Neurosurgery
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Interpretation of hospital quality requires objective evaluation of both inpatient and postdischarge adverse outcomes (AOs). ⋯ There was a 35% difference between best and suboptimal performing hospitals for this operation. Hospitals must know their risk-adjusted AO rates and benchmark their results to inform processes of care redesign.
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Remission rate is associated with higher dose of Gamma Knife Radiosurgery (GKRS; Gamma Knife: Elekta AB, Stockholm, Sweden) for acromegaly, but the dose ≥25 Gy is not always feasible when the functioning adenoma is close to optic apparatus. ⋯ Reasonable remission and new hormone deficiency rates can be achieved with low-dose GKRS for acromegaly. These rates may be comparable to those with standard GKRS margin doses.
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Young age has been reported as a negative prognostic factor for pituitary adenomas (PAs). They are very uncommon in children and adolescents; therefore, surgical outcomes are poorly described. ⋯ MTSA was safe and effective in children and adolescents as in adults, with the only exception of higher recurrence rate in pediatric GH-secreting adenomas. No complications related to young age appeared.
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Acute ischemic stroke (AIS) remains a significant source of morbidity and mortality worldwide. Multiple recent randomized clinical trials for AIS patients presenting with large vessel occlusion have demonstrated radical improvement in outcomes with mechanical thrombectomy (MT), which is now recognized as the new standard of care for patients presenting up to 24 hr. ⋯ The evolution of the standard of care interventional therapy for large vessel AIS utilizing MT raises concerns regarding work force needs, training standards, competency, and credentialing requirements for practitioners. The CAST framework represents the most modern and flexible approach for both individuals and training programs. Methods based on objective performance metrics utilizing simulation as primary vehicle may be the logical next steps in the evolution of NES.
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During the 1990s, endoscopic aqueductoplasty (AP) was considered to be a valuable alternative to endoscopic third ventriculostomy (ETV) in treating hydrocephalus related to idiopathic aqueductal stenosis (iAS), with promising short-term outcomes. ⋯ AP has a high risk of failure during long-term follow-up and is not recommended as the first choice of treatment in hydrocephalus caused by iAS. ETV should be done instead. AP may be reserved for a limited number of patients in whom ETV is not feasible but should be combined with stenting to avoid reclosure of the aqueduct.