Neurosurgery
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Studies have evaluated various strategies to prevent venous thromboembolism (VTE) in neuro-oncology patients, without consensus. ⋯ Although MP+LMWH is frequently considered the optimal prophylaxis for VTE risk reduction, our model suggests that MP+UFH is the safest and most cost-effective measure to balance VTE and hemorrhage risks in brain tumor patients at lower risk of hemorrhage. MP+LMWH may be more effective for patients at higher risk of VTE.
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Health care is expensive in the United States. There is an increasing focus on value rather than volume. ⋯ This article discusses the trials and techniques of measuring quality in spine surgery. A detailed analysis of advantages and disadvantages of various measures of quality, including process measurements, patient-reported outcome measurements, and safety measurements is included-from a historical perspective through modern practice.
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The goals of treating Koos grade IV vestibular schwannomas are to relieve brainstem compression, preserve or restore neurological function, and achieve long-term tumor control while minimizing tumor- and treatment-related morbidity. ⋯ Intended near-total removal results in excellent preservation of facial nerve function and has a low recurrence rate. Any progressive residual tumor may be treated by radiosurgery.