World Neurosurg
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Meta Analysis
The effectiveness of physical exercise after lumbar fusion surgery: a systematic review and meta-analysis.
The aim of the study was to review the effect of exercise interventions in patients after lumbar fusion surgery. It was sought to reveal the effect of exercise protocols on various clinical parameters. ⋯ The systematic review results demonstrated that cognitive therapy or consultation during the exercise program provides better outcomes in lumbar fusion surgery over exercise alone. Positive effects of core stabilization training on muscle strength and endurance were observed in the short term; however, this superiority was not the case in long-term studies. Meta-analysis results proved the positive effect of additional cognitive therapy to exercise on disability and kinesiophobia.
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Neurosurgeons have a rich history of involvement in medical student education. We review the scope of related published works with the goal of highlighting recently increased efforts to innovate in neurosurgical education and discuss where future efforts must go. A scoping review was performed after comprehensive search of PubMed MEDLINE and Embase databases. ⋯ Despite increasing need for neurosurgical education in medical school, available experiences in formal curricula are diminishing. Longitudinal exposure to neurosurgery throughout medical school will help ensure a foundational understanding of neurosurgical disease management for all physicians and provide a pathway of exploration, education, and mentorship for the most suitable candidates. Neurosurgery faculty mentorship is particularly important to ensure that the next generation of neurologic surgeons is well equipped to treat patients, catalyze innovative research, and espouse both diverse perspectives and novel ideas.
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Enhanced Recovery After Surgery (ERAS) protocols describe a standardized method of preoperative, perioperative, and postoperative care to enhance outcomes and minimize complication risks surrounding elective surgical intervention. A growing body of evidence is being generated as we learn to apply principles of ERAS standardization to neurosurgical patients. ⋯ This review synthesizes recent findings to generate evidence-based guidelines to manage neurosurgical oncology patients with standardized systems and assess ability of these systems to coordinate multidisciplinary, patient-centric care efforts. Furthermore, we highlight the potential usefulness of multimedia, app-based communication platforms to facilitate patient education, autonomy, and team communication within each of the 3 settings.
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Endovascular thrombectomy (EVT) for acute ischemic stroke via direct carotid puncture (DCP) has been commonly reported as case reports and series in the literature. However, the reported procedural risk and therapeutic outcome associated with this approach were variable. In this study, we aim to establish the role and safety profile of this alternative access technique by describing our single-center experience and conducting a comprehensive review of the literature. ⋯ Results from the literature review and our experience illustrate DCP as a feasible approach for EVT. The role of DCP as a bailout is iterated despite a higher complication risk, which may be imperative in low-volume stroke centers. Further studies to evaluate the role of DCP as a primary vascular access technique for EVT in selected cases could be explored.
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At our institution, patients undergoing neurosurgical procedures in the posterior cranial fossa are placed either in the semisitting or in the supine position. The major risk of the semisitting positioning is a venous air embolism (VAE), which may, however, also occur in the supine position. ⋯ The semisitting position with TEE monitoring and a standardized protocol is a safe and advantageous technique, taking account of a significant rate of VAEs. VAEs also occur in the supine position, but less frequently.