World Neurosurg
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Comparative Study
Identification of knowledge gaps in neurosurgery through analysis of responses to the Self-Assessment in Neurological Surgery (SANS).
To examine the gaps in knowledge of neurosurgeons responding to the Self-Assessment in Neurological Surgery (SANS). ⋯ SANS demonstrated areas of knowledge gaps in a broad group of neurosurgeons. There were also significant differences between residents and attending neurosurgeons. Identification of areas of deficiency could prove useful in future educational endeavors.
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Few reports have addressed long-term outcomes, as well as the safety and efficacy of the cervical microendoscopic foraminotomy (CMEF) and cervical microendoscopic diskectomy (CMED) procedures used in modern spine practice to treat degenerative disease of the cervical spine. Accordingly, we present long-term outcomes from a cohort of patients treated for foraminal stenosis or disk herniation with the CMEF or CMED procedure, respectively. ⋯ Posterior CMEF and CMED are safe and effective procedures for minimally invasive decompression in the cervical spine.
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Comparative Study
Middle cerebral artery aneurysms: a single-center series comparing endovascular and surgical treatment.
The optimal treatment for middle cerebral artery (MCA) aneurysms is controversial. MCA aneurysms have been considered more conducive to surgical treatment. Recent technology has led to successful endovascular treatment of MCA aneurysms. The objective of this study was to analyze the outcomes of endovascular and surgical treatment of MCA aneurysms as experienced by a single tertiary center. ⋯ In this nonrandomized sample of 90 MCA aneurysms treated with endovascular coiling or neurosurgical clipping, we observed a similar clinical outcome based on the modified Rankin scale and angiographic occlusion. Complication and retreatment rates were higher but not significant for the endovascular group. Both treatment modalities are good alternatives and should be individualized based on aneurysm angioarchitecture and the patient's general conditions.
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We analyzed consecutive subarachnoid hemorrhage (SAH) cases in patients older than 70 years of age who underwent aneurysm surgery. We report the influence of early ambulation on outcome in advanced-age SAH. ⋯ Elderly SAH patients with good Hunt-Hess grades should have a clip ligation or endovascular coiling. Early ambulation produces favorable outcome and a nondemential state in elderly SAH patients.
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Case Reports
Supraorbital eyebrow craniotomy for removal of intraaxial frontal brain tumors: a technical note.
To present the utility and selection criteria for the supraorbital (SO) craniotomy, an approach commonly used to remove extraaxial tumors such as meningiomas and craniopharyngiomas, to resect intraaxial frontal brain lesions. ⋯ The SO "eyebrow" craniotomy is a safe and effective keyhole method to remove intraaxial frontal lobe lesions, particularly lesions of the frontal pole and orbitofrontal region, allowing for minimal disruption of normal brain parenchyma and promoting a rapid recovery and short hospital stay. Metastatic tumors and select gliomas in this area are most amenable to this approach. Deeper intraaxial tumors can also be effectively accessed via this route with excellent clinical outcomes.