World Neurosurg
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Surgical site infections (SSIs) are the most common and costly of all hospital-acquired infections, occurring in 5 percent of patients and accounting for 20% of all hospital-acquired infections. Preoperatively, we developed a protocol where patients were screened using hemoglobin A 1c (HbA1c) and nasal swabs. If HbA1c was greater than 9, patients were rescheduled for surgery when their HbA1c was less than 9. All patients then underwent nasal swabs to identify methicillin-sensitive Staphylococcus aureus/methicillin-resistant S. aureus in addition to standard chlorhexidine gluconate bathing. If positive, mupirocin ointment was used to treat the patients 5 days prior to surgery. We sought to measure the effectiveness of this protocol in reducing SSI in elective neurosurgical patients who were undergoing hardware implantation or had a procedure anticipated to last greater than 2 hours. ⋯ This retrospective review of a presurgical protocol with measuring of HbA1c and nasal swabs revealed a significant decrease in the infection rate of patients undergoing elective neurosurgical procedures. Additional investigations are necessary; however, we recommend its use.
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Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), is a deleterious complication that can be fatal. However, the prevalence and underlying risk factors for VTE after spinal tumor surgery remain poorly defined. ⋯ The prevalence of VTE after spinal tumor surgery was 25.0%. Prolonged duration of postoperative bed rest was a risk factor for postoperative VTE. No DVT was found in 4 of 6 PTE-positive patients, suggesting that screening for PTE itself is also needed in high-risk cases of VTE.
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Brain shift may cause significant error in neuronavigation, leading the surgeon to possible mistakes. Intraoperative magnetic resonance imaging (MRI) is the most reliable technique in brain tumor surgery. Unfortunately, it is highly expensive and time consuming and, at the moment, it is available only in few neurosurgical centers. ⋯ Integration of multiple intraoperative imaging techniques combined with rigid and elastic image fusion of preoperative MRI may reduce the risk of incorrect neuronavigation during brain tumor resection. Further studies are needed to confirm the present findings in a larger population.
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Bibliometric analyses assess the impact and influence of articles in the academic community. There is no previous work that has used bibliometric analysis of microvascular decompression (MVD). This study aims to identify and characterize the 100 most cited articles on MVD. ⋯ This work provides a detailed evaluation of the 100 most cited articles on MVD, thus allowing recognition and selected reading of the most influential academic contributions related to this surgical technique in a variety of cranial nerve disorders.
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The aim of this study was to compare accuracy of surgical plans generated from in-person and telemedicine evaluations and assess the reasons for surgical plan changes between initial evaluation and surgery. The secondary objective was to assess the effect of changes in surgical planning on postoperative outcomes. ⋯ Telemedicine and in-person evaluations generated similarly accurate surgical plans. Changes to the initial surgical plans most often involved adding operative levels. Our findings show that telemedicine visits are an acceptable option for preoperative assessment to generate surgical plans; however, further research is needed.