Neurosurgery
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Microscopic and endoscopic transsphenoidal approaches to the sellar are well established. Surgical freedom is an important skull base principle that can be measured objectively and used to compare approaches. ⋯ Microscopic sublabial and endoscopic binostril approaches provided superior surgical freedom compared with the endonasal microscopic and uninostril endoscopic approaches. This work provides objective baseline values for the quantification and evaluation of future refinements in surgical technique or instrumentation.
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Minimum clinical important difference (MCID) has been adopted as the smallest improvement in patient-reported outcome needed to achieve a level of improvement thought to be meaningful to patients. ⋯ MCED serves as the smallest improvement in an outcome instrument that is associated with a cost-effective response to surgery. With the use of cost-effective anchor of < $50,000/QALY, MCED after transforaminal lumbar interbody fusion was 4 points for visual analog scale for low back pain, 3 points for visual analog scale for leg pain, 22 points for Oswestry Disability Index, and 0.31 QALYs for EuroQol 5D.
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Intracranial dolichoectasia is associated with high morbidity, and its pathophysiology remains poorly understood. ⋯ Elastase injection through the cisterna magna can induce intracranial dolichoectasia in mice. Fifteen to 25 mu of elastase is an appropriate dose to use with acceptable mortality.