World Neurosurg
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A histiocytosis is a group of immunoproliferative disorders of clonal cells. The management protocols are still evolving, with chemotherapy as the mainstay of treatment. ⋯ The role of stereotactic radiosurgery needs to be further evaluated as the current cohort with only 9 cases (2 are Rosai-Dorfman disease) is insufficient to make conclusions. It may be a viable alternative in localized disease, along with chemotherapy and targeted surgery.
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To identify spine patients' barriers to appropriate postoperative opioid use, comfort with naloxone, knowledge of safe opioid disposal practices, and associated factors. ⋯ Many spine patients report barriers to appropriate postoperative opioid use and are neutral or uncomfortable with naloxone. Some are unfamiliar with safe disposal. Associated factors include anxiety, lack of recent opioid use, and no previous postoperative use.
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External ventricular drain (EVD) placement is a common neurosurgical procedure, and EVD-related infection is a significant complication. We examined the effect of infection control protocol changes on EVD-related infection incidence. ⋯ The most significant reduction in EVD infections may be achieved through the combination of reducing EVD sampling frequency and standardizing alcoholic chlorhexidine cutaneous antisepsis and subcutaneous tunneling of the EVD catheter.
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Microvascular decompression (MVD) for trigeminal neuralgia (TN) results in durable pain freedom in a large percentage of appropriately selected patients. The decision to perform MVD is based on a combination of clinical symptomatic presentation and imaging findings demonstrating neurovascular compression (NVC) with surgeons weighting these variables differently. This study sought to determine the relative importance of clinical symptomatic presentation and imaging findings of NVC in decision-making to pursue MVD for TN among North American board-certified neurosurgeons. ⋯ The majority of responding neurosurgeons weigh symptomatic presentation more heavily than imaging evidence of NVC when deciding on whom to perform MVD. High-volume surgeons tend to be more attentive to NVC in their decision-making to perform MVD when compared with low-volume surgeons.
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To study pattern and rate of neurological functional recovery after surgery for cervical spondylotic myelopathy (CSM). ⋯ Minimal improvement occurred in the first month after CSM surgery to reach a peak at 3 months after surgery and steady improvement up to 1 year after surgery. Upper limbs recovered better and earlier than lower limbs and sphincter function. Preoperative severity of CSM is one of the main predictors of postoperative neurological outcome.