World Neurosurg
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Adjacent segment disease (ASD) may occur as a long-term consequence of spinal fusion and is associated with significant back and leg pain. Surgical management of symptomatic ASD consists of neural decompression and extension of fusion. However, conflicting results have been reported with respect to the long-term clinical effectiveness of revision surgery in this setting. We set out to comprehensively assess the long-term clinical outcome after revision surgery and determine its effectiveness in the treatment of adjacent segment disease. ⋯ Patients undergoing decompression and extension of fusion for adjacent segment disease-associated back and leg pain reported long-term improvement in pain, disability, and both physical and mental quality of life, suggesting that revision surgery is a highly effective treatment strategy in this patient population.
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To propose that chronic subdural hematoma (CSDH) should be conceived as a sentinel event in elderly patients and offer an analysis of long-term survival after diagnosis. ⋯ The increased mortality rates in patients with CSDHs relative to standardized mortality data corroborate the conception of subdural hematoma as a sentinel health event.
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During the past decade, endoscopic intraventricular and skull base operations have become widely used for a variety of evolving indications. A global survey of practicing endoscopic neurosurgeons was performed to characterize patterns of usage regarding endoscopy equipment, instrumentation, and the indications for using image-guided surgery systems (IGSs). ⋯ Many variations and permutations for performing intraventricular and skull base endoscopic surgery exist worldwide. Much can be learned by studying the patterns and indications for using various types of equipment and operative adjuncts such as IGSs.
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Case Reports
The transconjunctival transorbital approach: a keyhole approach to the midline anterior skull base.
To report an initial experience with a medial transorbital approach to the midline skull base performed via a transconjunctival incision. ⋯ The transconjunctival medial orbital craniectomy provides a minimally invasive keyhole approach to lesions located anteriorly along the anterior cranial fossa that are in the midline with lateral extension over the orbital roof. Based on our initial experience with this technique, the working space afforded limits complex surgical dissection; this approach is primarily well suited for less extensive pathology.
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The Agency for Healthcare Research and Quality patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are used to evaluate the safety and quality of health care provided by health care systems and individual facilities. To understand better the incidence of PSIs and HACs in hospitalized patients with stroke, we determined the rates of these events among patients with a diagnosis of stroke in the Nationwide Inpatient Sample (NIS) database. ⋯ Our results estimate baseline national incidence rates of PSIs and HACs in patients with stroke. These data may be used to determine individual institutional improvements or success by comparison.