Neurosurgery
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Review Meta Analysis
Diagnostic Value and Safety of Brain Biopsy in Patients With Cryptogenic Neurological Disease: A Systematic Review and Meta-analysis of 831 Cases.
The role of brain biopsy in patients with cryptogenic neurological disease is uncertain. ⋯ Brain biopsy in cryptogenic neurological disease was associated with the highest diagnostic yield in patients with suspected PACNS. The greatest clinical impact was seen in children with cryptogenic neurological disease. The presence of a radiological target was associated with a higher diagnostic yield.
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Surgical site infection (SSI) is an expensive complication associated with spine surgery. The application of intrawound vancomycin is rapidly emerging as a solution to reduce SSI. The impact of intrawound vancomycin has not been systematically studied in a well-designed multicenter study. We determine whether intrawound vancomycin application was associated with reduced risk of SSI in patients after spine surgery. ⋯ Intrawound application of vancomycin after elective spine surgery was associated with reduced risk of SSI and return to OR associated with SSI, even after controlling for confounding variables.
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Multicenter Study Clinical Trial
Validation of a System to Predict Recanalization After Endovascular Treatment of Intracranial Aneurysms.
With increasing use of endovascular techniques in the treatment of ruptured and unruptured aneurysms, the issue of obliteration efficacy has become increasingly important. We have previously reported the Aneurysm Recanalization Stratification Scale, which uses accessible predictors including aneurysm-specific factors (size, rupture, and intraluminal thrombosis) and treatment-related features (treatment modality and immediate angiographic result) to predict retreatment risk after endovascular therapy. ⋯ Surgical decision-making and patient-centered informed consent require comprehensive and accessible information on treatment efficacy. The Aneurysm Recanalization Stratification Scale is a valid prognostic index. This is the first comprehensive model that has been developed to quantitatively predict retreatment risk following endovascular therapy.
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Obesity is a significant comorbidity that can increase the risk and technical difficulty of surgery. Previous studies comparing minimally invasive (MIS) to traditional open spinal surgery in the obese have shown similar clinical outcomes but improved perioperative benefits of decreased estimated blood loss (EBL), length of stay (LOS), and complications with MIS approaches. Similar studies have not been performed for obese patients undergoing surgery for adult spinal deformity (ASD). This study's objective was to compare the impact of obesity in the treatment of ASD with MIS compared with open approaches. ⋯ Similar clinical and radiographic improvements were noted for MIS and open treatment of ASD. Although EBL was less in the MIS group, the frequency of complications and reoperations were similar, suggesting the potential benefit of MIS approaches may be mitigated by obesity. Larger comparative studies are needed to clarify the benefit of MIS in the obese undergoing ASD surgery.
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Clinical prediction and decision rules use evidence-based medicine to assist clinicians in diagnosing and treating illness. Although widespread in modern medical practice, there are relatively few clinical rules for neurosurgical conditions. ⋯ It also summarizes a list of clinical rules published for neurosurgical illnesses and analyzes each rule for how it was derived and whether it was validated and/or evaluated compared with similar rules. It reports on whether the implementation of each rule was studied and grades the overall quality of each report.