World Neurosurg
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Surgical treatment of advanced intracranial and extracranial communicating skull base tumors is challenging, especially for the reconstruction of the large composite defect left by tumor resection. The aim of the study is to evaluate the utility of the free flap reconstruction of the defects resulting from radical resection of these tumors in a single institution. ⋯ Free flap transfer is a safe and effective method with acceptable complications, useful for reconstruction of large composite skull base defects after salvage resection of advanced intracranial and extracranial communicating tumors. The functional and cosmetic results are satisfying.
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Previous studies have shown that deep brain stimulation (DBS) can improve the level of consciousness of comatose patients with traumatic brain injuries (TBIs). However, the most suitable targets for DBS are unknown, and the mechanisms underlying recovery remain to be determined. The aim of the present study was to assess the effects of lateral hypothalamic area-DBS (LHA-DBS) in comatose rats with TBIs. ⋯ Taken together, these results suggest that LHA-DBS promotes the recovery of consciousness in comatose rats with TBIs. Upregulation of α1-AR expression and downregulation of GABABR expression in the prefrontal cortex via the orexins and OX1R pathways might be involved in the wakefulness-promoting effects of LHA-DBS.
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One of the most preventable errors of a surgeon's career is operating on the incorrect surgical site (ICSS). No study in any specialty has ever investigated the incidence of ICSS events in lower-income countries. This study focuses on identifying the occurrence of these events along with an analysis of potential causes leading to these unfortunate events. ⋯ Due to a lack of application of safety checklist protocol, there is an increased occurrence of ICSS events in lower-income countries. The results of this study demonstrate the necessity of investing time and resources dedicated to avoiding preventable errors.
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Comparative Study
Robotic-Assisted vs. Conventional Posterior Lumbar Fusion - An Analysis of 90-day Complications & Readmissions.
To evaluate medical and surgical complication rates between robotic-assisted versus conventional elective posterior lumbar fusions. ⋯ Patients who underwent a robotic-assisted fusion had similar rates of surgical and medical complications compared with those who underwent a conventional fusion. Further studies are warranted to better understand the future role of robots in spine surgery.
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No established standard of care currently exists for the postoperative management of patients with surgically resected pituitary adenomas. Our objective was to quantify the efficacy of a postoperative stepdown unit protocol for reducing patient cost. ⋯ These results suggest that use of a postoperative stepdown unit could result in a 12.5% savings for eligible patients undergoing treatment of pituitary tumors by shifting patients to a less acute unit without worsened surgical outcomes. Historical controls indicate that over half of all pituitary patients would be eligible. Further refinement of patient selection for less costly perioperative management may reduce cost burden for the health care system and patients.