World Neurosurg
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Retracted Publication
Surgical Steps And Lessons Learned In Final Separation Of Three-Years-Old Craniopagus Twins.
The only published paper1 describing the separation of the conjoined twins did not describe the novel steps and techniques of the microsurgery part, which lasted 26 hours. That paper did not include the neurosurgical video, either. The massive intracerebral hemorrhage that occurred on postoperative day 33 was not reported, and its potential causes have not been scrutinized. ⋯ It is impossible to say with certainty the cause of the hemorrhage, since there may have been other unknown causes (e.g., blood pressure spike). As a contributing factor, congestion of the veins is also possible.3 We concluded that closer monitoring, a stricter management of the interdisciplinary team work, and realizing the seriousness of the lack of sufficient structural support earlier could have prevented this unfortunate complication. In a similar case we advise future professionals to use a halo ring postoperatively for posterior protection until a sufficient cranioplasty can safely be done.
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While clinical guidelines provide a framework for hospital management of spontaneous intracerebral hemorrhage (ICH), variation in the resource use and costs of these services exists. We sought to perform a systematic literature review to assess the evidence on hospital resource use and costs associated with management of adult patients with ICH, as well as identify factors that impact variation in such hospital resource use and costs, regarding clinical characteristics and delivery of services. ⋯ Hospital resource use and costs for patients with ICH were high and differed widely across studies. Making concrete conclusions on hospital resources and costs for ICH care was constrained, given methodologic and patient variation in the studies. Future research should evaluate the long-term cost-effectiveness of ICH treatment interventions and use specific economic evaluation guidelines and common data elements to mitigate study variation.
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Academic neurosurgeons with international medical training play a large role in the U.S. neurosurgical workforce. We aimed to compare U.S.-trained neurosurgeons with internationally trained neurosurgeons to reveal differences in subspecialty preferences and training opportunities abroad. ⋯ International medical training affected subspecialty choice and fellowship training. Internationally trained neurosurgeons more often specialized in oncology and vascular neurosurgery. Functional neurosurgeons were more likely to complete international fellowships, spine neurosurgeons were less likely to complete international fellowships, and peripheral nerve neurosurgeons more often had both U.S. and international fellowships.
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Incidental durotomies resulting in symptomatic postoperative cerebrospinal fluid (CSF) leaks can be treated with bedrest, subarachnoid lumbar drain, and surgical re-exploration. Another option is an epidural blood patch, which forms a clot over the dural tear in a minimally invasive manner. Our objective was to describe our center's outcomes and complications following epidural blood patches for symptomatic postoperative durotomies. ⋯ The incidence of dural tears/blebs was 1.4% in cervical, 6.7% in lumbar, and 5.0% in all spine surgeries. Of the 10 patients with symptomatic CSF leaks, 9 were successfully treated with blood patches. Targeted epidural blood patch is effective in treating symptomatic CSF leaks and minimizes the morbidity of surgical re-exploration.
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Dysphagia, mostly resulting from prevertebral soft tissue swelling (PSTS), is a common and refractory complication of anterior cervical discectomy and fusion (ACDF). Although the symptoms are mild and moderate in most cases, severe dysphagia can incur significant mental burdens and morbidity in some patients. This retrospective study aims to analyze the effect of absorbable collagen sponge and steroid injection (ACS-SI) for patients with ACDF. ⋯ The use of ACS-SI is beneficial to relieve postoperative odynophagia, reduce PSTS, and recover swallow function.