World Neurosurg
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Observational Study
Application of Causal Inference Methods in the Analysis of Observational Neurosurgical Data: G-Formula and Marginal Structural Model.
When using observational data to estimate the causal effects of a treatment on clinical outcomes, we need to adjust for confounding. In the presence of time-dependent confounders that are affected by previous treatment, adjustments cannot be made via the conventional regression approach or propensity score-based methods, but requires sophisticated methods called g-methods. We aimed to introduce g-methods to estimate the causal effects of treatment strategies defined by treatment at multiple time points, such as treat 2 days versus treat only day 1 versus never-treat. ⋯ Both g-formula and inverse probability-weighted marginal structural models can correctly estimate the effect of the treatment strategy under 3 identifiability assumptions, which conventional regression analysis cannot. G-methods may assist in estimating the effect of treatment strategy defined by treatment at multiple time points.
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To evaluate demographics, treatment options, and outcomes of traumatic brachial plexus injuries in pediatric patients. ⋯ Pediatric traumatic brachial plexus injuries are often high-energy injuries resulting in nerve root avulsions. Most patients were able to regain antigravity elbow flexion or stronger after brachial plexus reconstruction, and more than half had similar improvement in shoulder function. Treatment should be directed with goals of elbow flexion, shoulder stability/external rotation, and rudimentary grasp.
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To determine the association of preoperative hyponatremia with short-term postoperative complications and health care utilization (length of stay, readmissions) after anterior cervical fusion and discectomy (ACDF). ⋯ Preoperative hyponatremia is an independent risk factor for pneumonia and prolonged length of stay after ACDF.
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Recent publications on minimally invasive surgery (MIS) for hematoma evacuation have suggested survival benefits in select patients. Since 2015, our center has been performing an MIS technique using continuous irrigation with aspiration through an endoscope (stereotactic intracerebral underwater blood aspiration [SCUBA]). It is unknown how these patient outcomes compare with intracerebral hemorrhage (ICH) score predictions. Our aim is to determine if SCUBA patients had better 30-day mortality than predicted by their presenting ICH score. ⋯ This study suggests that minimally invasive hematoma evacuation with the SCUBA technique for ICH may reduce predicted 30-day mortality, with a number needed to treat of 4 to prevent 1 mortality.
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Sellar arachnoid cysts (SACs) are rare lesions that require treatment only if symptomatic. The endoscopic endonasal approach has been widely used. Despite their simple cystic appearance and the straight-forward surgical intervention, important associated risks exist, with cerebrospinal fluid (CSF) leak the prevalent risk. ⋯ The results from the present study have shown that SACs can be effectively treated using a simple cyst-opening technique. The routine use of nasoseptal flaps significantly reduced the risk of CSF leakage without compromising nasal quality of life in the long term or mandating additional incisions. Long-term follow-up is important to monitor for late recurrence.