Neurosurgery
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Numerous catastrophic events in the 21st century have motivated renewed discussion regarding whether the traditional definition of standard of care appropriately applies to clinical decision-making in crisis scenarios. Some authorities have proposed the adoption of a crisis standard of care, which refines physician responsibilities during a crisis event in accordance with population health principles. ⋯ To clarify these points and provide practicing neurosurgeons with guidance, we provide a review of current literature on the evolving definitions of crisis standard of care. Additionally, we provide an assessment of the implications of a crisis standard of care, as it relates to legal liability, clinical ethics, and neurosurgical practice.
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Microvascular decompression (MVD) surgery is the treatment of choice for trigeminal neuralgia (TGN). However, decompression becomes difficult when the offending vessel penetrates the trigeminal nerve root. ⋯ Intraneural offending vessels requiring treatment are uncommon and are seen in less than 1 in 10 patients undergoing MVD for TGN. For intraneural offending artery, decompression by shredded Teflon wrapping interposition is recommended. Management of the INOV depends on the individual situations, and the management includes sacrifice, wrapping decompression, or leaving them untreated.
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Machine learning (ML) holds promise as a tool to guide clinical decision making by predicting in-hospital mortality for patients with traumatic brain injury (TBI). Previous models such as the international mission for prognosis and clinical trials in TBI (IMPACT) and the corticosteroid randomization after significant head injury (CRASH) prognosis calculators can potentially be improved with expanded clinical features and newer ML approaches. ⋯ We developed high-performing well-calibrated ML models for predicting in-hospital mortality for both the HIC and LMIC settings that have the potential to influence clinical management and traumatic brain injury patient trajectories.
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Reports suggest that phosphatidylinositol 3-kinase pathway alterations confer increased risk of progression and poor prognosis in oligodendroglioma, IDH-mutant, and 1p/19q-codeleted molecular oligodendrogliomas (mODG). However, factors that affect prognosis in mODG have not been thoroughly studied. In addition, the benefits of adjuvant radiation and temozolomide (TMZ) in mODGs remain to be determined. ⋯ Our findings suggest that mODGs harboring PIK3CA mutations have worse OS. Except for an advantage in PFS with TMZ treatment, adjuvant TMZ, radiation, or a combination of the two showed no significant improvement in OS.
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Spine surgery outcomes assessment currently relies on patient-reported outcome measures, which satisfy established reliability and validity criteria, but are limited by the inherently subjective and discrete nature of data collection. Physical activity measured from smartphones offers a new data source to assess postoperative functional outcomes in a more objective and continuous manner. ⋯ The perioperative clinical course of patients undergoing spine surgery was systematically classified using smartphone-based mobility data. Our findings highlight the potential utility of such data in a novel quantitative and longitudinal surgical outcome measure.