Neurosurgery
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There is a significant increase and large variation in craniotomy costs. However, the causes of cost differences in craniotomies remain poorly understood. ⋯ After controlling for patient/clinical factors, hospital type, bed size, and wage index, hospitals in the western United States had higher costs than those in other parts of the country, based on analyses from 2 separate national databases.
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The concept of minimum clinically important difference (MCID) has been shown to be effective in spine surgery to differentiate between clinically insignificant and significant improvements as determined by the patient. ⋯ The MCID for SCS placement was calculated using 4 different methods. The results are similar to calculations for the MCID for many lumbar and cervical procedures done for pain. Our results suggest that an improvement of 1.2 to 3.7 points on the VAS scale and 8.2 to 13.3 points on the ODI is clinically meaningful to the patient. Further defining the MCID for SCS therapy will remain of utmost importance in order to justify the cost of the procedure.
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Lumbar decompression for disc herniation is frequently performed on elderly patients, and this trend will continue as the population ages. Clinical reports on the complications of lumbar discectomy show good results and cost effectiveness in young or middle-aged patients. ⋯ In this large sample of patients who received a single-level lumbar decompression procedure for disc displacement without myelopathy, elderly patients, particularly with American Society of Anesthesiologists class 3 and 4, had a statistically significant increase in morbidity and mortality, but the overall risk of complications remains low.
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Randomized Controlled Trial Multicenter Study
Practice Patterns for Neurosurgical Utilization and Outcome in Acute Intracerebral Hemorrhage: Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials 1 and 2 Studies.
The prognosis in acute spontaneous intracerebral hemorrhage (ICH) is related to hematoma volume, where >30 mL is commonly used to define large ICH as a threshold for neurosurgical decompression but without clear supporting evidence. ⋯ Early identification of severe ICH, based on age and clinical and imaging parameters, may facilitate neurosurgery and intensive monitoring of patients.
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Multicenter Study
Stereotactic Radiosurgery for Brainstem Arteriovenous Malformations: A Multicenter Study.
The management of brainstem arteriovenous malformations (bAVMs) is a formidable challenge. bAVMs harbor higher morbidity and mortality compared to other locations. ⋯ SRS for bAVMs results in obliteration and avoids permanent complications in the majority of patients.