ The use of FELD achieved satisfactory outcomes for the treatment of radiographic stable ASD, which were not worse than those with PLIF. With less trauma and faster recovery, FELD could be an alternative option.
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Review Meta Analysis
The Impact of Resident Participation During Surgery on Neurosurgical Outcomes: A Meta-Analysis.
There has been much attention recently on whether the involvement of neurosurgical residents during surgery impacts patient outcomes. Our goal was to perform a meta-analysis of all existing studies in order to determine the true effect of resident involvement. ⋯ We found that, when adjusted for comorbidities, complexity, and procedure type, there was no difference in outcomes in terms of surgical complications, reoperation, length of stay more than 5 days, and mortality. While these results suggest that our apprenticeship teaching model is safe for developing independent physicians, using new educational modalities such as simulation and resident-directed labs may be useful to attenuate potential patient complications in higher-risk procedures and in patients with comorbidities.