Neurosurgery
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Randomized Controlled Trial
Withholding Perioperative Steroids in Patients Undergoing Transsphenoidal Resection for Pituitary Disease: Randomized Prospective Clinical Trial to Assess Safety.
Perioperative steroid protocols for patients undergoing transsphenoidal surgery (TSS) for pituitary pathology vary by institution. ⋯ Perioperative steroids can be safely withheld in patients with an intact HPA axis undergoing TSS. Although administration of perioperative glucocorticoids does not appear to increase the risk of complications, it may interfere with assessment of the HPA axis after surgery.
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Comparative Study
Virtual Reality Angiogram vs 3-Dimensional Printed Angiogram as an Educational tool-A Comparative Study.
Three-dimensional (3D) visualization of the neurovascular structures has helped preoperative surgical planning. 3D printed models and virtual reality (VR) devices are 2 options to improve 3D stereovision and stereoscopic depth perception of cerebrovascular anatomy for aneurysm surgery. ⋯ In selected cases with challenging cerebrovascular anatomy where stereoscopic depth perception is helpful, VR angiogram should be considered as a viable alternative to the 3D printed models for neurosurgical training and preoperative planning. An immersive virtual environment offers excellent resolution and ability to zoom, potentiating it as an untapped educational tool.
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Randomized Controlled Trial
The Impact of Alvimopan on Return of Bowel Function After Major Spine Surgery - A Prospective, Randomized, Double-Blind Study.
Pain management following major spine surgery requires high doses of opioids and is associated with a risk of opioid-induced constipation. Peripheral mu-receptor antagonists decrease the gastrointestinal complications of perioperative systemic opioid administration without antagonizing the analgesic benefits of these drugs. ⋯ This study shows that the perioperative use of alvimopan significantly reduced the time to return of bowel function with no increase in postoperative opioid use despite a slight increase in pain scores.