World Neurosurg
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Vertebral cement augmentation techniques are routinely used to treat osteoporotic vertebral compression fractures (VCFs). In the current study, we used a state-level outpatient database to compare costs and postoperative outcomes between vertebroplasty and kyphoplasty. ⋯ Our analyses from a state-level database of patients undergoing vertebroplasty and kyphoplasty for osteoporotic VCFs show similar postoperative outcomes for the 2 procedures but a higher cost for kyphoplasty.
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We aimed to quantify and compare surgical exposure and freedom at the anterior communicating artery (ACoA) complex using pterional (PT), supraorbital (SO), extended supraorbital withorbital osteotomy (SOO), and endonasal endoscopic transtubercular-transplanum (EEATT) approaches. ⋯ The SO, SOO, and PT approaches provided a better hemilateral view of the ACoA complex and similar surgical exposure, whereas the EEATT approach offered greater exposure in the upper part of the ACoA complex, with relatively limited exposure of perforators from ACoA and surgical freedom. The EEATT approach can play a role in exposure of lesion involving the ACoA complex.
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Case Reports
Awake Craniotomy with Cortical and Subcortical Speech Mapping for Supramarginal Cavernoma Resection.
Awake craniotomy allows mapping of eloquent brain regions and monitoring neurocognitive functioning intraoperatively to maximize extent of resection and minimize cognitive morbidity.1,2 During resection of cavernous malformations in eloquent areas, intraoperative cognitive monitoring can also allow for safer maximal excision of the hemosiderin ring, which is correlated with improved seizure-free outcome.3,4 We present the case of a 33-year-old right-handed male with a new-onset seizure who presented to his local emergency department after experiencing visual hallucinations before losing consciousness. Computed tomography scan of the head revealed a calcified lesion in the left temporal/parietal area. ⋯ The patient was discharged to home on postoperative day 4 with outpatient speech therapy for speech hesitancy. At 1-week postoperative testing, language skills were considered within normal limits.
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As the climate of medical care continually shifts, more is expected of surgical specialists than ever before. The rate of burnout among providers appears to be increasing, whereas the career longevity of the modern physician continues to rise to meet the growing demands of our patient population. Spinal surgery is a demanding field, requiring significant amounts of mental and physical fortitude. We intend to highlight issues that cause debility in this cohort of providers. ⋯ This study highlights the need to improve the work environment and maintain physician health. Although this report sheds light on the problems affecting our colleagues, there is much work that is needed to improve on them. Often the medical philosophy is to ignore one's own personal discomfort in the quest to help patients. In an era in which physician career longevity is needed, these issues must be identified and addressed.