World Neurosurg
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Geographic variations in health care costs have been reported for many surgical specialties. ⋯ Our results show significant geographic cost disparities associated with TPS. Understanding factors behind disparate costs is important for developing cost containment strategies.
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Lateral interbody fusion (LIF) is traditionally performed in lateral decubitus on a breaking surgical table to improve L4-L5 access. Prone transpsoas (PTP) LIF may improve sagittal alignment and facilitate single-position circumferential procedures; but may require manipulation of the iliac crest for L4-L5 accessibility. ⋯ Compared with lateral decubitus, prone positioning provides equivalent or better L4-L5 LIF access around the iliac crest when a positioner is used that enables coronal bending, and improved positional lordosis, which may facilitate segmental correction and achievement of surgical alignment goals.
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Meningioma has the second highest incidence among primary intracranial tumors. There is no effective treatment or targeted therapy for meningioma except excision and radiotherapy. Sp1 (specificity protein 1) is a transcription factor that regulates tumor growth, but the literature describing the relationship between Sp1 and meningioma is scarce. The purpose of this study was to investigate the relationship between Sp1 expression and the clinicopathological parameters in meningioma by immunohistochemical staining. ⋯ High expression of Sp1 in patients with meningioma was linked to poor prognosis of recurrence-free time. Therefore Sp1 may be a candidate biomarker of prognosis and therapy target in meningioma.
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Although there may theoretically be a disturbance in the eye or the visual pathways due to abnormal cerebrospinal fluid (CSF) dynamics in idiopathic normal pressure hydrocephalus (iNPH), it has not been studied systemically. Optical coherence tomography (OCT) is a noninvasive, reproducible procedure for quantitative and qualitative analysis of retinal morphology. ⋯ This pilot study shows OCT findings that differ from HIs and implies a rational for becoming a valuable tool in the diagnosis of iNPH. Further studies are warranted to elucidate the pathology of the retina in iNPH.
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Practice consolidation in healthcare has widespread consequences for providers and patients. Although many studies describe this phenomenon in various medical specialties, no such analysis has been performed in neurosurgery specifically. The goal of this study was to assess the trends in the size of U.S. neurosurgery practices over a 5-year period. ⋯ This study shows that over the past 5 years, a substantial trend toward increasing practice sizes has evolved. The effect of the differences in practice size should be examined to determine the large-scale impacts on patient care, payment models, and healthcare access, in addition to neurosurgeon compensation, and satisfaction.