World Neurosurg
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To define the role of neuroendoscopy as an adjuvant technique for the management of pediatric complex hydrocephalus. ⋯ We have confirmed that neuroendoscopy has a main role in the long-term management of complex hydrocephalus, significantly contributing to the reduction of the number of shunts and the shunt revision rate. Neuronavigation should be performed in all cases in which the ideal trajectory should be established.
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Single-level open lumbar microdiscectomy surgery is one of the most straightforward and effective spinal surgeries performed by spinal surgeons today to treat disk herniation. Although a common operation, little in the literature is reported on the exact overall time, cost, and effort associated with the performance of this surgery. The consistency of this operation across institutions and disciplines makes it a good starting point to accurately track the total time and effort of all phases of the surgical intervention. ⋯ Comparing our results with the Centers for Medicare and Medicaid Services data, a significant discrepancy and underestimation was observed. As such, we hope our results enable health care providers to more accurately allocate resources for the provision of high-quality medical care to patients with this increasingly common condition.
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Case Reports
Skin Augmentation as a Last-Resort Operative Technique During Decompressive Craniectomy.
Since 2009, we have performed skin augmentation using a Gore-Tex patch as a last-resort measure to reduce intracranial pressure (ICP) in uncontrollable brain swelling during decompressive craniectomy (DC). Here, we report our experience and outcome in a consecutive series of patients undergoing DC with skin augmentation (DC+S). ⋯ Decompressive craniectomy with skin augmentation may be used as a last-resort measure in cases of severe brain swelling despite DC.
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Older patients are increasingly presenting for surgery with intracranial meningioma because of progress with diagnostic imaging and longer life expectancy. However, older patients have many problems, such as comorbidities and reduced physiological capacity reflected in the frailty index. This study examines the factors affecting clinical deterioration after surgery in older patients, particularly factors associated with frailty. ⋯ Skull base tumor location and serum albumin correlated with deterioration of clinical status after surgery.
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Complete cavernous sinus resection has been described for patients with malignant or recurrent cavernous sinus tumors without other therapeutic options but has been associated with high morbidity and mortality rates. We reviewed the complications associated with complete cavernous sinus resection to gain insights for future complication avoidance. ⋯ Despite the high peri- and postoperative risks, complete cavernous sinus resection can be considered for select patients with tumors involving the cavernous sinus without other treatment options. Familiarity with cerebral bypass and free flap reconstruction of skull base defects is critical for complication avoidance and management.