World Neurosurg
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The internal carotid artery (ICA) course has been discussed extensively. Several classification systems have attempted to delineate an accurate and helpful trajectory for microsurgical and endoscopic guidance, thus allowing a better neurosurgical performance while avoiding intraoperative complications. ⋯ We present an illustrative review of 8 notable ICA classification systems using lateral and anterior views as a rapid tool for neuroanatomic consultation. The appraisal of the vessel anatomy from different perspectives while recognizing their usefulness and limitations might provide a comprehensive understanding of the ICA, optimize the intraoperative performance, and facilitate communication.
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Nontraumatic subarachnoid hemorrhage (SAH) refers to high pressure extravasation of blood into the subarachnoid space that typically occurs spontaneously from rupture of cerebral aneurysm. The purpose of this study was to identify postoperative complications requiring increased surveillance in obese, diabetic, and hypertensive patients. ⋯ In patients undergoing surgical management of SAH, hypertensive and diabetic patients had poorer outcomes, including prolonged ventilator dependence, pneumonia, stroke/cerebrovascular accident, and death. Surprisingly, preexisting obesity was not associated with poor outcomes. In fact, overweight body mass index, class I obesity, and class II obesity had decreased need for transfusion in the 30-day postoperative period.
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To describe the use of intraoperative anteroposterior long cassette radiographs (APLCRs) to guide kickstand rod application in adult spinal deformity. ⋯ Intraoperative APLCRs can help guide application of a kickstand rod in adult thoracolumbar deformity correction. Patients with a greater fractional lumbar curve may derive greater benefit of kickstand usage, independent of major curve magnitude.
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The fate of residual tumor after salvage surgery for recurrent vestibular schwannoma (VS) after radiosurgery has not been elucidated so far. We reviewed our surgical series of salvage surgery for recurrent VS, with focus on the natural history of the residual tumor after salvage surgery. ⋯ The behavior of residual tumors after salvage surgery for irradiated VS was stable. Adjuvant treatment for these residual tumors may not be necessary.
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Correctly triaging patients to a surgeon or a nonoperative provider is an important part of the referral process. Clinics typically triage new patients based on simple intake questions. This is time-consuming and does not incorporate objective data. Our goal was to use machine learning to more accurately screen surgical candidates seen in a spine clinic. ⋯ Our models used patient data to accurately predict whether patients will receive a surgical recommendation. The high negative predictive value demonstrates that this approach can reduce the burden of nonsurgical patients in surgery clinic without losing many surgical candidates. This could reduce unnecessary visits for patients, increase the proportion of operative candidates seen by surgeons, and improve quality of patient care.