World Neurosurg
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Thoracic Eden IV dumbbell tumors are rare conditions characterized by neoplasms that arise from neurogenic elements, with intraforaminal and posterior mediastinal involvement. Surgical resection is commonly performed to treat thoracic Eden IV dumbbell-shaped tumors. The combined thoracic-neurosurgical approach is a routine surgical procedure according to the literature. We present our experience with resection of thoracic Eden IV dumbbell tumors with combined percutaneous spinal endoscopic and thoracoscopic procedures in a single stage. ⋯ Percutaneous spinal endoscopic combined with thoracoscopic surgery for the treatment of Eden IV type thoracic dumbbell tumors is a novel, safe, and effective surgical method that can not only remove tumors inside and outside of the thoracic intervertebral foramen in a single stage but also minimize damage to the normal structure of the spine and help in early recovery.
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"Hybrid workshops during COVID-19 pandemic" - Dawn of a new era in neurosurgical learning platforms.
During the COVID-19 pandemic, disruption of surgical hands-on training has hampered the skills acquisition by budding neurosurgeons. Online and virtual classrooms have not been able to substitute the hands-on experience and learning via direct interaction with senior colleagues. To overcome these challenges, we organized a hybrid workshop where simulation-based learning modules, and direct and virtual interaction with surgeons during live surgeries or didactic lectures were utilized to help delegates in understanding the nuances of neurosurgery. ⋯ In this era of the COVID-19 pandemic, "hybrid" microneurosurgery workshops offer unique opportunities to enhance surgical skills acquisition by hands-on simulation-based learning and observing live surgical demonstrations, apart from 2-way interactions with experts under one roof. This may be a stepping stone for what lies ahead in the future of neurosurgical training.
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Observational Study
Supraprophylactic Anti-Xa Levels are Associated with Major Bleeding in Neurosurgery Patients Receiving Prophylactic Enoxaparin.
Prior studies demonstrated reduced risk for venous thromboembolism (VTE) in neurosurgical patients secondary to prophylaxis with both heparin and low-molecular-weight heparin. The ability to monitor low-molecular-weight heparin by obtaining anti-factor Xa (anti-Xa) serum levels provides an opportunity to evaluate safety and efficacy. The aim of this study was to describe characteristics of patients who have anti-Xa levels outside of the goal range (0.2-0.4/0.5 IU/mL) and investigate incidence of major bleeding and VTE. ⋯ Anti-Xa-guided enoxaparin dosing for VTE prophylaxis in neurosurgical patients may help prevent major bleeding. These data suggest that a higher anti-Xa level may predispose patients to major bleeding. Further evaluation is needed to identify the goal anti-Xa level for VTE prophylaxis in this population.
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There have been few literature reports on the use of perioperative parameters to predict the risk of albumin transfusion after spinal tuberculosis surgery based on the application of nomogram and propensity score matching (PSM) analysis. ⋯ The PSM analysis had a good matching effect and the nomogram had a good predictive ability. Surgical approach, aspartate aminotransferase/alanine aminotransferase levels, drainage, and kyphosis might be predictors of albumin transfusion after spinal tuberculosis surgery.
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Idiopathic normal pressure hydrocephalus (iNPH) is a chronic neurologic syndrome that affects the elderly population in a context of concomitant medical conditions. The aim of this study was to understand the significance of comorbidities using 4 validated and specific clinical scores: Cumulative Illness Rating Scale (CIRS), American Society of Anesthesiologists (ASA) score, Comorbidity Index (CMI), and Charlson Comorbidity Index (CCI). ⋯ Patients with multiple comorbidities have a worse preoperative condition compared to patients with less concomitant diseases, and the proposed comorbidity scores, CIRS in particular, are useful clinical tools for the anesthesiologist. Comorbidities, though, do not impact overall postoperative outcome.