World Neurosurg
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Case Reports
Percutaneous Transverse Sinus Cannulation for Dural Arteriovenous Fistula Coiling: Operative Video.
This is the case of an 84-year old woman, found to have a symptomatic transverse sinus dural arteriovenous fistula. The transverse sinus was isolated from all venous circulation and its arterial feeders stemmed from the occipital artery, precluding both arterial and venous access for effective obliteration of the fistula. Therefore the patient underwent a combined open surgical/endovascular approach, where the sinus was percutaneously cannulated through a single burr hole, allowing access for effective coiling of the fistula. In this video, we present the rationale, feasibility, and technical implications for this procedure.1.
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In the past decade, prevalence of obesity in the United States have been soaring at a disparaging rate. Previous spine studies have associated obesity with inferior surgical outcomes, increased complication and 30-day readmission rates, and worsening patient-reported outcomes. However, there is a paucity of data identifying whether the impact of obesity is sustained in patients undergoing complex deformity correction involving 7 levels or greater. The aim of this study was to determine whether obesity impacts surgical outcomes, patient-reported pain scores, and 30-day readmission rates after complex spinal fusions ≥7 levels. ⋯ Our study suggests that obesity does not significantly affect surgical outcomes, patient-reported pain scores, and 30-day readmission rates after complex spinal surgery requiring ≥7 levels of fusion. Further studies are necessary to corroborate our findings.
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An increasing body of literature describing use of high-fidelity surgical training models is challenging long-held dogma that cadavers provide the best medium for postgraduate surgical skills training. The purpose of this study was to describe a surgical skills course comprising entirely synthetic training models developed by resident and attending neurosurgeons and to evaluate their perceptions of the overall usefulness of this course and its usefulness compared with cadaveric courses. ⋯ Resident and attending neurosurgeons subjectively believe that high-fidelity synthetic models were superior to cadavers as a surgical skills teaching platform. This study raises the question of whether cadavers should remain the gold standard for surgical skills courses. Expanded use of these teaching models and further study are warranted.
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Brain metastasis (BM) from breast cancer is increasingly encountered clinically because of the continuing success in the oncological control of the primary disease. Data-driven reports on the surgical treatment of BM from breast cancer are sparse in sub-Saharan Africa. ⋯ Surgical resection is feasible for BM from breast cancer even in low-resource clinical practice. It has a salutary effect on the patients' quality of life.
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Cervical spondylotic myelopathy (CSM) severity and presence of symptoms are often difficult to predict based simply on clinical imaging alone. Similarly, improved machine learning techniques provide new tools with immense clinical potential. ⋯ Machine learning provides a promising method for prediction, diagnosis, and even prognosis in patients with CSM.