Journal of neurosurgery
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Journal of neurosurgery · Jun 2017
Predictors of 30-day readmission after aneurysmal subarachnoid hemorrhage: a case-control study.
OBJECTIVE Despite persisting questions regarding its appropriateness, 30-day readmission is an increasingly common quality metric used to influence hospital compensation in the United States. However, there is currently insufficient evidence to identify which patients are at highest risk for readmission after aneurysmal subarachnoid hemorrhage (SAH). The objective of this study was to identify predictors of 30-day readmission after SAH, to focus preventative efforts, and to provide guidance to funding agencies seeking to risk-adjust comparisons among hospitals. ⋯ Furthermore, despite the significant association between discharge disposition and readmission, less than 25% of readmitted patients were discharged to a skilled nursing facility. CONCLUSIONS Although discharge disposition remained significant in multivariate analysis, most routinely collected variables appeared to be weak independent predictors of 30-day readmission after SAH. Consequently, hospitals interested in decreasing readmission rates may consider multifaceted, cost-efficient interventions that can be broadly applied to most if not all SAH patients.
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Journal of neurosurgery · Jun 2017
Case ReportsModification of electrophysiological activity pattern after anterior thalamic deep brain stimulation for intractable epilepsy: report of 3 cases.
OBJECTIVE Thalamic stimulation can provoke electroencephalography (EEG) synchronization or desynchronization, which can help to reduce the occurrence of seizures in intractable epilepsy, though the underlying mechanism is not fully understood. Therefore, the authors investigated changes in EEG electrical activity to better understand the seizure-reducing effects of deep brain stimulation (DBS) in patients with intractable epilepsy. METHODS Electrical activation patterns in the epileptogenic brains of 3 patients were analyzed using classical low-resolution electromagnetic tomography analysis recursively applied (CLARA). ⋯ However, with CLARA, electrical activity in the postoperative on-stimulation period was localized in the anterior cingulate area, basal ganglia, and midbrain. CONCLUSIONS Anterior thalamic stimulation could spread electrical current to the underlying neuronal networks that connect with the thalamus, which functions as a cortical pacemaker. Consequently, the thalamus could modify electrical activity within these neuronal networks and influence cortical EEG activity by inducing neuronal synchronization between the thalamus and cortical structures.
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Journal of neurosurgery · Jun 2017
CommentUtility of the intensive care unit in patients undergoing microvascular decompression: a multiinstitution comparative analysis.
OBJECTIVE Use of the ICU during admission to a hospital is associated with a significant portion of the total health care costs for that stay. Patients undergoing microvascular decompression (MVD) for cranial neuralgias are routinely admitted postoperatively to the ICU for monitoring. The primary purpose of this study was to compare complication rates of patients with and without a postoperative ICU stay following MVD. ⋯ Patients from Institution A without a postoperative ICU stay had a significantly shorter length of stay, by approximately 16 hours (p < 0.001), and received less postoperative imaging (p < 0.001, OR 14.39, 95% CI 7.75-26.74) and postoperative diagnostic testing (p < 0.001) than patients from Institution B with an ICU stay. Estimated cost savings in patients without an ICU stay and 1 less day of inpatient recovery was calculated as $1400 per patient. CONCLUSIONS Selective versus routine use of ICU care as well as postoperative imaging and diagnostic testing may be safe after MVD and can lead to a reduction in overall health care costs.
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Journal of neurosurgery · Jun 2017
Midline and off-midline infratentorial supracerebellar approaches to the pineal gland.
OBJECTIVE A common approach to lesions of the pineal region is along the midline below the torcula. However, reports of how shifting the approach off midline affects the surgical exposure and relationships between the tributaries of the vein of Galen are limited. The purpose of this study is to examine the microsurgical and endoscopic anatomy of the pineal region as seen through the supracerebellar infratentorial approaches, including midline, paramedian, lateral, and far-lateral routes. ⋯ Shifting from midline to off-midline exposure also provides a better view of the cerebellomesencephalic fissure, collicular plate, and trochlear nerve than the midline approaches. Endoscopic assistance may aid exposure of the pineal gland while preserving the bridging veins. CONCLUSIONS Understanding the characteristics of different infratentorial routes to the pineal gland will aid in gaining a better view of the pineal gland and cerebellomesencephalic fissure and may reduce the need for venous sacrifice at the level of the tentorial sinuses draining the upper cerebellar surface and the tributaries of the vein of Galen.
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Journal of neurosurgery · Jun 2017
Correlation between GH and IGF-1 during treatment for acromegaly.
OBJECTIVE The relationship between growth hormone (GH) and insulin-like growth factor-1 (IGF-1) in patients with acromegaly as serial levels drop over time after treatment has not been examined previously. Knowledge of this relationship is important to correlate pretreatment levels that best predict response to treatment. To examine the correlation between GH and IGF-1 and IGF-1 z-scores over a wide range of GH levels, the authors examined serial GH and IGF-1 levels at intervals before and after surgery and radiosurgery for acromegaly. ⋯ CONCLUSIONS In acromegaly, although IGF-1 levels represent a combination of the integrated effects of GH secretion and GH action, the tumor produces GH, not IGF-1. Nonlinearity between GH and IGF-1 occurs at GH levels far below those previously recognized. To monitor tumor activity and tumor viability requires measurement of GH levels.