World Neurosurg
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Investigating neurosurgical interventions for traumatic brain injury (TBI) involves complex methodological and practical challenges. In the present report, we have provided an overview of the current state of neurosurgical TBI research and discussed the key challenges and possible solutions. ⋯ In settings in which traditional RCTs are difficult to conduct and substantial confounding by indication can be present, observational studies using an instrumental variable analysis and "pragmatic" RCTs are promising alternatives. Embedding TBI research into standard clinical practice should be more frequently considered but will require fundamental modifications to the current health care system. Finally, multimodality outcome assessment will be key to improving future surgical and nonsurgical TBI research.
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Proximal junctional kyphosis (PJK) is a widely recognized complication of adult spinal deformity surgery, and various PJK prevention strategies have been reported in recent years. The goal of the present study was to perform a systematic review of the PJK prevention strategies, report on their effectiveness, and delineate future directions for investigation regarding PJK prevention. ⋯ The reports of PJK prevention strategies were heterogeneous, and high-level evidence regarding any particular technique remains limited. Further development of additional PJK prevention techniques and validation of their efficacy in clinical practice are needed to optimize the outcomes of adult spinal deformity surgery.
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Some giant intracranial aneurysms can develop serpentine morphology, secondary to a peculiar near-complete intra-aneurysmal thrombosis. The resulting complex angioarchitecture, along with atypical clinical presentations (i.e., mass effect, distal ischemia) seen, makes management of such aneurysms technically challenging. These aneurysms are not amenable to endovascular treatment, and hence the only remaining treatment option is a tailored microsurgical procedure (clipping/parent vessel occlusion or reconstruction/trapping/aneurysmorrhaphy) accompanied by a safety bypass (high-flow, low-flow, or in situ bypass, subject to dependence of distal circulation on proximal trunk with reference to aneurysm). ⋯ Intraoperative and postoperative angiography confirmed the anastomosis patency. The patient's recovery was uneventful. This treatment can save operating time, eliminate donor artery-related morbidity, and offer a surgical alternative to the conventional strategy of STA-MCA bypass.
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Biomedical research can generally be categorized into 1 of 3 aims: describing the occurrence of disease; identifying persons with or at increased risk of disease including diagnostic and prognostic studies; and explaining the occurrence of disease including etiologic and efficacy studies.
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It is essential for any epidemiologic and clinical investigation to determine the appropriate covariates for which to ascertain measures and subsequently model. A number of recent articles have sought to elucidate covariate selection in the context of data analysis. Unfortunately, few articles characterize covariate selection in the context of data collection and discuss their principles under the assumption that data are measured and available for analyses. ⋯ To the extent possible, this paper attempts to communicate these principles clearly and in the absence of advanced causal inference terminology. Finally, this paper provides a conceptual framework for covariate inclusion and exclusion with respect to data analysis and regression modeling. Specifically, this framework suggests that regression models 1) include all known common cause covariates; 2) include all sociodemographic covariates; 3) exclude any covariate that is known to be both a consequence of the exposure and cause of the outcome; and 4) generally, for every term included in the statistical model, there should be at least 10 observations in the data set.