World Neurosurg
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Three-dimensional (3D) printing technology presents a promising avenue for the development of affordable neurosurgical simulation models, addressing many challenges related to the use of cadavers, animal models, and direct patient engagement. The aim of this study is to introduce and evaluate a new high-fidelity neurosurgical simulation model targeted for both burr hole and craniotomy procedures. ⋯ The findings indicate that widely accessible and economical desktop SLA 3D printers can provide an effective solution in neurosurgical training, thus promoting their integration in hospitals.
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A low neurosurgeon-to-patient ratio persists to be a problem in many developing nations including Pakistan. Concurrent gender disparities further exacerbate the challenges posed by the already limited workforce. An understanding of the perceptions of neurosurgery among female early career doctors is crucial in the evolution of the field in terms of both, workforce strength and inclusivity. ⋯ Significant differences exist in how male and female medical students perceive neurosurgery as a career choice. Interventions including availability of daycare facilities for children, creation of inclusive workplace environment, and promotion of mentorship programs catering to women can help bridge this gap and contribute to evolution of the field of neurosurgery in the developing world.
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Comparative Study
What is the True Cost of Motion Preservation? A Time-driven Activity-Based Cost Analysis of Anterior Cervical Discectomy and Fusion Versus Disc Replacement.
Total disc replacement (TDR) has become a viable alternative to anterior cervical discectomy and fusion (ACDF) for select patients. Although most comparative studies have assessed outcomes, cost differences remain largely uninvestigated. This information is critical as we move towards value-based reimbursement. To address this knowledge gap, we used time-driven activity-based costing to compare total intraoperative costs between the 2 procedures. ⋯ Time-driven activity-based costing is a highly useful methodology for estimating differences in true costs between procedures and determining cost drivers. TDRs were associated with an additional $3885 of total intraoperative cost as compared to ACDFs, the majority of which was driven by the cost of implants.
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Although magnetic resonance imaging is the primary modality of investigation for determining the extent of posterior ligamentous complex (PLC) injuries in lower lumbar fractures (LLF) (L3-L5), the reliability of computed tomography (CT) has not been well defined. The main objective of this study is to analyze the diagnostic accuracy of combined CT findings for detecting PLC injury in patients with LLF. ⋯ Among the various CT parameters, facet joint diastasis (FJDS > 4.2 mm and FJDA > 3.5 mm) is the most reliable factor in determining PLC injury.
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Case Reports
Intradural Extramedullary Small Cell Lung Cancer Metastasis Resection: 2-Dimensional Operative Video.
The presented surgical video (Video 1) demonstrates the resection of an intradural extramedullary metastasis in a 62-year-old female patient with a history of metastatic small cell lung cancer (SCLC). SCLC commonly metastasizes to the central nervous system.1,2 However, the vast majority of such metastases are to the brain.1,2 Interestingly, the presented patient had a cerebellar SCLC metastasis operated on 10 months earlier. Several cases of intradural extramedullary spinal drop metastases arising from cerebellar tumors have been described in the literature, suggesting that a drop metastasis is a likely mechanism to explain this rare topography.3-5 Preoperatively, the patient presented with 1 month of back pain and rapidly progressing left lower extremity weakness and myelopathic signs so surgery was offered.6-10 Interval imaging showed an intradural extramedullary T4-T5 lesion suspicious for metastatic disease. ⋯ Complete resection required sacrifice of the left T5 nerve root and cutting of the dentate ligament in 2 locations for adequate visualization. Postoperative neurologic exam demonstrated improvement in her lower extremity weakness, and postoperative magnetic resonance imaging showed gross total resection. The postoperative course was uneventful, and the patient was discharged home on postoperative day 6.