World Neurosurg
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Fluorescence-guided surgery may improve completeness of resection in transsphenoidal surgery for Cushing disease (CD) by enabling visualization of residual tumor tissue at the margins. In this review we discuss somatostatin receptors (SSTRs) as targets for fluorescence-guided surgery and overview existing SSTR-specific imaging agents. We also compare SSTR expression in normal pituitary and corticotrophinoma tissues from human and canine CD patients to assess canines as a translational model for CD. ⋯ Further studies must fill the knowledge gaps related to species-specific SSTR expression, so using canine CD as a translational model may be premature. We do conclude that the expression profile of SSTR5 (i.e., high local expression in pituitary adenomas relative to normal surrounding tissues) makes SSTR5 a promising molecular target for FGS.
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We used a data-driven methodology to decrease the departmental surgical site infection rate to a goal of 1%. ⋯ The findings highlight the importance of systematically investigating areas of gap in existing clinical practice and quality improvement projects to increase patient safety and enhance the value of care delivered to neurosurgical patients.
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Case Reports
Intracranial Solitary Fibrous Tumor of the Skull Base: Two Cases and Systematic Review of the Literature.
Intracranial solitary fibrous tumors (ISFTs) are rare neoplasms of mesenchymal origin that originate from the meninges. ISFTs of the skull base can be challenging to treat, as resection can be complicated by skull base anatomy. We present 2 cases of ISFT, the first manifesting with compressive cranial neuropathy from Meckel cave involvement and the second a posterior fossa lesion causing symptomatic hydrocephalus. ⋯ We discuss presentation, imaging, histopathology, and management considerations for ISFTs while highlighting the potentially complex nature of skull base lesions and need for multidisciplinary approach to treatment.
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Randomized Controlled Trial
The Preventive Effect of Computed Tomography Image-Guided Electroacupuncture Combined with Continuous Femoral Nerve Block on Deep Vein Thrombosis After Total Knee Arthroplasty Based on an Adaptive Algorithm.
Based on an adaptive algorithm model, this study proposed 2 special model structures of randomized fusion and an optimized convolution kernel and use it for image recognition. The adaptive algorithm model combined image-guided electroacupuncture with a continuous femoral nerve block to prevent deep vein thrombosis after total knee arthroplasty. A total of 200 patients after total knee arthroplasty were randomly divided into 4 groups. ⋯ It also enabled patients to participate in joint movement and lower limb muscle strength training as soon as possible, which not only is conducive to postoperative functional recovery, but also reduces the body stress response triggered by pain and the hypercoagulable state. Moreover, electroacupuncture stimulation of electroacupuncture points can reduce the inflammatory edema associated with surgery, improve blood circulation at the surgical site, and activate the body's anticoagulation mechanism. This study provides new ideas and references for formulating multimode prevention and control strategies.
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The choice of surgical technique in sight-threatening Grave orbitopathy remains controversial. Available data are mostly derived from mixed cohorts with multiple surgical indications and techniques. The authors assessed predictors for visual outcome after standardized pterional orbital decompression for dysthyroid optic neuropathy. ⋯ This cohort is the largest series of pterional orbit decompressions and the first to focus exclusively on dysthyroid neuropathy. Complication rates were low. Decompression surgery was highly effective at restoring and maintaining visual acuity in patients with dysthyroid optic neuropathy.