World Neurosurg
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Explore the consequences of the coronavirus pandemic (COVID-19) on patients suffering from cerebrovascular disorders necessitating interventions. ⋯ The pandemic led to more severe disease progression and reduced diagnoses due to screening delays, indicating deferred care. Prolonged operative times, extended hospital stays, and worsening outcomes, including infections and thrombotic events, hint at the repercussions of persistent staff shortages in health care facilities. Ethnic and racial minorities faced disproportionate impacts. To minimize harm to patients with cerebrovascular disease in future public health crises, it is crucial to develop policies that address these findings.
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Chiari I malformation results from a mismatch between the posterior fossa bones and neural components. Management usually relies on surgical treatment. Despite being the most common assumed positioning, the prone position can be challenging in high body mass index (BMI) patients (>40 kg/m2). ⋯ We present our results and technical nuances on positioning high BMI patients for posterior fossa decompression using a semi-sitting position.
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To trace the evolution of ideas and practice in the management of meningeal injury from the ancient world to the end of the 18th century. ⋯ The evolution of the management of meningeal injury was colored by erroneous concepts. It was not until the Renaissance and finally the Enlightenment that a milieu developed that permitted examination, analysis, and clarification of the underlying processes that could lead to rational management.
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Paddle lead spinal cord stimulation (SCS) is used to treat refractory chronic pain. Morbidly obese patients seek SCS to reduce chronic pain. However, these patients face worse surgical outcomes, and the SCS literature has not evaluated safety and efficacy in this patient population. This study is the largest single-surgeon case series to date on morbidly obese patients with paddle lead SCS implantations. The primary objective is to report postoperative complication rates in morbidly obese patients receiving SCS implants. The secondary objective is to report patient-reported pain scores and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function scores in these patients. ⋯ Paddle lead SCS implantation is safe for morbidly obese patients. The only minimal-risk complications present were postoperative infections and wound dehiscence. Surgical care can be modified to further reduce the rates of infection and dehiscence.
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Endovascular treatment (EVT) of unruptured cerebral aneurysms (UCA) offers a safer alternative to clipping. However, it is still associated with an increased risk for Postprocedural Neurological deficit (PPND). Prompt recognition using intraoperative neurophysiologic monitoring (IONM) and intervention can reduce the incidence and impact of new postoperative neurological complications. We aim to evaluate the diagnostic accuracy of IONM in predicting PPND after EVT of UCA. ⋯ IONM with somatosensory evoked potentials alone or in combination with electroencephalography has high diagnostic accuracy in detecting periprocedural complications and resultant PPND during EVT of UCA.