Neurosurgery
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Comparative Study
Observation Versus Intervention for Low-Grade Intracranial Dural Arteriovenous Fistulas.
Low-grade intracranial dural arteriovenous fistulas (dAVF) have a benign natural history in the majority of cases. The benefit from treatment of these lesions is controversial. ⋯ Intervention for low-grade intracranial dAVFs achieves superior obliteration rates compared to conservative management, but it fails to improve neurological or functional outcomes. Our findings do not support the routine treatment of low-grade dAVFs.
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American tort law (a.k.a. negligence) is designed to be flexible and elastic to adapt to changes in time and public policy. It provides a structure of elements and factors to be applied to each case's specific facts on a case-by-case basis. The purpose of this structure is to achieve as much uniformity as possible in the application of tort law. ⋯ The physician typically owes her or his patient the duty to exercise care. However, there are special situations in which a physician may not owe a duty of care and thus cannot be held liable for medical negligence. This article is designed to provide an overview of the most common situations and summarizes the processes to determine whether a duty is owed.
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Gliomas are often in close proximity to functional regions of the brain; therefore, electrocortical stimulation (ECS) mapping is a common technique utilized during glioma resection to identify functional areas. Stimulation-induced seizure (SIS) remains the most common reason for aborted procedures. Few studies have focused on oncological factors impacting cortical stimulation thresholds. ⋯ SISs are rare but serious events during ECS mapping. SISs are most common when mapping the frontal lobe. Greater stimulation current is not associated with the identification of more cortical functional sites during glioma surgery.
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While maximizing extent of resection (EOR) is associated with longer survival in lower-grade glioma (LGG) patients, the number of cases remains insufficient in determining a EOR threshold to elucidate the clinical benefits, especially in IDH-wild-type LGG patients. ⋯ Our results support the core role of maximal safe resection in the treatment of IDH-wild-type LGGs, especially for IDH-wild-type + TERTp-mutant LGGs. Importantly, the survival benefits of surgery could only be elucidated at a high EOR cut-off point.
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Frailty severity may be an important determinant for impaired recovery after cervical spine deformity (CD) corrective surgery. ⋯ While all groups exhibited improved postop disability and pain scores, frail patients experienced greater amount of improvement in overall health state compared to baseline disability. This signifies that with frailty severity, patients have more room for improvement postop compared to baseline quality of life.