RESUMO
BACKGROUND: Intraoperative neuromonitoring is a common, well-established modality used in spine surgery to prevent intraoperative neural injury. Neuromonitoring use in lumbar discectomy, however, is based on surgeon preference, without evidence-based data. The purpose of this research was to determine intraoperative utility and overall cost effectiveness of neuromonitoring for lumbar discectomy. METHODS: We retrospectively reviewed adult patients who underwent a lumbar discectomy, with at least 1â¯month of follow-up at a single tertiary care center. Patient age, sex, body mass index (BMI), lumbar level operated, and operative time and cost were collected. Neuromonitoring and operative reports were reviewed for any electromyography (EMG) abnormalities noted intraoperatively, pre- and post-operative motor exam and post-operative pain relief were collected. RESULTS: Ninety-one (47 with and 44 without neuromonitoring) lumbar discectomy cases were reviewed. There was no significant difference between mean age, sex, and BMI between the two groups. There was a significant (pâ¯=â¯0.006) increase in operating room time (174â¯min; with vs. 144â¯min; without neuromonitoring). Neuromonitoring was associated with a significant (pâ¯=â¯0.006) overall operative cost ($21,949; with vs. $18,064; without). Of the 47 cases with neuromonitoring; one had abnormal intraoperative EMG activity, which returned to normal by case conclusion. No patient in either group demonstrated new post-operative motor weakness. There was no difference in the number of patients who endorsed post-operative pain relief between the two groups. CONCLUSIONS: Neuromonitoring for lumbar discectomy confers greater operative time and cost, without any difference in neurological outcome.
Assuntos
Custos e Análise de Custo , Discotomia/métodos , Cuidados Intraoperatórios/métodos , Vértebras Lombares/cirurgia , Monitorização Neurofisiológica/métodos , Adulto , Bases de Dados Factuais , Discotomia/economia , Discotomia/normas , Eletromiografia , Feminino , Humanos , Cuidados Intraoperatórios/economia , Masculino , Pessoa de Meia-Idade , Monitorização Neurofisiológica/economia , Estudos Retrospectivos , Fatores de TempoRESUMO
Flow diverters and flow disruption technology, alongside nuanced endovascular techniques, have ushered in a new era of treating cerebral aneurysms. Here, we provide an overview of the latest flow modulation devices and highlight their clinical applications and outcomes.
Assuntos
Circulação Cerebrovascular , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Hemodinâmica , Aneurisma Intracraniano/terapia , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Desenho de Equipamento , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Resultado do TratamentoRESUMO
The pathophysiology of giant cerebral aneurysms renders them difficult to treat. Advances in technology have attempted to address any shortcomings associated with open surgery or endovascular therapies. Since the introduction of the flow diversion technique, the endovascular approach with flow diversion has become the first-line modality chosen to treat giant aneurysms. A subset of these giant aneurysms may persistent despite any treatment modality. Perhaps the best option for these recurrent and/or persistent giant aneurysms is to employ a multimodal approach-both surgical and endovascular-rather than any single technique to provide a curative result with favourable patient outcomes. This paper provides a review of the histopathology and treatment options for giant cerebral aneurysms. Additionally, an illustrative case is presented to highlight the unique challenges of a curative solution for giant cerebral aneurysms that persist despite initial treatment.