Journal of neurosurgery
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Journal of neurosurgery · Dec 2013
Changing our culture to advance patient safety: the 2013 AANS Presidential Address.
"Changing our culture to advance patient safety" served as the theme of the 81st Annual Meeting of the American Association of Neurological Surgeons and is an issue of personal importance to the author. To improve outcomes for patients and prevent avoidable surgical errors, neurosurgeons must change the culture that currently exists in the operating room so that safety concerns are of the utmost importance and that each member of the care team has a personal sense of accountability. Doing this will involve implementing and consistently applying systems-based strategies to ensure an adequate level of safeguards; improving communication with all members of the care team and dismantling authority gradients; and maintaining a well-trained and well-rested workforce.
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Journal of neurosurgery · Dec 2013
Hearing preservation in vestibular schwannoma stereotactic radiosurgery: what really matters?
Stereotactic radiosurgery (SRS) for vestibular schwannomas has evolved and improved over time. Although early short-term follow-up reports suggest that fractionation yields hearing preservation rates equivalent to modern single-dose SRS techniques, significant questions remain regarding long-term tumor control after the use of fractionation in a late responding tumor with a low proliferative index and α/β ratio. ⋯ The potential after SRS for hearing toxicity from altered endolymph and/or perilymph fluid dynamics either via impaired fluid production and/or absorption has yet to be explored. Serous otitis media, ossicular or temporal bone osteonecrosis, and chondromalacia are not likely to be relevant factors or considerations for hearing preservation after SRS.