World Neurosurg
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To compare perioperative outcomes, patient-reported outcome measures (PROMs), and minimum clinically important difference achievement after single-level transforaminal lumbar interbody fusion (TLIF) in patients stratified by preoperative comorbidity burden. ⋯ The results suggest that patients undergoing MIS TLIF with severe comorbidities can expect a similar postoperative trajectory for disability, leg and back pain, and physical function. However, long-term (1 year) mental health improvement from preoperative baseline was noted only in the mild to moderate comorbidity group.
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In a flipped classroom, students learn lecture material before class and then participate in active learning during in-person sessions. This study examines preferences for flipped classroom activities during a neurosurgery presentation on traumatic brain injury. ⋯ Medical students highly preferred case scenarios because according to their comments, this method was relevant to real-life situations and led to higher information retention. This information suggests that the flipped classroom model for neurosurgical-based lectures is preferred, is beneficial, and should incorporate case scenarios. This methodology may also apply to neurosurgical residency training.
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Posterior fossa approaches are common neurosurgical procedures. Rates of postoperative infection, pseudomeningocele, and cerebrospinal fluid (CSF) fistula are high; however, evidence regarding predisposing risk factors and treatment outcomes remain sparse. ⋯ History of diabetes, cranioplasty, revision surgery, and surgery for tumor resection are identified as risk factors for the development of infection, pseudomeningocele, and CSF fistula, respectively.
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Observational Study
Pilot study of neurological pupil index as a predictor of external ventricular drain clamp trial failure after subarachnoid hemorrhage.
External ventricular drains (EVDs) provide a temporary egress for cerebrospinal fluid (CSF) in patients with symptomatic hydrocephalus following aneurysmal subarachnoid hemorrhage. Before EVD removal, a wean trial, which involves clamping the EVD, is typically attempted to ensure that CSF self-regulation is achieved. Automated infrared pupillometry (AIP) has been shown to detect early neurologic decline. We sought to explore the use of AIP to detect early EVD clamping trial failure. ⋯ The pilot study data support that Neurological Pupil index <3 is a potential indicator of early clamp trial failure, but a CT scan has a higher sensitivity and NPV for predicting successful EVD removal. This finding suggests the benefits of including AIP assessments during clamping trials.