Journal of neurosurgery
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Journal of neurosurgery · Oct 2024
Risk assessment of early therapeutic anticoagulation following cranial surgery: an institutional case series.
Postoperative thrombotic complications represent a unique challenge in cranial neurosurgery as primary treatment involves therapeutic anticoagulation. The decision to initiate therapy and its timing is nuanced, as surgeons must balance the risk of catastrophic intracranial hemorrhage (ICH). With limited existing evidence to guide management, current practice patterns are subjective and inconsistent. The authors assessed their experience with early therapeutic anticoagulation (≤ 7 days postoperatively) initiation for thrombotic complications in neurosurgical patients undergoing cranial surgery to better understand the risks of catastrophic ICH. ⋯ The incidence of catastrophic ICH was significantly increased when anticoagulation was initiated within 48 hours of cranial surgery. Patients undergoing intra-axial exploration during their index surgery were at higher risk of a catastrophic ICH.
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Journal of neurosurgery · Oct 2024
Historical ArticleAn early case of successful peripheral nerve repair in 1880: Francis L. Parker, MD.
The modern technique of epineural suture repair, along with a detailed reporting of functional restoration, came from Carl Hueter in 1873. While there is extensive information on peripheral nerve surgery throughout recorded history leading up to the 1800s, little early American scientific literature is available. While Schwann, Nissl, and Waller were publishing their work on nerve anatomy and physiology, Francis LeJau Parker was born. ⋯ The authors reviewed these records in detail and provide a case description of nerve repair not previously reported in the modern literature. The history, neurological examination, and details of the case provide insight into the adroit surgical skills of Dr. Parker.
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Journal of neurosurgery · Oct 2024
Visualization of the nervus intermedius during microvascular decompression in hemifacial spasm: anatomical study.
The surgical anatomy of the nervus intermedius (NI) is highly variable. The aim of this study was to describe the anatomy of the NI during endoscope-assisted microvascular decompression (MVD) in hemifacial spasm (HFS), and the involvement of the nerve in the vascular conflict. ⋯ The anatomy of the NI is for the first time evaluated endoscopically in MVD for HFS. The nerve had various anatomical patterns that were clearly identified. Further studies to evaluate the compression patterns in relation to NI neuralgia are warranted.
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Journal of neurosurgery · Oct 2024
An intraoperative accelerometry and real-time analysis tool for magnetic resonance-guided focused ultrasound thalamotomy.
Magnetic resonance-guided focused ultrasound (MRgFUS) is one of the newest surgical treatments for essential tremor (ET). During this procedure, a lesion is created within the thalamus to mitigate tremor. Targeting is done using a combination of stereotaxy, MR tractography, and sublesional heating, with tremor assessed during the procedure to gauge therapeutic effectiveness. ⋯ This method was used in 20 surgeries, with patients experiencing a 50.7% (95% CI -64.1% to -37.3%) improvement in the treated limb per the Clinical Rating Scale for Tremor. This method does not interrupt the surgery and is quantitative. As research on optimizing MRgFUS treatment for ET continues-for example, the refinement of targeting during sublesional sonications-such quantifying and recording of tremor changes will provide rapid and objective feedback.
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Journal of neurosurgery · Oct 2024
Opiate-reduction protocol for common outpatient spinal procedures: a long-term feasibility study and single-center experience.
The opioid epidemic continues to be at the forefront of public health. As a response to this crisis, many statewide and national medical groups have sought to develop opioid-prescribing guidelines for both acute and chronic pain states. Given the lack of evidence in the neurosurgical landscape, the authors' institution implemented opioid-prescribing guidelines for common outpatient spinal procedures in 2017, subsequently demonstrating a significant reduction in the narcotics prescribed. However, the ability to maintain the results garnered from such guidelines long term has not been described. The objective of this study was to evaluate postoperative opioid utilization at a high-volume quaternary referral center 5 years after the initial implementation of an opioid-reduction protocol for common outpatient spinal procedures. ⋯ A standardized discharge protocol for postoperative outpatient spinal procedures can lead to long-term reductions in opioid discharge quantity, without compromising patient safety or increasing the utilization of hospital resources through readmissions, refill requests, or clinic phone calls. This study provides an example of a feasible and effective discharge prescription regimen that may be generalizable to common outpatient neurosurgical procedures with long-term evidence that a small intervention can lead to ongoing reduced quantities of postoperative opioids at the time of discharge.