World Neurosurg
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Stereoelectroencephalography (sEEG), despite its established usefulness, has not been thoroughly evaluated for its adverse events profile. In this study, hemorrhage rates were evaluated both per patient and per lead placed not only in the immediate postoperative period, but also over the course of admission and after explantation when available. ⋯ Hemorrhage after sEEG lead implantation and explantation may be more common than previously reported. Consistent postexplantation imaging may be of clinical benefit in detecting hemorrhage that precludes patients from immediate discharge, particularly in older patients.
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Attainment of micro-neurosurgical skills is a challenge in teaching hospitals throughout training. Models that mimic the workflow as well as haptics are time-consuming, expensive, and unsuitable to serve as a routine platform. Our objective was to present a model and a set of tasks, based on a hard-boiled egg, microscope, and a Cavitron ultrasonic aspirator (CUSA; Integra Lifesciences Corp., Tullamore, Ireland), which is cheap, easy to setup and can be used for training microsurgery and CUSA skills, required for removal of deep-seated tumors. ⋯ The egg model is an easy-to-handle, cheap model that enables the acquisition of basic micro-neurosurgical skills and basic workflow required for removing of intrinsic brain tumors. This study has validated and defined reproducible tasks that can be scored, correlated with performance. This model can be incorporated into a resident's routine and potentially provide an accessible training platform for neurosurgical trainees.
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Trigeminal neuralgia is defined by paroxysmal pain on the trigeminal nerve territory. The petroclival meningioma presents with trigeminal neuralgia in less than 5% of the cases. We report a case of a petroclival meningioma that encased the fifth nerve and was resected through a Kawase approach. ⋯ The Kawase approach is an interesting access for petroclival tumor resection.
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Practicing neurosurgery in 2021 requires a detailed knowledge of the vocabulary and mechanisms for coding and reimbursement, which should include general knowledge at the global level and fluency at the provider level. It is specifically of interest for the neurosurgeon to understand conceptually the nuances of hospital reimbursement. That knowledge is especially germane as more neurosurgeons become hospital employees. ⋯ We illustrate the formula to generate physician reimbursement through the current relative value unit structure. We also seek to explain hospital-level reimbursement through the diagnosis-related group structure. Finally, we expand about different and ancillary income streams available to neurosurgeons and provide a realistic assessment including the opportunities and challenges of those entities.
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The demand of thrombectomy treatment for acute ischemic stroke increased dramatically in the United States after the publication of 5 pivotal trials in 2015. The impact of call burden on career satisfaction and burnout in neurointerventionalists has not been explored. ⋯ The burden of stroke call has strong implications for career satisfaction and burnout in neurointerventionalists. This model can be used by hospitals, departments, and physician groups to better conceptualize conditions that facilitate burnout and attrition. Changes to hospital management practices and culture may be the most productive focal areas for intervention.