World Neurosurg
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To comprehensively analyze malpractice claims relating to arteriovenous malformations. ⋯ While the courts rule in favor of defendants more than plaintiffs, the time and psychological demands of litigation place a high burden on physicians.
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Although neurotropic, the varicella-zoster virus (VZV) is a rare cause of mycotic cerebral aneurysms. As with other mycotic aneurysms, medical management can provide complete resolution. Surgery for refractory aneurysms can be complicated by vessel friability and complex morphologies requiring excision and revascularization. ⋯ Postoperatively, she was at her neurologic baseline and was discharged 2 weeks later. Immediate and 5-month postoperative vascular imaging demonstrated bypass patency and no residual aneurysm. Similar to other mycotic aneurysms, VZV-associated cerebral aneurysms refractory to medical management can be safely treated with definitive excision and revascularization in selected patients.
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Innovations in spinal endoscopy technology and technique have broadened their applications during the past 10 years. Smaller outer-diameter working-channel endoscopes have permitted safe usage in the cervical spine for full endoscopic decompressions. Endoscopic fusions have now been widely reported, leveraging compatible instrumentation for disc preparation and expandable interbody grafts. ⋯ Revision surgery after open or minimally invasive posterior discectomy or instrumentation can now be performed with endoscopic techniques, which often leverage the transforaminal approach to avoid scar tissue and adhesions. These procedures, among other endoscopic surgeries, are now being increasingly performed in ambulatory surgery centers, as safe outcomes, economic benefits to the healthcare system, and patients' desire to recover at home are becoming more apparent. Finally, the standardization of endoscopic terminology, which has long been a confounder to proper communication and education in this field, has recently been addressed by leading experts in a consensus document, which will serve as the foundation for future collaborative advancements.