World Neurosurg
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Metric-based surgical training can be used to quantify the level and progression of neurosurgical performance to optimize and monitor training progress. Here we applied innovative metrics to a physical neurosurgery trainer to explore whether these metrics differentiate between different levels of experience across different tasks. ⋯ It is possible to differentiate between the skill levels of novices and experts according to parameters derived from the PsT1 platform, paving the way for the quantitative assessment of training progress using this system. During the current coronavirus disease 2019 pandemic, neurosurgical simulators that gather surgical performance metrics offer a solution to the educational needs of residents.
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Differences in presentation and outcomes in children and adults with spinal dermoid tumors have not been documented. Surgical outcomes for dermoid tumors in different spinal cord planes have also not been studied. ⋯ Presentation of dermoid cysts is distinctively different in children and adults. GTR is a challenge for intramedullary and large tumors. Recurrences may manifest several years after surgery, mandating life-long surveillance.
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In recent decades, the ever-expanding use of endoscopes and development of dedicated instrumentation have reshaped the panorama of surgical approaches to the frontal sinus.1 Nonetheless, the far lateral portion of the sinus might still represent a concern, especially in cases with unfavorable or distorted anatomy.2,3 We report the case of a 52-year-old man, referred to our department for recurrent episodes of left orbital swelling and supraorbital headache, 3 months after Draf III frontal sinusotomy for marsupialization of multiple frontal mucoceles. Computed tomography and magnetic resonance imaging scans were consistent with persistent inflammatory tissue in the far lateral left frontal sinus. ⋯ The patient is asymptomatic after 16 months (Video 1). The transorbital approach is effective in managing orbital and frontal sinus diseases,6 and the combination with the endonasal route grants complete access to the frontal sinus, even in cases of high pneumatization and lateral extension.4,7 Multiportal transorbital approaches represent additional techniques in the rhinologist's surgical armamentarium, which can overcome the limits of a single port approach.8,9 Reports on their use providing technical hints and critical considerations are to be encouraged to ease and stimulate the surgical training in this field.
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The objectives of this study were 1) to assess the long-term patient-reported outcomes of carpal tunnel release (CTR) in patients 80 years of age or older, and 2) to determine the long-term mortality rate of this population after CTR. ⋯ There are long-term benefits from CTR in patients 80 years of age or older. The mortality rate of this cohort mirrors that of the general population, and CTR is justified in this elderly age group both for the magnitude and duration of treatment effect.
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Neurosurgery is considered to have one of the greatest risks of medical malpractice claims. However, medicolegal issues in neurosurgery are often disregarded and underrated worldwide. Medical errors in the neurosurgical field can be attributed to multiple factors, including highly morbid pathologies, the technical difficulty of neurosurgical procedures, and the involvement and interaction of a multidisciplinary team in the care of neurosurgical patients. ⋯ Often, governments use additional tactics to decrease the burden on compensators and extrajudicial institutions and to decrease the court's flow of irrational litigation. Continuous amendments to health care acts and newer reforms to address these issues have materialized worldwide. In the present narrative review, we have reviewed the global perspectives of medicolegal issues, with a focus on neurosurgical discipline.