World Neurosurg
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Paper-based patient records have been associated with disorganization and redundancy and thus lack of efficiency and security. The electronic health record (EHR) is an electronic record for patient health information that has alleviated many of the traditional issues associated with paper-based records. However, in the current era of the internet and with the variability of EHR systems, privacy, security, and interoperability remain challenges of the current patient health information management systems. ⋯ In addition, new frameworks have explored the utility of blockchain-based applications in addressing concerns in different medical disciplines such as neurosurgery. This review discusses these applications, including blockchain-based solutions impacting all of medicine, relating to the EHR, and directly relating to neurosurgery. This review also discusses blockchain technology and the related intricacies for appreciating the relevant frameworks, while also highlighting the challenges associated with this technology.
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Comparative Study
ChatGPT as a Decision Support Tool in the Management of Chiari I Malformation: A Comparison to 2023 CNS Guidelines.
ChatGPT has been increasingly investigated for its ability to provide clinical decision support in the management of neurosurgical pathologies. However, concerns exist regarding the validity of its responses. To assess the reliability of ChatGPT, we compared its responses against the 2023 Congress of Neurological Surgeons (CNS) guidelines for patients with Chiari I Malformation (CIM). ⋯ Moderate incoherence was observed between ChatGPT responses and CNS guidelines on the diagnosis and management of CIM. The recency of the CNS guidelines and mixed support for contradictory ChatGPT responses highlights a need for further refinement of large language models prior to their application as clinical decision support tools.
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To evaluate the effects of a multimodal management technique combining surgical muscle wrapping, clipping, and flow-diverter stent (FDS) placement in patients with ruptured blood blister-like aneurysms (BBAs) in the internal carotid artery (ICA). ⋯ We discuss a promising multimodal management approach for ruptured ICA BBAs combining muscle wrapping, surgical clipping, and FDS embolization. This technique was safe and effective in preventing re-rupture, achieving positive short-term clinical outcomes. Further research and more extensive studies are required to validate the long-term efficacy of this approach.
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The modified Brain Injury Guidelines (mBIG) were developed to improve care of patients with traumatic brain injury (TBI). This study aimed to assess if utilization of mBIG by neurosurgeons would improve TBI patient throughput at a Level I trauma center, particularly for patients meeting mBIG 1 criteria. ⋯ The mBIG 1 criteria were safe and improved low-risk TBI patient throughput at a Level I trauma center. Neurosurgical involvement may be beneficial to the mBIG while still facilitating significant resource savings.
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Comparative Study
Silent corticotroph adenomas demonstrate predilection for sphenoid sinus, cavernous sinus, and clival invasion compared to other subtypes.
Nonfunctional pituitary neuroendocrine tumors (PitNETs) exhibit wide variability in growth pattern based on subtype. Silent corticotroph adenomas (SCAs) demonstrate aggressive growth compared with other nonfunctional pituitary adenomas (NFPAs), especially into the cavernous sinus. In this study, we sought to characterize other growth patterns of SCAs compared with NFPAs. ⋯ Silent corticotroph PitNETs demonstrate predilection for invasion of bony structures, with higher rates of growing through the sellar floor into the sphenoid sinus, growing posteroinferiorly into the clivus and laterally into the cavernous sinuses. Other nonfunctional PitNETs tended to follow the path of least resistance, growing superiorly into the suprasellar space. These differences in growth patterns may account for some of the clinical challenges of treating silent corticotroph PitNETs.