World Neurosurg
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Candidates for anterior cervical discectomy and fusion (ACDF) have a higher rate of opioid use than does the public, but studies on preoperative opioid use have not been conducted. We aimed to understand how preoperative opioid use affects post-ACDF outcomes. ⋯ Chronic opioid users had more comorbidities than opioid nonusers and mild opioid users, longer hospitalizations, and higher rates of postoperative complication, readmission, and reoperation. After balancing patients across covariates, the outcome differences persisted, suggesting a durable association between preoperative opioid use and negative postoperative outcomes.
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The neurosurgical sub-internship is a crucial step for prospective neurosurgeons. However, the expectations for sub-interns, particularly the technical skills required by residents and attendings, often are unclear. We present survey data on what medical students, residents, and attendings believe are important procedural proficiencies for neurosurgical sub-internships. We incorporated these tasks into a pilot skills-based craniotomy workshop, and here we report on the impact of the session on the neurosurgical training of medical students. ⋯ Although the expectations for sub-interns may be heterogeneous, there is general agreement that proficiency in the initial and final steps of craniotomies, as well as minor procedures, is recommended. Cadaveric labs can improve student engagement in neurosurgery, facilitate interactions with neurosurgical departments, and enhance technical skills.
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Interfacility transfers represent a large proportion of neurosurgical admissions to tertiary care centers each year. In this study, the authors examined the impact of the COVID-19 pandemic on the number of transfers, timing of transfers, demographic profile of transfer patients, and clinical outcomes including rates of surgical intervention. ⋯ The COVID-19 pandemic did not reduce the number of monthly transfers, operation rates, or catchment area for transfer patients. Transfer rates of uninsured patients increased during the COVID Era, potentially reflecting changes in access to community neurosurgery care. Shorter time to surgery seen in COVID-Era patients possibly reflects institutional policies that improved operating room efficiency to compensate for surgical backlogs. COVID status affeted time to surgery, reflecting the preoperative care that these patients require before intervention.
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Recurrence rates of anaplastic meningioma (AM) are high even after a complete resection with postoperative radiotherapy. ⋯ Early managements of patients with AM, before presence of poor preoperative KPS and large tumor size, are critical for survival. For patients with recurrent AM, survival benefits could be obtained from radiotherapy and multiple resections.
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There are limited data on the association between transport distance and outcomes in pediatric patients with severe traumatic brain injuries (sTBIs), despite children having to travel further to pediatric trauma centers (PTCs). ⋯ Regardless of the distance from the PTC at which their injury occurred, most children in this cohort made a moderate to good recovery. Children injured at greater distances from the PTC did not have worse outcomes; however, studies with larger cohorts are needed to more definitively assess prehospital pediatric transport systems in this population.