British journal of neurosurgery
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Surgical site infection (SSI) is an unfortunate and unpreventable complication of any surgical intervention including spinal surgery. Early deep SSI (EDSSI) after instrumented spinal fusion are particularly difficult to manage due to the implanted, and possibly infected, instrumentation. The purpose of this study is to retrospectively review patients who underwent spinal surgery, investigate the rate of EDSSI, identify patient-related and surgery-related risk factors and to assess the effectiveness of continuous indwelling irrigation on the eradication of these infections. ⋯ All infections resolved, and no recurrence has been observed at final follow-up. Removal of the instrumentation was required in only one patient. Based on our results, we believe that continuous surgical site irrigation is an effective adjunct in the surgical treatment for early SSI following spinal surgery.
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The placement of external ventricular drain (EVD) is a common neurosurgical procedure to drain cerebrospinal fluid (CSF) in many acute neurosurgical conditions that disrupt the normal CSF absorption pathway. Infection is the primary complication with infection rates ranging between 0% and 45%, and this is associated with significant morbidity and mortality, prolonged hospital stay and increased hospital costs.This article compares and discusses the differences in rates of EVD CSF infection between clinical neurosurgical practice and the infection rates in a group of research patients where EVDs were sampled frequently as part of the study. ⋯ Sampling or irrigating ventricular drainage systems does not increase the risk of CNS infection providing the operator has appropriate experience and has used theatre standard aseptic technique.
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Awake craniotomy is increasingly used to facilitate safe maximal resection of brain tumours. Very little published data is available to determine patient experiences and satisfaction. This knowledge may lead to improvement in technique and enhance future patient care. ⋯ This study demonstrates high levels of patient satisfaction and provides surgeons with useful data for consenting patients. We identified no difference in levels of patient satisfaction comparing day-case patients with those admitted. We identified areas for improvement including provision of written information, enhancing post-discharge support and allowing more time for anaesthetic discussion before surgery.
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The current study evaluates the feasibility and safety of coil embolisation of the anterior communicating artery (ACoA) for the treatment of complicated anterior communicating arterial aneurysms (ACoAAs). ⋯ Combined coil embolism of the aneurysm sac and the ACoA could be a feasible and safe method for the treatment of complicated ACoAAs without bilateral aplasia of the A1 segment.
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Since 2005, Acute National Health Service (NHS) Trusts have been funded using a system called Payment by Results. This provides a national or regionally set tariff per patient treated, according to a health resource group code. Health resource group codes vary according to diagnosis or procedures carried out and patient co-morbidities. ⋯ In our region, this has been remedied by charging neighbouring trusts a fee for emergency neurosurgical referral advice. However, this is difficult to administrate and would be better served as a service-level agreement with our commissioners. Only when this has been achieved, can neurosurgical centres provide a comprehensive consultant-led emergency service without it being to the detriment of the host trust.