Journal of neurosurgery
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Journal of neurosurgery · Dec 2013
The prevalence of patient safety indicators and hospital-acquired conditions in patients with ruptured cerebral aneurysms: establishing standard performance measures using the Nationwide Inpatient Sample database.
The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are publicly reported metrics used to gauge the quality of health care provided by health care institutions. To better understand the prevalence of these events in hospitalized patients treated for ruptured cerebral aneurysms, the authors determined the incidence rates of PSIs and HACs among patients with a diagnosis of subarachnoid hemorrhage and procedure codes for either coiling or clipping in the Nationwide Inpatient Sample database. ⋯ These results estimate baseline national rates of PSIs and HACs in patients treated for ruptured cerebral aneurysms. These data may be used to gauge individual institutional quality of care and patient safety metrics in comparison with national data.
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Journal of neurosurgery · Dec 2013
Radiation exposure of normal temporal bone structures during stereotactically guided gamma knife surgery for vestibular schwannomas.
The dosimetry of radiation exposure of healthy inner, middle, and external ear structures that leads to hearing loss, tinnitus, facial weakness, dizziness, vertigo, and imbalance after gamma knife surgery (GKS) for vestibular schwannomas (VSs) is unknown. The authors quantified the dose of radiation received by these structures after GKS for VS to assess the likelihood that these doses contributed to postradiosurgery complications. ⋯ Doses delivered to middle and external ear structures are unlikely to contribute to post-GKS complications, but unexpectedly high doses may be delivered to sensitive areas of the intratemporal facial nerve and inner ear. Unintentional delivery of high doses to the stria vascularis, the sensory neuroepithelium of the inner ear organs and/or their ganglia, may play a role in the development of post-GKS tinnitus, hearing loss, dizziness, vertigo, and imbalance. Minimizing treatment complications post-GKS for VS requires precise dose planning conformality with the three-dimensional surface of the tumor.