Journal of neurosurgery
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Journal of neurosurgery · Aug 2014
Relevance of early head CT scans following neurosurgical procedures: an analysis of 892 intracranial procedures at Rush University Medical Center.
Early postoperative head CT scanning is routinely performed following intracranial procedures for detection of complications, but its real value remains uncertain: so-called abnormal results are frequently found, but active, emergency intervention based on these findings may be rare. The authors' objective was to analyze whether early postoperative CT scans led to emergency surgical interventions and if the results of neurological examination predicted this occurrence. ⋯ Over a 1-year period in an academic neurosurgery service, no patient who was neurologically intact or who had a predicted neurological change required an immediate return to the operating room based on early postoperative CT findings. Obtaining early CT scans should not be a priority in these patients and may even be cancelled in favor of MRI studies, if the latter have already been planned and can be performed safely and in a timely manner. Early postoperative CT scanning does not assure an uneventful course, nor should it replace accurate and frequent neurological checks, because operative interventions were always decided in conjunction with the neurological examination.
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Journal of neurosurgery · Aug 2014
The effect of duty hour regulations on outcomes of neurological surgery in training hospitals in the United States: duty hour regulations and patient outcomes.
The effects of sleep deprivation on performance have been well documented and have led to changes in duty hour regulation. New York State implemented stricter duty hours in 1989 after sleep deprivation among residents was thought to have contributed to a patient's death. The goal of this study was to determine if increased regulation of resident duty hours results in measurable changes in patient outcomes. ⋯ Regulation of resident duty hours has not resulted in significant changes in outcomes among neurosurgical patients.
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Journal of neurosurgery · Aug 2014
Arachnoid membranes in the posterior half of the incisural space: an inverted Liliequist membrane-like arachnoid complex.
The aim of this study was to describe the similarity of configuration between the arachnoid complex in the posterior half of the incisural space and the Liliequist membrane. ⋯ The arachnoid complex in the posterior half of the incisural space can be regarded as an inverted Liliequist membrane. This concept can help neurosurgeons to gain better understanding of the surgical anatomy at the level of the tentorial incisura.
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Journal of neurosurgery · Aug 2014
Historical ArticleThe skull of Chios: trepanation in Hippocratic medicine.
Cranial trepanation is the oldest neurosurgical operation and its roots date back to prehistory. For many centuries, religion and mysticism were strongly linked to the cause of diseases, and trepanation was associated with superstitions such as releasing evil spirits from inside the skull. The Hippocratic treatise "On injuries of the head" was therefore a revolutionary work, as it presented a systematic approach to the management of cranial trauma, one that was devoid of spiritual elements. ⋯ The skull bears a parietal bur hole in association with a linear fracture, and it is clear that the patient survived the procedure. In this analysis, the authors examine the application of the original Hippocratic teaching to the skull of Chios. The rationalization of trepanation was clearly a significant achievement in the evolution of neurosurgery.
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Journal of neurosurgery · Aug 2014
Virtual interactive presence for real-time, long-distance surgical collaboration during complex microsurgical procedures.
The shortage of surgeons compels the development of novel technologies that geographically extend the capabilities of individual surgeons and enhance surgical skills. The authors have developed "Virtual Interactive Presence" (VIP), a platform that allows remote participants to simultaneously view each other's visual field, creating a shared field of view for real-time surgical telecollaboration. ⋯ Virtual Interactive Presence is a feasible paradigm for real-time, long-distance surgical telecollaboration. Delay, resolution, scaling, and registration are parameters that require further optimization, but are within the realm of current technology. The paradigm potentially enables remotely located experts to mentor less experienced personnel located at the surgical site with applications in surgical training programs, remote proctoring for proficiency, and expert support for rural settings and across different counties.