World Neurosurg
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Traumatic brain injury (TBI) is the leading cause of morbidity and mortality worldwide. Several prognostic factors have been developed to predict functional outcomes and mortality rate in patients with TBI. Neutrophil-to-lymphocyte ratio (NLR) is an objective, available, low-cost, and reproducible indicator of inflammation. ⋯ Further, higher NLR value is in correlation with lower Glasgow Coma Scale scores. Thus its role as a complementary index to other factors, such as Glasgow Coma Scale, in predicting outcomes after TBI is under investigation. This review aims at gathering the most recent data on the prognostic value of NLR in patients with TBI.
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Review Historical Article
A Forgotten Tale from the Great War: General Lorenzo Bonomo and the Birth of Italian War Neurosurgery.
Little is known of the advances in battlefield medicine achieved in Italy before and during the Great War. Some deserve wider recognition; this is especially true for the field of neurosurgery. There are a limited number of historical records currently available, fewer still in English, and most of the systematic investigations on field surgery have been in the form of monographs within science history reviews, which obviously lack a strictly clinical perspective. ⋯ Lorenzo Bonomo. His incredibly advanced and modern ideas had unfortunately been forgotten. He pioneered research in the ballistic and forensic medical fields, building on first-hand experience, as he performed surgeries himself before the conflict and even while on the frontline, actively working to improve the chances of survival for the Italian troops fighting in the Great War.
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The authors discuss the implications of the COVID-19 pandemic on the use of telehealth in the United States.
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Case Reports
Nasoseptal Flap Necrosis After Endoscopic Skull Base Surgery in the Setting of SARS-CoV-2/COVID-19.
A novel viral strain known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created a worldwide pandemic known as coronavirus 2019 (COVID-19). Early reports from China have highlighted the risks associated with performing endoscopic endonasal skull base surgery in patients with SARS-CoV-2. We present a rare complication of nasoseptal flap (NSF) necrosis associated with COVID-19, further emphasizing the challenges of performing these procedures in this era. ⋯ To our knowledge, this is the first reported case of NSF necrosis in a patient with COVID-19. We postulate that the thrombotic complications of COVID-19 may have contributed to vascular pedicle thrombosis and NSF necrosis. Although the pathophysiology of SARS-CoV-2 and its effect on the nasal tissues is still being elucidated, this case highlights some challenges of performing endoscopic skull base surgery in the era of COVID-19.
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Recently, there has been significant interest in understanding the cost-effectiveness of treatments in spine surgery as health care systems in the United States move toward value-based care and alternative payment models. Previous studies have shown comparable outcomes of cervical disc arthroplasty (CDA) and anterior cervical discectomy fusion; however, there is a lack of consensus on the cost-effectiveness of CDA to support full adoption. Evidence of the limitations of these cost-analysis studies also exists in the literature, including industry funding, potential selection bias, and varying methods of calculating value. The goal of this narrative review is to provide an overview of the cost-effectiveness of CDA compared with anterior cervical discectomy and fusion, and potential limitations with cost-analysis studies in spine surgery.