World Neurosurg
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Multimodal intraoperative neuromonitoring (IOM) using somatosensory-evoked potentials and motor-evoked potentials is a sensitive and specific tool for detecting intraoperative neurologic injury during spine surgery. This study aimed to evaluate the use of multimodal IOM in a lower-middle-income country (LMIC) during cervical and thoracic spine surgery in order to prevent and predict new postoperative neurologic deficits early on. This is the first report of multimodal IOM application in LMICs. ⋯ Because of the limited experience and the many technical difficulties faced in LMICs, we found that this cutoff limit resulted in more false-positive warnings but helped to avoid any false-negative results, thus enhancing the safety of surgery.
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Meta Analysis
Outcomes of Pre-injury Utilization of Statins in Patients with Traumatic Brain Injury: A Systematic review and Meta-analysis.
No completely effective pharmacotherapies have been developed to improve the outcomes of traumatic brain injury (TBI). Given the reporting of cohort studies suggesting that preinjury statin use may reduce TBI-associated mortality, this study aimed to evaluate the effects of statin use in patients with TBI. ⋯ Preinjury statin use may contribute to mortality reduction in patients with TBI, whereas statin withdrawal might increase mortality. In clinical management, statin use should not be discontinued after TBI.
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Virtual reality (VR) use in health care has increased over the past few decades, with its utility expanding from a teaching tool to a highly reliable neuro-technology adjunct in multiple fields including neurosurgery. Generally, brain tumor surgery with the patient awake has only been performed for mapping of language and motor areas. With the rise of VR and advancing surgical techniques, neurosurgical teams are developing an increased understanding of patients' anatomo-functional connectivity. Consequently, more specific cognitive tasks are being required for the mapping and preservation of deeper layers of cognition. ⋯ The authors advocate for the use of a VR protocol as a feasible functional tool in awake-patient brain tumor surgery by using it as a complement during cognitive screening in addition to language testing.
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Mortality After Trauma Craniotomy Is Decreasing in Older Adults-A Nationwide Population-Based Study.
No evidence-based guidelines are available for operative neurosurgical treatment of older patients with traumatic brain injuries (TBIs), and no population-based results of current practice have been reported. The objective of the present study was to investigate the rates of trauma craniotomy operations and later mortality in older adults with TBI in Finland. ⋯ Among older adults in Finland, the rate of trauma craniotomy and later mortality has been decreasing although the mean age of operated patients has been increasing. This can be expected to be related to an improved understanding of geriatric TBIs and, consequently, improved selection of patients for targeted therapy.
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Review
Paving the path to wellness: a systematic review of wellness programs for neurosurgery trainees.
Neurosurgical trainees have a heavy workload and poor quality of life, resulting in high rates of burnout and attrition. Consequently, wellness programs have been used by various training institutions to combat this situation. ⋯ There is a paucity of literature regarding trainee wellness in neurosurgery. A few training programs have instituted wellness initiatives for trainees, and the feedback was generally positive. However, objective measures of efficacy such as validated questionnaires and scales yielded mixed results.