Surgical neurology international
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The transition from the International Classification of Disease-9(th) clinical modification to the new ICD-10 was all set to occur on 1 October 2015. The American Medical Association has previously been successful in delaying the transition by over 10 years and has been able to further postpone its introduction to 2015. The new system will overcome many of the limitations present in the older version, thus paving the way to more accurate capture of clinical information. ⋯ With the implementation deadline gradually approaching, spine surgery practices that include multidisciplinary health specialists have to anticipate and prepare for the ICD change in order to mitigate risk. Education and communication is the key to this process in spine practices.
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Placement of external ventricular drains (EVDs) is a common, life-saving neurosurgical procedure indicated across a variety of settings. While advances have made the procedure quite safe, the potential for iatrogenic morbidity and mortality continues. We document our experience with the endovascular management of three pseudoaneurysms associated with EVD placement and discuss the endovascular treatment options for EVD-associated cerebrovascular injury. ⋯ Although EVD-associated cerebrovascular injury remains a rare phenomenon, such procedures are not entirely benign. Endovascular repair for such lesions proves a viable, effective option.
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Extracranial-intracranial (EC-IC) bypass and intracranial stenting (ICS) are both revascularization procedures that have emerged as treatment options for intracranial atherosclerotic disease (ICAD). This study describes and compares recent trends in utilization and outcomes of intracranial revascularization procedures in the United States using a population-based cohort. It also investigates the association of ICS and EC-IC bypass with periprocedural morbidity and mortality, unfavorable discharge status, length of stay (LOS), and total hospital charges. ⋯ The ideal management of patients with ICAD cannot yet be defined. Although much data from randomized and prospective trials on revascularization have been collected, many questions remain unanswered. There still remain cohorts of patients, specifically patients who have failed aggressive medical management, where not enough evidence is available to dictate decision-making. In order to further elucidate the safety and efficacy of these intracranial revascularization procedures, further clinical trials are needed.
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There are a number of surgical treatment options for cervical spondylotic myelopathy (CSM). In this study, the authors present their clinical results with cervical laminectomy and fusion for the treatment of patients with CSM. ⋯ Cervical laminectomy and fusion is a safe and efficacious procedure for the treatment of CSM. The clinical outcomes appear to be quite reproducible, and this technique is an important part of a spine surgeon's armamentarium.
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Gamma knife radiosurgery (GKRS) has emerged as an important treatment option for metastasis brain tumors (MBTs). However, the long-term outcome of GKRS on MBTs originating from lung carcinoma is not well understood. The treatment of MBTs derived from lung cancer with GKRS at our institution is reviewed. ⋯ Long-term follow-up revealed that GKRS offers a high rate of tumor control and good overall survival period in both new and recurrent patients with MBTs originating from lung carcinoma. Thus, GKRS is an effective treatment option for new patients with MBTs from lung cancer, as well as an adjuvant therapy in patients with recurrent MBTs derived from lung cancer.