World Neurosurg
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With the emergence of the concept of value-based care, efficient resource allocation has become an increasingly prominent factor in surgical decision-making. Validated machine learning (ML) models for cost prediction in outpatient spine surgery are limited. As such, we developed and internally validated a supervised ML algorithm to reliably identify cost drivers associated with ambulatory single-level lumbar decompression surgery. ⋯ The gradient-boosted ensemble model predicted total charges and associated cost drivers associated with ambulatory single-level lumbar decompression using a large, statewide database with excellent performance. External validation of this algorithm in future studies may guide practical application of this clinical tool.
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Intraoperative ultrasounds for surgery of cranial traumatic acute subdural hematoma: Technical note.
Intraoperative ultrasonography (IOUS) in traumatic brain injury is a fast, easy, and low-cost technique that has been poorly investigated so far even though it could potentially answer many of the intraoperative needs of the surgeon. The aim of this study was to investigate the role of IOUS in patients undergoing surgery for traumatic acute subdural hematoma (aSDH), focusing on its influence on intraoperative surgical strategy, particularly regarding the management of intracerebral contusions (ICCs) associated with aSDH. ⋯ Our study suggests that IOUS in patients undergoing surgery for traumatic aSDH can promptly identify possible evolution of a primary head injury, leading to early and effective treatment.
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Effective therapies for acute pain management in trigeminal neuralgia (TN) are limited. We aimed to investigate the role of steroids in TN patients experiencing acute pain flares. ⋯ Steroid administration in patients with acute TN pain flares may reduce the likelihood of surgical intervention both during admission and within 6 months of discharge. Future prospective studies should examine the efficacy of steroids as an adjunctive medication in acute TN pain management.
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Although pituitary adenomas and intracranial aneurysms often coexist,1 the locations of these lesions rarely affect surgical planning. In such cases, however, a simultaneous (rather than staged) approach avoids multiple procedures or delays in treating the dominant pathology. Building on limited prior reports of transnasal aneurysm clipping,2-6 we describe simultaneous transnasal treatment of an adrenocorticotropic hormone-secreting adenoma and a paraclinoid aneurysm in a 35-year-old woman (Video 1). ⋯ Postoperatively, the patient developed transient diabetes insipidus and hydrocortisone dependence but was neurologically intact and eupituitary on follow-up. With sufficient transnasal and vascular surgical experience, transnasal clipping of aneurysms can be safely performed in very selected cases. The patient consented to the procedures and publication.
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The prevalence of moyamoya disease (MMD) is relatively high in East Asia, whereas the susceptibility genes of MMD have not been identified. ⋯ According to the findings of literature review, this is the first study indicating the association between RASA1 mutations and MMD.