World Neurosurg
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Multicenter Study
Pipeline embolization in patients with posterior circulation subarachnoid hemorrhages: Is Takotsubo cardiomyopathy a limiting factor?
Hemorrhagic vascular lesions in the posterior cerebral circulation such as ruptured aneurysms and dissections can be challenging to treat. Flow diversion has become an important off-label option, but few studies have analyzed the safety of these devices in this setting. Using an international, multicenter cohort, we reviewed posterior circulation subarachnoid hemorrhage (SAH) patients treated with the Pipeline Embolization Device (PED) in the acute setting and assessed the incidence of Takotsubo cardiomyopathy (TCM). ⋯ We describe an unexpectedly high incidence of TCM after the placement of PEDs in patients with posterior circulation SAH in our large case series. Further studies will be needed to elucidate possible causes.
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Meta Analysis
Burnout among neurosurgeons and residents in neurosurgery: a systematic review and meta-analysis of the literature.
Burnout syndrome (BS) is a common condition among medical professionals. It is composed of 3 different subdimensions: emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). In the last years, interest in BS in the neurosurgical community has increased. Here we investigated burnout among neurosurgeons and residents in neurosurgery. ⋯ Neurosurgery is a rewarding career choice, but numerous challenges and stressors can lead to lower levels of satisfaction and dangerously increased levels of burnout. We hope that our results will generate discussion, raise awareness, stimulate further studies, and lead to programs designed to mitigate excessive stress and burnout in neurosurgeons.
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A high-riding vertebral artery (HRVA) has been defined as a C2 isthmus height of ≤5 mm and/or internal height of ≤2 mm measured 3 mm lateral to the border of the spinal canal. Its reported prevalence has varied widely. If overlooked during the approach for craniocervical fusion, injury to the vertebral arteries can occur, affecting the outcome. The present meta-analysis aimed to provide the pooled prevalence of HRVAs. ⋯ Craniocervical fusion should be preceded by examination of the vertebral arteries at the level of C2 because the presence of HRVAs is common and might preclude the safe insertion of transarticular or transpedicular screws.
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Review Case Reports
Adersson lesion occurred in the lumbosacral segment of a young man: A case report and literature review.
Andersson lesion (AL) is not a rare complication of ankylosing spondylitis (AS), but it seldom occurs in single lumbosacral segments or young people. We present a case of a young patient with AS and AL between L5 and S1. ⋯ AL rarely occurs in the lumbosacral region or in young people and can be misdiagnosed as spinal tuberculosis. Surgical treatment of AL aims to relieve spinal nerve compression, reconstruct spinal stability, and restore sagittal balance. In view of the ambiguous anatomic landmark of patients with AS, we recommend surgery assisted with O-arm navigation, which clearly showed the entry point and guaranteed the accuracy of pedicle screw placements.
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New York City is the epicenter of the novel coronavirus disease 2019 (COVID-19) pandemic in the United States. Traumatic brain injury accounts for a significant proportion of admissions to our trauma center. We sought to characterize the effect of the pandemic on neurotraumas, given the cancellation of nonessential activities during the crisis. ⋯ A decrease in the frequency of neurotraumas was observed during the COVID-19 crisis concomitant with the increase in COVID-19 patients in the city. This trend began after the cancellation of nonessential activities and implementation of social distancing recommendations.