Neurosurgery
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Chronic subdural hematoma (CSDH) is a common neurosurgical condition with a high risk of recurrence after treatment. ⋯ Recurrence after evacuation occurs in approximately 10% of cSDHs, and the various surgical interventions are approximately equivalent. Corticosteroids are associated with reduced recurrence but also increased morbidity. Drains reduce the risk of recurrence, but the position of drain (subdural vs subgaleal) did not influence recurrence. Middle meningeal artery embolization is a promising treatment warranting further evaluation in randomized trials.
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Interviews are critical to the neurosurgery resident application process. The COVID-19 pandemic forced residency interview activities are conducted virtually. To maintain a degree of control during a period of uncertainty, our department implemented a standardized survey for interviewers to evaluate the noncognitive attributes and program compatibility of applicants. ⋯ ICC analysis demonstrated good (ICC 0.75-0.90) or excellent (ICC > 0.90) reliability for all questions and overall score. The standardized interviewer survey was a feasible and reliable method for evaluating noncognitive attributes during neurosurgery residency interviews. There was no perceptible evidence of sex bias in our single-program experience.
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The Hemorrhage, Age, Treatment, Clinical State, Hydrocephalus (HATCH) Score has previously shown to predict functional outcome in aneurysmal subarachnoid hemorrhage (aSAH). ⋯ This multicenter external validation analysis confirms the HATCH score to be a strong independent predictor for functional outcome. Its incorporation into daily practice may be of benefit for goal-directed patient care in aSAH.
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The management of atlas fractures is controversial and hinges on the integrity of transverse atlantal ligament (TAL). ⋯ LMD > 7 mm on CT is not sensitive for TAL injury. Some atlas fractures with TAL injury can be managed with a cervical collar. Nonunion rates are not different between halo immobilization and cervical collar, but a strong selection bias precludes directly comparing the efficacy of these modalities. Age independently predicts nonunion.