World Neurosurg
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Exposure to magnetic fields may alter the settings of programmable ventriculoperitoneal shunt valves or even cause permanent damages to these devices. There is little information about this topic, none on live patients. ⋯ HC valves presented a variable perturbation rate, with an alteration rate of 40% with 1.5-telsa MRI. We have not observed malfunctioning hardware as a result of magnetic influence. We claim a cranial x-ray immediately after the MRI because of a high risk (40%) of decalibration, especially in patients with low ventricles compliance.
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Segmental arterial mediolysis (SAM) is not yet well known in the neurosurgical field, even though it has become an increasingly recognized pathology in arterial dissection. ⋯ It is very important that SAM is recognized as a systemic disease that affects the central nervous system, visceral arteries, and coronary arteries. The possibility of SAM should always be considered, particularly in patients with ruptured VA dissection-which is nowadays treated by endovascular techniques-since concomitantly involved visceral arteries may cause unexpected hemorrhagic complications other than SAH.
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Spontaneous rupture of a Rathke cleft cyst is very rare, and rapid de novo aneurysm formation associated with pituitary apoplexy is rare. ⋯ This case features a rare clinical presentation of rapid de novo aneurysm formation after Rathke cleft cyst rupture. The severe inflammation around the vasculature after rupture of the Rathke cleft cyst might have been involved in aneurysm formation.
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The Hospital Readmission Reduction Program section of the Patient Protection and Affordable Care Act uses readmission rates as a proxy for measuring quality of care. Multiple studies have demonstrated that readmission rates are highly imprecise proxies for quality of care because readmission rates contain large amounts of statistical noise and are dependent on disease type, insurance type, severity, population, and a multitude of other factors. The current study was conducted to investigate characteristics associated with readmission and the quality of neurosurgical care. ⋯ The findings suggest that readmission is affected by patient factors that are beyond the control of treating physicians. These findings also suggest that readmission rates may not be a good proxy for measurement of quality of care in neurosurgical patients.
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Meta Analysis
Predictors and Rates of Delayed Symptomatic Hyponatremia After Transsphenoidal Surgery: A Systematic Review.
Delayed symptomatic hyponatremia (DSH) is a known complication of transsphenoidal surgery that can lead to prolonged hospital stay, readmission, and in rare cases, death. Many potential predictors for development of DSH have been investigated. A better understanding of DSH risk can lead to better patient outcomes. We performed a systematic review to determine the rates and predictors of DSH after both endoscopic transsphenoidal surgery and microscopic transsphenoidal surgery. ⋯ Age, gender, tumor size, rate of decline of blood sodium, and Cushing disease are potential predictors of DSH. By identifying patients at high risk for DSH, preventative efforts can be implemented in the perioperative setting to reduce the incidence of potentially catastrophic hyponatremia following transsphenoidal surgery.