World Neurosurg
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Neurosurgical residency applicants' prior research experience can amplify their ability to stand out to prospective neurosurgery programs. We attempted to accurately quantify the number of research publications coauthored by applicants by analyzing the publications of applicants who matched into neurosurgery in the 2021 Match. ⋯ Students matriculating to neurosurgery residency programs display a wide range of research productivity. Typical U.S. Doctor of Medicine and Doctor of Osteopathic Medicine applicants have coauthored a mean of 5.1 and a median of 4.0 publications. This information may assist program directors in weighing applicants' research background and give medical students interested in the field reasonable research expectations.
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Wound dehiscence after cervical spine surgery is a well-known complication that can be a challenge for spine surgeons to manage, especially in cases of exposed implants. However, few studies have focused primarily on this phenomenon in cervical spine surgery to date. This investigation sought to determine the frequency of wound dehiscence following posterior cervical spine surgery and identify patient-based risk factors. ⋯ The observed frequency of postoperative wound dehiscence in cervical spine surgery was 5.2%. As extended T1 fusion and dialysis may increase the risk of dehiscence after surgery, patients who display such risk factors may require additional observation and care.
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Anterior lumbar interbody fusion (ALIF), traditionally performed supine, allows for significant restoration of lumbar lordosis, disc height, and foraminal height in degenerative spine diseases; however, an iatrogenic injury to the viscera and the great vessels can have devastating consequences. Although lateral lumbar interbody fusion (LLIF) is an acceptable and minimally invasive alternative at the L5-S1 level, this approach is suboptimal because of a narrow surgical corridor limited by the iliac crest, common iliac artery and vein, and psoas. Furthermore, combining supine L5-S1 ALIF and lateral decubitus (LD) LLIF requires time-consuming patient repositioning.1,2 To maximize the advantages of both procedures in patients with disease spanning the lumbosacral junction, ALIF and LLIF can be performed in a single stage with the patient remaining in an LD position throughout. ⋯ The patient consented to this procedure; all participants consented to publication of their images. This tracking system allowed for accurate and precise virtual projections of surgical instruments, thereby facilitating the identification of midline and proper trajectories to perform discectomy and implant placement, reducing the amount of intraoperative fluoroscopy use, and eliminating intraoperative computed tomography. To our knowledge, this is the first operative video showing a fluoroscopy-based instrument tracking system used in a combined single-position LD-ALIF and LD-LLIF.
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Case Reports
The "Microcisternal Drainage" technique for clipping a middle cerebral artery aneurysm.
Arachnoid dissection is often challenging because of tight corridors, microvasculature crossing the membranes, and a narrow operative field.1-4 It is often said that "splitting" the sylvian fissure measures the talent of a cerebrovascular neurosurgeon, and there are as many styles of sylvian fissure dissection as neurosurgical schools.4-8 Our principle is to dissect the subarachnoid space sharply and with minimal trauma to neither the microvasculature nor the pia matter.4,7-10 We have developed a technique that allows efficient and safe sharp dissection through the subarachnoid space: the "microcisternal drainage" technique. This technique (Video 1) consists of applying a pledget to a narrow cistern and suctioning the cerebrospinal fluid while maintaining uplifting retraction with the suction shaft. Clear trabeculae are dissected sharply to release microvessels at the convexity of their turns. ⋯ We report an example of the "microcisternal drainage" technique to split the sylvian fissure during treatment of an irregular middle cerebral artery bifurcation aneurysm on a 56-year-old woman. The patient tolerated the procedure well, was discharged without neurologic deficits, and resumed normal life with no aneurysm remnant. The patient consented to the procedure and video and photography publication.
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Despite the significant clinical consequences and socioeconomic costs of gunshot wounds to the head (GSWH), studies examining prehospital risk factors, geospatial patterns, and economic cost are lacking. ⋯ In the first analysis of GSWH with the inclusion of both hospital and ME data in a representative urban setting, our findings show prehospital risk factors and the unequal distribution of the significant economic costs of GSWH.