World Neurosurg
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One possibly problematic feature of lumboperitoneal shunt (LPS) placement involves inaccuracy in handling the shunt valve compared with ventriculoperitoneal shunt. Flushing the valve to ascertain shunt patency and adjusting the valve pressure in LPS are often more difficult than with ventriculoperitoneal shunt, particularly when the valve is routinely located in abdominal fat. To overcome this inaccuracy, we applied a simple alteration to the usual LPS procedure. We changed the valve location from the abdominal fat to a lumbar posterior site where the paravertebral spinal muscle, in contrast to the nonsupportive abdominal fat, offers a good anchoring point for valve implantation. ⋯ In this series, our modification increased the accuracy of handling the valve without increasing discomfort.
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Acquisition of Basic Microsurgical Skills Using Low Cost Readily Available Models: The Orange Model.
Attainment of basic microsurgical skills in neurosurgery presents a departmental challenge worldwide. Models for teaching are either not readily available or expensive and are incompatible with a resident's busy schedule, requiring lengthy and proper setup. We present a model and a set of measurable tasks, based on a fruit (orange) that is cheap, easy to set up instantly when desired, and useful for training of basic microsurgical skills. ⋯ The orange model is an easily accessible, cheap model that enables the acquisition of basic microneurosurgical skills. In this work, we validated and defined reproducible tasks that can be scored and tracked, correlated with operator's proficiency and experience. This model can be incorporated into a resident's workflow environment and provides a platform for attainment of elementary microsurgical skills for neurosurgical residents.
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Acromegaly is a rare, chronic disorder that mostly results from growth hormone (GH)-secreting pituitary adenoma. Transsphenoidal surgery is the first-line treatment of this adenoma. This study aimed to identify factors associated with remission outcome in patients with GH-secreting pituitary adenomas following transsphenoidal surgery. ⋯ Preoperative insulin-like growth factor 1 index ≥2.5 and Knosp classification grade 3-4 were important prognostic factors that determined remission outcome after treatment. Patients who have both of these poor prognostic factors should be aggressively treated with surgery, medication, and probably radiation to optimally control the disease.