World Neurosurg
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Comparative Study
Maximizing Interhospital Transfer Resources for Neurosurgical Patients.
Delays in patient transfers are associated with worse outcomes for some neurosurgical conditions. One of the primary causes of transfer delay is lack of neurosurgery intensive care unit bed availability. In the present study, we characterize the results of implementing an interhospital transfer protocol to reduce unnecessary transfers and improve bed availability. ⋯ The transfer protocol implemented in the present study allowed transfer determination based on the need for specialized neurosurgical care rather than chance unavailability of beds. Developing interhospital transfer protocols may be an effective strategy to efficiently allocate limited hospital resources and improve transfer systems.
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Comparative Study
Assessing the Role of Preoperative Embolization in the Surgical Management of Cerebral Arteriovenous Malformations.
Preoperative embolization is established as an advantageous adjunct in multimodality treatment of cerebral arteriovenous malformations (AVMs). However, the benefit of preoperative embolization in AVMs with favorable surgical risk profile is debatable, because it has yet to be supported by evidence in comparative studies. In this study, we assessed outcome of surgically treated patients in a comparative setting. ⋯ Our data do not support substantial benefit of preoperative embolization for patients with a favorable surgical risk profile. Because of risks and costs with this intervention, the prudent use of preoperative embolization should be individually considered.
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Extreme lateral interbody fusion (ELIF) has gained popularity as a minimally invasive technique for indirect decompression. However, graft subsidence potentially threatens long-term success of ELIF. This study evaluated whether 26-mm-wide cages can eliminate subsidence and subsequent loss of decompression in ELIF. ⋯ The 26-mm-wide cages almost eliminated cage subsidence in ELIF. Compared with 18-mm-wide and 22-mm-wide cages, 26-mm-wide cages significantly reduced cage subsidence in ELIF at midterm follow-up. A 26-mm-wide cage should be used in ELIF to achieve sustained indirect decompression.
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Comparative Study
Global Diversity and Academic Success of Foreign-Trained Academic Neurosurgeons in the United States.
To quantify the proportion of academic neurosurgeons practicing in the United States who acquired residency training outside of the United States and compare their training backgrounds and academic success with those who received their residency training in the United States. ⋯ A small group of U.S. academic neurosurgeons (6.3%) have acquired residency training outside of the United States, representing all major regions of the world. Their general demographic data and academic accomplishments are comparable to those of U.S.-trained neurosurgeons.
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We aimed to elucidate the effects of arachnoid plasty (ARP) on chronic subdural hematoma (CSDH) occurrence following clipping surgery. ⋯ Patients who underwent ARPs developed fewer CSDHs following UIA clipping surgery. The factors that predicted the development of CSDH included male sex, SDFC volume on POD 8, and ARP. In addition, the ARP patients had lower SDFC volumes (<15 mL). These findings suggested that ARP reduced the incidence of CSDHs after surgical clippings in patients with unruptured aneurysms.