Surgical neurology international
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Intraoperative qualitative indocyanine green (ICG) angiography has been used in cerebrovascular surgery. Hyperperfusion may lead to neurological complications after superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. The purpose of this study is to quantitatively evaluate intraoperative cerebral perfusion using microscope-integrated dynamic ICG fluorescence analysis, and to assess whether this value predicts hyperperfusion syndrome (HPS) after STA-MCA anastomosis. ⋯ Time-dependent intraoperative parameters from the ICG transit curve provide quantitative information regarding cerebral circulation time with quality and utility comparable to information obtained by PET. These parameters may help predict the occurrence of postoperative HPS.
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Extracranial-intracranial (EC-IC) bypass and intracranial stenting (ICS) are both revascularization procedures that have emerged as treatment options for intracranial atherosclerotic disease (ICAD). This study describes and compares recent trends in utilization and outcomes of intracranial revascularization procedures in the United States using a population-based cohort. It also investigates the association of ICS and EC-IC bypass with periprocedural morbidity and mortality, unfavorable discharge status, length of stay (LOS), and total hospital charges. ⋯ The ideal management of patients with ICAD cannot yet be defined. Although much data from randomized and prospective trials on revascularization have been collected, many questions remain unanswered. There still remain cohorts of patients, specifically patients who have failed aggressive medical management, where not enough evidence is available to dictate decision-making. In order to further elucidate the safety and efficacy of these intracranial revascularization procedures, further clinical trials are needed.
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The optimal timing of cranioplasty after decompressive craniectomy for trauma is unknown. The aim of this study was to determine if early cranioplasty after decompressive craniectomy for trauma reduces complications. ⋯ After decompressive craniectomy for trauma, early (<12 weeks) cranioplasty does not alter the incidence of complication rates. In patients <18 years of age, early (<12 weeks) cranioplasty increases the risk of bone resorption. Delaying cranioplasty (≥12 weeks) results in longer operative times and may increase costs.
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On 1 October 2015, a new federally mandated system goes into effect requiring the replacement of the International Classification of Disease-version 9-Clinical Modification (ICD-9-CM) with ICD-10-CM. These codes are required to be used for reimbursement and to substantiate medical necessity. ICD-10 is composite with as many as 141,000 codes, an increase of 712% when compared to ICD-9. ⋯ With the deadline rapidly approaching, gaps in implementation result in delayed billing, delayed or diminished reimbursements, and absence of quality and outcomes data. It is thereby essential for spine surgeons to understand their role in transitioning to this new environment. Part I of this article discusses the background, coding changes, and costs as well as reviews the salient features of ICD-10 in spine surgery.
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Post-operative cerebrospinal fluid (CSF) leak in posterior fossa surgery remains a significant source of morbidity. TissuePatchDural (TPD), a novel impermeable adhesive membrane, was used to reinforce dural closure. A comparison with one of the most commonly used dural sealing devices, DuraSeal, has been made. ⋯ TPD seems to be a safe tool for use as an adjunct to standard dural closure in posterior fossa surgery, particularly in patients without pre- or post-oper ative risk factors, in those who did not develop hydrocephalus, and who underwent craniectomy. The CSF leak rate in TPD group was found to be lower or within the range of the more advanced alternative dural closure strategies, including polyethylene glycol (PEG)-based sealant.