World Neurosurg
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Review Case Reports
Rapid Recurrence and Anaplastic Transformation of a Pilocytic Astrocytoma in an Elderly Patient: A Case Report and Review of the Literature.
Rapid recurrence of a pilocytic astrocytoma with anaplastic transformation is extremely rare. The case of an elderly patient with a cerebellar pilocytic astrocytoma with anaplastic transformation during short-term follow-up is reported. ⋯ It is extremely rare, as in the present case, that a cerebellar PA in an elderly patient recurs rapidly with anaplastic transformation, despite deferred postoperative adjuvant therapy including radiation and chemotherapy. A novel molecular-targeted therapy is needed for anaplastic PA showing aggressive biological behavior.
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Case Reports
Endoscopic Endonasal Approach for Clival Chordoma with Subarachnoid Invasion: a 2D Step-by-Step Operative Video.
Chordomas are slow-growing, low-grade, locally invasive, and locally aggressive tumors. They peak at 40-60 years of age, with a male preponderance (2:1). ⋯ An endoscopic endonasal transclival approach was performed and gross total removal was achieved (Video 1). The patient had an uneventful recovery with no deficits, and he was then sent to proton beam therapy.
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To propose and validate a novel and comprehensive classification of lumbosacral spondylolysis and spondylolisthesis in the pediatric population according to surgical managements. ⋯ In our study, we proposed and validated a novel comprehensive classification of pediatric lumbosacral spondylolysis and spondylolisthesis. The pedicle screw-U rod system provided more benefits in the treatment of simple lumbosacral spondylolysis, and fusion from L5 to S2 combined with S2 screw would also benefit patients with high-degree spondylolisthesis.
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Outpatient spine surgery has been increasingly used recently owing to its perceived cost benefits and its ability to offset the volume from the inpatient setting. However, the 30-day outcomes of outpatient posterior lumbar fusion (PLF) for low-risk patients have not been extensively studied. In the present study, we assessed the 30-day outcomes of outpatient PLF surgery for low-risk patients using a national surgical quality registry. ⋯ Our results have demonstrated that the 30-day outcomes of patients who have undergone outpatient PLF might be comparable to those of patients who have undergone PLF in an inpatient setting. However, outpatient surgery might be associated with a greater overall reoperation rate.
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The utilization of locum tenens physicians in the United States has risen significantly as a stopgap for clinical practice needs, particularly in rural and other underserved areas. The difficulty in hiring new physicians to remote hospitals has resulted in the dependence of these institutions on locum tenens coverage. Here, we assess the quality and cost of neurosurgical care between locum and non-locum neurosurgeons in the United States, the first study in our knowledge to do so. ⋯ Among Medicare beneficiaries, there exists no difference in short-term complication rates, lengths of hospitalization, or costs between locum and non-locum neurosurgeons.