World Neurosurg
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Meta Analysis
An Algorithmic Approach to the Reconstruction of Esophageal/Hypopharyngeal Injuries after Anterior Cervical Spinal Fusion.
Anterior cervical disk fusion (ACDF) is a common surgical approach for the treatment of cervical spine pathology. Esophageal perforations, though uncommon, are a devastating complication of this surgery. The objective of this paper is to assess the success of different treatment approaches for the management of esophageal/pharyngeal injury after ACDF. ⋯ Pharyngoesophageal injuries, albeit rare, are a serious and often complex complication after ACDF procedures. We propose a detailed algorithmic approach to guide decision making if faced with this clinical challenge. The huge variability in how these patients are treated emphasizes the potential utility of future multiinstitutional studies.
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The presence of symptomatic lumbar facet cysts has been associated with segmental instability. Given this association, decompression versus decompression with fusion is a frequently debated topic. Multiple grading scales have been devised to identify patients at high risk for development of cyst recurrence; however, there exists no external evaluation of these scales. ⋯ The Rosenstock and NeuroSpine scores demonstrate good overall interrater reliability but are inconsistent in their ability to predict recurrence of lumbar facet cysts.
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Case Reports
Clinical features of pineal parenchymal tumors of intermediate differentiation (PPTID): A single institution series.
Pineal parenchymal tumors of intermediate differentiation (PPTID) are rare tumors of the pineal gland. Their treatment is often heterogeneous due to the lack of literature to compile standardized treatments. Although no single institution has large numbers of cases, our experience has been that the clinical course is more varied and complicated than reported. ⋯ Herein, we report clinical patterns of disease progression and treatment patterns of PPTID. Many patients progressed during the follow-up period. Disseminated disease was the most common presentation at recurrence. Ultimately, given the risk of recurrence and dissemination at recurrence, more aggressive treatment strategies should be considered. Specifically, our series suggests a benefit of adjuvant radiation at initial diagnosis for grade II patients.
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To explore the safe duration of temporary clipping of the parent artery under intraoperative electrophysiological monitoring. ⋯ Temporary intraoperative block is the risk factor for cerebral ischemia after operation. In this study, the temporary clipping time of the parent artery should not be longer than 6 minutes, and there is approximately 1 minute to adjust the current procedure after the electrophysiological warning to restore the baseline of intraoperative electrophysiological monitoring.
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Concerns about the changing demographics in the United States and the aging of the neurosurgical workforce exist. Both the importance and inherent risk of surgical responsibilities suggest that thought be given to whether workloads should change later in surgeons' careers. We sought to assess current neurosurgeons' expectations concerning their late-stage careers. ⋯ This study suggests that neurosurgeons have differing views on how workloads should change later in their careers. Younger neurosurgeons support an earlier decrease in workload or even a policy-mandated stop to operating after a certain age. These results may give insight into future trends and turnover in neurosurgery and provide a valuable tool to help practices anticipate workforce changes.