World Neurosurg
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Enhanced recovery after surgery (ERAS) is a multimodal, evidence-based approach to perioperative care that aims to reduce physiological and psychological stress, improve the quality of rehabilitation, and speed up the recovery of patients. Our study aims to investigate the benefits of perioperative use of ERAS for a short-segment posterior lumbar interbody fusion. ⋯ The benefits of our ERAS protocol for patients undergoing short-level posterior lumbar fusion are evident in terms of reduced hospital stay and time to get out of bed, reduced incidence of postoperative complications, intraoperative blood loss, opioid use and hospital costs, and improved early postoperative pain and dysfunction.
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Sneezing is a poorly understood, protective reflex response. It's characterized by the following sequence: eye closure, inspiration, glottic closure, forced expiration with sudden glottic opening, and release of an elevated intrathoracic pressure creating a flow of explosive air through the nose.1 Studies have indicated an anatomic sneezing area of the brainstem corresponding to the central recipient zone of the nasal sensory neurons in the lateral medulla.2 The traditional pathophysiology of the sneeze is thought to begin by stimulation of the distal branches of the trigeminal nerve within the nasal mucosa. Afferent neural stimuli are transmitted to the trigeminal ganglion and then the lateral medulla. ⋯ During the operation we elicited a sneeze response on 3 occasions on stimulation of the olfactory nerve (Video 1). Although we cannot completely exclude costimulation of the sensory trigeminal terminations in the anterior fossa floor, the actual sneezing occurred during tumor peeling away from the arachnoid surface overlaying the olfactory nerve. This suggests a potential accessory route of sneeze stimulation involving the olfactory nerve distinct from the previously described trigemino-related, autonomic (sympathetic and parasympathetic systems) and psychogenic etiologies.
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Cranial dural arteriovenous fistulas (dAVFs) are rare acquired neurovascular disorders that have the potential to profoundly alter the local and global cerebral venous drainage. Factors such as location, angioarchitecture, degree of shunting, and mode of presentation all appear to have some bearing on the natural history of dAVFs, which can vary from almost entirely benign to life-threatening. ⋯ It is only through a thorough understanding of their behavior and the treatment options available that we will be able to deliver tailored treatment to the correct dAVF and the correct patient. We aimed to provide an up-to-date summary of the reported data on the natural history and predictors of aggressive behavior for cranial dAVFs in general, followed by site-specific management considerations.