World Neurosurg
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The use of multidisciplinary teams (MDTs) comprised of all members of the patient care team is becoming increasingly popular in the field of oncology. We present a single-center experience exploring the utility and uniqueness of an MDT in the care of patients undergoing brain and spine stereotactic radiosurgery (SRS). ⋯ We present our institutional MDT model, a framework and workflow that can be incorporated at other large academic centers. We believe that the SRS conference has educational, academic, and patient care value.
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Navigated transcranial magnetic stimulation (nTMS) provides a reliable identification of "eloquent" cortical brain areas. Moreover, it can be used for diffusion tensor imaging fiber tracking of eloquent subcortical tracts. We describe the use of nTMS-based cortical mapping and diffusion tensor imaging fiber tracking for defining the "eloquence" of areas surrounding brain arteriovenous malformations (BAVMs), aiming to improve patient stratification and treatment. ⋯ The nTMS-based information allows an accurate stratification and allocation of patients with BAVMs to the most effective treatment according to a modern, customized, neurophysiological identification of the adjacent eloquent brain networks.
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Deciding to treat unruptured intracranial aneurysms (UIA) involves discussion with patients about outcomes data and personal attitudes toward risk of rupture versus procedural complication risk. We performed a qualitative analysis of online interpatient discussions to investigate perspectives on medical decision making. ⋯ This is the first ethnographic account of decision making among patients with UIAs. Newly diagnosed patients explored treatment options using online forums. They faced ambiguity in identifying optimal management, creating apprehension and decisional conflict. Further research is required to improve risk communication and individualized decision making for patients with UIAs.
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Minimally invasive surgical techniques may have beneficial effects on spontaneous intracerebral hemorrhage. Accurate localization of the hematoma and real-time guided puncture are more important in minimally invasive surgical procedures than in traditional craniotomy. Here, we introduce a novel simple puncture positioning and guidance system for intracerebral hematoma and demonstrate its utility for hematoma puncture surgery in a simulation experiment and series of patients. ⋯ We demonstrate a novel simple puncture positioning and guidance system that has the advantages of simplicity, low-cost, device availability, and individual real-time guidance. We believe this system may be useful in resource-limited centers where navigation is not available.
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Vagus nerve stimulation (VNS) has become an increasingly popular procedure for the treatment of epilepsy and depression. Significant complications or side effects associated with VNS surgery may result from either the inadvertent direct injury to the vagus nerve as part of the surgical approach, placement of the electrode, or the concomitant stimulation of vagal efferent fibers. To mitigate these effects, the recognition of anatomic variants that may place the nerve at increased risk is necessary. ⋯ This is the first reported case of cervical vagus nerve duplication presented in the literature. Surgeons performing VNS implantations should be cognizant of this potential anomaly in order to avoid inadvertent injury to the nerve.