World Neurosurg
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Neurosurgery (NS) is among the most selective specialties in the United States. As the United States Medical Licensing Examination (USMLE) Step 1 transitions to a binary pass/fail score, residency programs face unclear challenges in screening and evaluating applicants. The aim of this study is to provide insights into the perceived impact of changes to the USMLE Step 1 grading in the applicant selection process. ⋯ Reporting binary Step 1 grades marks a significant shift in assessing applicants for NS residency by emphasizing Step 2 CK, class rank, and research productivity.
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The objective of the study was to compare the efficacy of halo-gravity traction (HGT) with subsequent surgical treatment in adolescent and adult patients with severe scoliosis by evaluating the radiographic outcomes and clinical complications. ⋯ HGT is an effective and safe method to correct spinal deformities and improve lung function, especially in adolescent patients with severe scoliosis. In addition, it can potentially reduce the risk of neurological complications and the level of osteotomy in posterior spinal instrumented fusion surgery.
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To evaluate the influence of facility case volume and type on skull base chordoma treatment and overall survival (OS). ⋯ Higher facility case volume and academic facility type appear to be associated with improved survival outcomes in treatment of skull base chordomas.
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Spinal synovial cysts are acquired, fluid-filled lesions of the facet joint that most commonly occur in the lumbar spine. They are thought to arise from degenerative changes and to result from segmental instability. Although the treatment of these lesions has been studied, the long-term implications and effects of the different strategies for surgical intervention (i.e., decompression and fusion vs. decompression alone) have not yet been elucidated or established. ⋯ Patient-specific factors and surgeon-patient-shared decision-making should be used when planning interventions for these lesions. However, synovial cysts might not require a fusion procedure for presumed instability. Further investigation is required, using randomized and prospective studies, to further evaluate the effective treatment of this entity.
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The postoperative course of hemifacial spasm (HFS) varies. We analyzed the clinical outcomes from 1 to ≥5 years after microvascular decompression (MVD) in patients with HFS. ⋯ Long-term outcomes from 1 to ≥5 years after MVD in patients with HFS were diverse. Nondiabetes, intraoperative offending vessel without a vein, and intraoperative discoloration of the facial nerve were better prognostic factors for outcomes at ≥5 years postoperatively. It is advisable to consider these results when evaluating the long-term outcomes of this surgery.