World Neurosurg
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Meta Analysis
Crossing the Cervicothoracic Junction in Multilevel Cervical Arthrodesis: A Systematic Review and Meta-Analysis.
In multisegment cervical arthrodeses, a common clinical dilemma for the surgeon is whether to extend the fusion past the cervicothoracic junction (CTJ). This meta-analysis compares clinical outcomes and radiologic parameters when crossing and not crossing the CTJ. ⋯ In multilevel cervical arthrodesis, not crossing the CTJ is associated with a higher risk of overall reoperation and ASD requiring reoperation than crossing the CTJ, along with lower EBL and LOS. Differences in successful fusion, patient-reported outcomes, and sagittal radiologic parameters were not significant.
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The overall safety and efficacy of flow diverting stents (FDSs) deployed in small caliber parent arteries (≤2.5 mm) for the treatment of intracranial aneurysms remains unclear. Recent studies have provided additional outcomes data to assess the use of FDSs for such arteries. In the present review, we have summarized the reported clinical and angiographic outcomes of FDS-treated brain aneurysms in small parent arteries. ⋯ FDSs for the treatment of intracranial aneurysms located in small caliber arteries was associated with rates of long-term complete aneurysm occlusion, mortality, and permanent neurologic deficit comparable to the rates with FDS-treated aneurysms in larger parent arteries. However, the relatively increased risk of symptomatic stroke of these FDS-treated aneurysms should not be ignored. Direct comparisons with alternative endovascular approaches are necessary to further define the optimal use of FDS for these aneurysms.
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Modern cerebrovascular bypass surgery uses either extracranial-intracranial (EC-IC) or intracranial-intracranial (IC-IC) approaches. Compared with EC-IC bypasses, IC-IC bypasses allow neurosurgeons to safely address tumors, aneurysms, and other lesions using shorter grafts that are well matched to the size of recipient vessels. Fewer than 100 articles have been published on IC-IC bypasses compared with more than 1000 on EC-IC bypasses. This study examined the increase of interest and innovation in IC-IC bypass. ⋯ As more work is undertaken on IC-IC bypasses, it is critical for knowledge to be shared through research, collaboration, publication, and early teaching within residency training programs. This field has increased exponentially in the past 2 decades and has yet to reach an inflection point, indicating possible additional interest and growth over time.
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Review
Diversity in Neurosurgical Recruitment and Training in the United States: A Systematic Review.
The benefits of diversity are particularly salient in neurosurgical training because of treatment of varied patient populations and the importance of close collaboration between trainees and attending neurosurgeons of different backgrounds. However, there is a paucity of literature that comprehensively examines diversity in neurosurgical recruitment and training. The aim of this study is to systematically review the scope of diversity in neurosurgical recruitment and training. ⋯ This systematic review shows the scope of studies of diversity within neurosurgery and provides impetus for efforts to expand our understanding of diversity within the field.
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Neurosurgery is a medical field that requires specialized professionals and equipment, 2 important but scarce resources in low- and middle-income countries. Our goal was to report our experience with the replacement and implementation of linear accelerators with radiosurgery capabilities at "Sociedad de Lucha Contra el Cáncer" (SOLCA) Hospital in Quito, Ecuador, and give some recommendations for future technological replacements (TRs). ⋯ The TR in SOLCA had similarities with other experiences in low- and middle-income countries, but the pandemic brought additional limitations, mainly complicating the staff training. Nevertheless, those limitations can be resolved with a structured training program and international collaboration. Overall, the benefits obtained from a TR result in exponentially better medical care and accessibility to novel treatments.