World Neurosurg
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Before the COVID-19 pandemic, telemedicine utilization was mostly used for postoperative visits only in neurosurgery. Shelter-in-place measures led the rapid expansion of telemedicine to address the needs of the neurosurgical patient population. Our goal is to determine the extent of adoption of telemedicine across tumor, vascular, spine, and function neurosurgery and utilization for new patient visits. ⋯ Use of telemedicine drastically increased across all 4 divisions within neurosurgery with a significant increase in online-first encounters in order to meet the needs of our patients once the shelter-in-place measures were implemented. We provide a detailed account of the lessons learned and discuss the anticipated role of telemedicine in surgical practices once the shelter-in-place measures are lifted.
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A carotid web (CW), an atypical fibromuscular dysplasia, is rare and may cause ischemic stroke. It is challenging to recognize a CW promptly and treat it accordingly. We report a case of an initially misdiagnosed CW. ⋯ Clinicians should be aware of CW as a potential cause of ischemic stroke. Head and neck computed tomography angiography is a reliable imaging method to detect CWs.
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Racial disparities, such as differential treatment and provider bias, negatively affect quality of life for minority patients. However, literature evaluating racial/ethnic differences in the treatment of primary spinal cord tumors (SCTs), a rare condition relying primarily on neurosurgical care, is lacking. ⋯ African Americans were less likely to receive surgical intervention for treatment of primary SCTs compared with whites. Hispanic patients faced longer hospital stays. These disparities may be attributed to compromised access, provider attitudes and biases, communication barriers, or historical distrust in the medical community: issues that health care reform should address.
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Lesions arising at the ventral thalamopeduncular junction are difficult to resect. In addition to being relatively inaccessible, these lesions are located in one of the most sensitive areas of the brain. A critical question is whether new approaches could be developed to allow surgeons to adequately resect these lesions with reasonable outcomes. In the present report, we describe our approach to resect lesions in this region of the brain using an eyebrow craniotomy approach with a trajectory through the supracarotid triangle. ⋯ Lesions arising at the ventral thalamopeduncular junction can be adequately resected with reasonable outcomes using an eyebrow, supracarotid triangle approach. This operative technique establishes another potential operative corridor by which neurosurgeons can resect lesions arising within this relatively inaccessible part of the brain.