World Neurosurg
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Frailty status has been associated with higher rates of complications after spine surgery. However, frailty patients constitute a heterogeneous group based on the combinations of comorbidities. The objective of this study is to compare the combinations of variables that compose the modified 5-factor frailty index score (mFI-5) based on the number of comorbidities in terms of complications, reoperation, readmission, and mortality after spine surgery. ⋯ There is high variability in terms of relative risk of complications based on the number and combination of different comorbidities, especially with CHF and dependent status. Therefore, frailty status encompasses a heterogeneous group and sub-stratification of frailty status is necessary to identify patients with significantly higher risk of complications.
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There are several landmarks to safely identify the limits of the retrosigmoid approach and its intradural variations; however, there has been little discussion about how those landmarks may vary among patients. ⋯ The retrosigmoid approach is the workhorse of posterior skull base surgery. By recognizing patient-specific variations in known landmarks, the approach may be tailored prevent complications.
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Asia has a marked shortage of neurosurgical care, with approximately 2.5 million critical cases left untreated. The Young Neurosurgeons Forum of the World Federation of Neurosurgical Societies surveyed Asian neurosurgeons to identify research, education, and practice. ⋯ Improving neurosurgical care hinges on regional and international collaboration and national policies to ensure universal access to essential neurosurgical care.
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In aneurysm clipping, the use of an endoscope improves the visualization of the anatomic structures around the aneurysm, allowing for improved dissection and clipping techniques. Furthermore, it makes the surgery less invasive. The disadvantage of using the endoscope and microscope together is that the surgeon must move the line of sight significantly between viewing the operative field through the eyepiece of the microscope and viewing the endoscope monitor. This disadvantage makes it difficult for the surgeon to safely insert the endoscope in the optimal position. This study presents a new method for observing the surgical field with a picture-in-picture system using both an endoscope and an exoscope that can overcome the disadvantage of multiscope surgery. ⋯ The endoscope and exoscope multiscope picture-in-picture system can facilitate safer aneurysm clipping compared with combined microscopic and endoscopic surgery.
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We present the case of a 67-year-old patient with a left middle cerebral artery (MCA) aneurysm treated with a Woven EndoBridge (WEB) device, who experienced neck recurrence after initial complete obliteration. The initial angiogram showed a wide-necked left MCA aneurysm that measured 8 × 7 mm with a 5-mm neck, treated with a WEB device. Post implantation, the initial follow-up angiogram showed complete obliteration. ⋯ Literature review of retreatment options for WEB device failures highlights that the retreatment rate after WEB embolization is approximately 10%. For surgically accessible aneurysms, surgical clipping is an effective retreatment strategy after WEB failure given the compressibility of the device. Video 1 and our literature review provide valuable insights into a rare case of aneurysm recurrence after complete obliteration at initial follow-up after WEB embolization that was successfully treated with surgical clipping.1-8.