World Neurosurg
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Intracranial tuberculomas (IT) are often misdiagnosed or overdiagnosed, resulting either in delay in treatment of this curable illness or in unnecessary surgical intervention. A new method of diagnostic criteria for preoperative diagnosis of IT is proposed. ⋯ We suggest that empirical antituberculous treatment should be started in a patient without the need for invasive surgery if our criteria are met. If the criteria are not met, we suggest further evaluation of the patient for an alternative diagnosis or early surgery for definitive management. Surgery decreases the duration of antituberculous treatment and helps in early resolution of lesions.
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Comparative Study
Inverse National Trends in Decompressive Craniectomy versus Endovascular Thrombectomy for Stroke.
Endovascular thrombectomy (ET) for acute large vessel occlusion reduces infarct size, and it should hypothetically decrease the incidence of major ischemic strokes requiring decompressive craniectomy (DC). The aim of this retrospective cohort study is to determine trends in the utilization of ET versus DC for stroke in the United States over a 10-year span. ⋯ We identified an inverse relationship between national trends in rising ET and diminishing DC utilization for stroke treatment over a recent decade. Although direct causation cannot be inferred, our findings suggest that ET curtails the necessity for DC.
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To examine the risk for burnout in neurosurgery trainees across the globe to compare work-related factors that may contribute to burnout and to determine if there are international differences. ⋯ Risk for burnout in neurosurgery residents and fellows is driven by multiple factors, including personal, demographic, programmatic, and institutional. Among work-related factors, long and frequent shifts were found to contribute to the risk of burnout in the global cohort. The regional variabilities in the impact of these factors are discussed.
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The operative microscope, a commonly used tool in neurosurgery, is critical in many supratentorial tumor cases. However, use of operating microscope for supratentorial tumor varies by surgeon. ⋯ Use of operative microscope for supratentorial resections varies by state and is associated with higher cost of surgery. Microscope use may be associated with lower rates of intraoperative cerebral edema and some cerebrovascular complications, but is not associated with significant differences in other complications, readmissions, or 30-day costs.
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Artificial intelligence (AI) may favorably support surgeons but can result in concern among patients and their relatives. The aim of this study was to evaluate attitudes of patients and their relatives regarding use of AI in neurosurgery. ⋯ Most patients and their relatives believed that AI has a role in neurosurgery and found it acceptable. Notable exceptions were fully autonomous systems, with most wanting the neurosurgeon ultimately to remain in control.