World Neurosurg
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Red blood cell (RBC) transfusion is commonly indicated in brain tumor surgery due to risk of blood loss. Current transfusion guidelines are based on evidence derived from critically ill patients and may not be optimal for brain tumor surgeries. Our study is the first to synthesize available evidence to suggest RBC transfusion thresholds in brain tumor patients undergoing surgery. ⋯ A restrictive Hb threshold of 8 g/dL appears to be safe and minimizes potential complications of transfusion in brain tumor patients.
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Vestibular schwannomas are benign, slow-growing tumors that often reduce patient quality of life by compressing nearby nerves. Neurological function preservation is one of the indicators of treatment success, with hearing preservation being the most difficult to obtain. This paper provides a bibliometric analysis of hearing preservation in treating acoustic neuromas and a greater understanding of the most highly cited articles, which have enhanced our understanding of this topic. ⋯ Bibliometric analyses summarize and assess potential areas of strength and knowledge gaps within the literature. Studies on hearing preservation in vestibular schwannomas mostly consist of retrospective reviews that assess postoperative outcomes of microsurgery and radiosurgery. Prospective studies and novel treatment options for hearing preservation in vestibular schwannomas are needed to increase current literature diversity.
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Lateral lumbar interbody fusion (LLIF) and percutaneous posterior screw fixation (PPSF) techniques is used to treat degenerative lumbar pathologies. Dual-position (DP) lumbar surgery involves repositioning the patient from the supine or lateral decubitus position to prone for posterior fixation. Single-position (SP) lumbar surgery is commonly performed nowadays, a minimally invasive alternative performed entirely from the lateral decubitus position. However, controversy still exists. This meta-analysis aimed to compare perioperative outcomes between SP lumbar surgery and DP lumbar surgery for LLIF and PPSF. ⋯ This meta-analysis found that SP have lower operative time and length of hospital stay compared with DP LLIF and PPSF. However, no differences in intraoperative blood loss, radiation dose, radiographic change, complications, and reoperation rates were found.
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Multicenter Study
Neurosurgery subspecialty practice during a pandemic: a multicenter analysis of operative practice in 7 U.S. neurosurgery departments during COVID-19.
Changes to neurosurgical practices during the coronavirus disease 2019 (COVID-19) pandemic have not been thoroughly analyzed. We report the effects of operative restrictions imposed under variable local COVID-19 infection rates and health care policies using a retrospective multicenter cohort study and highlight shifts in operative volumes and subspecialty practice. ⋯ Operative restrictions during the COVID-19 surge led to distinct shifts in neurosurgical practice, and local infective burden played a significant role in operative volume and patient acuity.
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Supplementary motor area syndrome (SMAS) may occur after frontal tumor surgery, with variable presentation and outcomes. We reviewed the literature on postoperative SMAS after brain tumor resection. ⋯ Postoperative SMAS may occur within the first 24 hours after mesial frontal tumor surgery. Preoperative mapping and intraoperative neuromonitoring may assist resection and predict outcomes. Neuroplasticity and interhemispheric connectivity play a major role in resolution.