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1.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(5): 529-531, 2019 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-31713386

RESUMO

OBJECTIVE: To analyze the clinical characteristics of 24 patients with cysticercosis of the fourth ventricle, and to evaluate the therapeutic efficacy of microsurgery. METHODS: The clinical data of 24 patients with cysticercosis of the fourth ventricle referred the Department of Neurosurgery of the Affiliated Hospital of Qinghai University from January 2000 to December 2018 were collected, and the clinical features, imaging characteristics, surgical methods, therapeutic efficacy and postoperative complications were analyzed. RESULTS: The 24 patients included 15 men and 9 women, and had a mean age of 43.5 years (range, 16 to 68 years). Preoperative imaging examinations showed obvious dilatation of bilateral lateral ventricles, the third ventricle and middle cerebral aqueduct, and spherical or cystic dilatation of the fourth ventricle. There were 18 cases positive for antibodies against cysticercus, and 3 of the 21 cases were egg positives. All 24 cases received microsurgery, including 8 cases via the median aperture approach, 7 cases via the median aperture-cerebellar vermis approach, and 9 cases via the transcerebellomedullary fissure approach. There were 17 cases with complete delivery of vesicles, 5 cases with vesicle rupture and 2 cases with extraction of cystic fluid followed by separation and removal of cystic wall. All cases had obvious retraction of the ventricular system and disappearance of intracranial hypertension following surgery. There were 19 cases (79.17%) with well recovery, and 5 cases (20.83%) with aggravation or development of cerebellar ataxia, which recovered following treatment for 1 to 2 weeks. CONCLUSIONS: The transcerebellomedullary fissure approach is a safe and lowly invasive approach for the treatment of cysticercosis of the fourth ventricle.


Assuntos
Cisticercose , Quarto Ventrículo , Microcirurgia , Neurocisticercose , Procedimentos Neurocirúrgicos , Adolescente , Adulto , Idoso , Animais , Feminino , Quarto Ventrículo/parasitologia , Quarto Ventrículo/cirurgia , Humanos , Masculino , Microcirurgia/normas , Pessoa de Meia-Idade , Neurocisticercose/patologia , Neurocisticercose/cirurgia , Procedimentos Neurocirúrgicos/normas , Resultado do Tratamento , Adulto Jovem
2.
Med Hypotheses ; 129: 109257, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31371088

RESUMO

Decompressive craniectomy (DC) plays a significant role in treating refractory intracranial hypertension. During this surgical procedure, part of the skull is removed and the underlying dura mater is open, which can effectively release intracranial pressure. However, in some cases, the decision whether or not to remove the bone flap relies on the surgeon's personal experience. Positive decisions are usually made to avoid massive postoperative cerebral edema and infarction, which can lead to overtreatment. The procedure is related to many side-effects, which may affect the recovery of neurological function. Patients who have survived have to be anesthetized and undergo secondary cranioplasty 3 or 6 months later. Despite its technical simplicity, complications associated with cranioplasty are hard to ignore. Therefore, there is a need for a new surgical procedure combining decompressive craniectomy and cranioplasty. Acute expansion of the skin flap is limited, and the compensatory capacity of the skull after DC depends on the volume of the bone flap at the early stage. The titanium mesh is thin and strong, does not take up extra space provided by bone flap. Therefore, we put forward the concept of Decompressive Bone Flap Replacement. During this procedure, neurosurgeons resect the massive bone flap, open the dura mater, remove the hematoma in a similar manner to a standard craniotomy and then use titanium mesh shaped appropriately to replace the bone flap. Compared with traditional DC, it can ensure the integrity of the skull without affecting the effect of decompression. This paper presents 2 cases of DC and reviews the literature sustaining our hypothesis.


Assuntos
Craniectomia Descompressiva/instrumentação , Telas Cirúrgicas , Titânio/química , Circulação Cerebrovascular , Tomada de Decisões , Craniectomia Descompressiva/métodos , Hematoma/cirurgia , Humanos , Pressão Intracraniana , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Midríase/cirurgia , Procedimentos Neurocirúrgicos/normas , Complicações Pós-Operatórias , Risco , Retalhos Cirúrgicos , Procedimentos Cirúrgicos Operatórios , Infecção da Ferida Cirúrgica , Tomografia Computadorizada por Raios X
3.
Best Pract Res Clin Endocrinol Metab ; 33(2): 101299, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31431397

RESUMO

In this paper, the currently used and well evaluated techniques for the surgery of pituitary tumors will be reviewed. Since the first surgical approaches to pituitary tumors more than 100 years have elapsed. Various surgical techniques have been developed, refined and standardized. Most of these tumors are to date treated via transsphenoidal approaches. Many pituitary adenomas, particularly, smaller, enclosed ones, can be completely excised and a selective adenomectomy is usually attempted. It leads to remission of hormonal oversecretion and also to recovery of pituitary function in many patients. The resection of pseudocapsule around the adenoma seems to improve the operative results further. Transcranial approaches, employing craniotomies, are still needed in some patients with pituitary adenomas and in many of those harbouring craniopharyngiomas. The operative techniques will be described and briefly commented. Moreover, the application and usefulness of several technical developments will be reviewed, such as the use of the endoscope, magnetic resonance imaging, fluorenscent dyes and neuronavigation. The use of the intraoperative Doppler probe, ultrasound and the value of intraoperative hormonal measurements will be briefly discussed. There is sufficient evidence that the best and optimal outcome in terms of tumor resection and correction of hormonal oversecretion as well as the lowest rate of complications are obtained in centers of excellence with sufficiently experienced, specialized surgeons and a high patient load.


Assuntos
Adenoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Adenoma/diagnóstico , Adenoma/epidemiologia , Humanos , Imagem por Ressonância Magnética , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/normas , Hipófise/cirurgia , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
4.
Int J Med Inform ; 130: 103934, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31437619

RESUMO

OBJECTIVE: Accessing medical records is an integral part of neurosurgical procedures in the Operating Room (OR). Gestural interfaces can help reduce the risks for infections by allowing the surgical staff to browse Picture Archiving and Communication Systems (PACS) without touch. The main objectives of this work are to: a) Elicit gestures from neurosurgeons to analyze their preferences, b) Develop heuristics for gestural interfaces, and c) Produce a lexicon that maximizes surgeons' preferences. MATERIALS AND METHODS: A gesture elicitation study was conducted with nine neurosurgeons. Initially, subjects were asked to outline the gestures on a drawing board for each of the PACS commands. Next, the subjects performed one of three imaging tasks using gestures instead of the keyboard and mouse. Each gesture was annotated with respect to the presence/absence of gesture descriptors. Next, K-nearest neighbor approach was used to obtain the final lexicon that complies with the preferred/popular descriptors. RESULTS: The elicitation study resulted in nine gesture lexicons, each comprised of 28 gestures. A paired t-test between the popularity of the overall gesture and the top three descriptors showed that the latter is significantly higher than the former (89.5%-59.7% vs 19.4%, p < 0.001), meaning more than half of the subjects agreed on these descriptors. Next, the gesture heuristics were generated for each command using the popular descriptors. Lastly, we developed a lexicon that complies with surgeons' preferences. CONCLUSIONS: Neurosurgeons do agree on fundamental characteristics of gestures to perform image manipulation tasks. The proposed heuristics could potentially guide the development of future gesture-based interaction of PACS for the OR.


Assuntos
Comunicação , Gestos , Heurística , Neurocirurgiões/normas , Procedimentos Neurocirúrgicos/normas , Guias de Prática Clínica como Assunto/normas , Sistemas de Informação em Radiologia , Feminino , Humanos , Masculino , Reconhecimento Automatizado de Padrão , Interface Usuário-Computador
5.
World Neurosurg ; 130: e726-e736, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31284064

RESUMO

BACKGROUND: Undesirable events in the neurosurgery operating theater have less often been the result of a technical error than of a dysfunction linked to nontechnical skills (NTSs). The essential aim of our study was to perform a systematic review of the reported data on NTS in neurosurgery. Our secondary objective was to identify the NTSs more specific to neurosurgery to define the training needs of neurosurgery trainees. METHODS: The MEDLINE and Cochrane Database of Systematic Reviews were searched according to the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines. The search initially identified 2132 reports, of which 21 were eligible for systematic study. Data were extracted from the report regarding study design, sample size, NTSs assessed, and assessment tools, and the key results were collected. RESULTS: Interpersonal skills (communication, teamwork), cognitive skills (decision making, situational awareness), and personal resource factors (coping with stress or fatigue) were specifically identified. No study had used assessment tools such as NOTECHS (nontechnical skills), NOTSS (nontechnical skills for surgeons), or OTAS (observational teamwork assessment for surgery). They were performed in a real environment in 11 cases, in a simulated environment in 9, and during theoretical teaching in 1 case. CONCLUSIONS: Very few studies have been performed concerning neurosurgical NTSs, despite the increasing the number of studies during the past few years on NTSs in other domains of surgery. Society has been concentrating more and more on the quality and safety of medical care. The development and application of NTS assessment tools is, therefore, essential to provide assistance in the training of future neurosurgeons.


Assuntos
Competência Clínica/normas , Neurocirurgiões/normas , Procedimentos Neurocirúrgicos/normas , Habilidades Sociais , Comunicação , Humanos , Liderança , Neurocirurgiões/educação , Neurocirurgiões/psicologia , Procedimentos Neurocirúrgicos/educação , Procedimentos Neurocirúrgicos/psicologia
6.
World Neurosurg ; 130: e660-e665, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31276855

RESUMO

BACKGROUND: YouTube has rapidly become one of the most widely accessed educational platforms of our time. Over 1 billion hours of YouTube content are viewed every day, including neurosurgical videos. To date, there has never been a qualitative analysis of neurosurgical content on YouTube. METHODS: By evaluating the search interest of neurosurgical terms via Google Trends, we selected 8 search terms to assess on YouTube. For each term, we selected the top 20 videos, 10 when sorting by view count and 10 when sorting by relevance. Using the DISCERN criteria, we evaluated 131 unique YouTube videos to assess bias and overall educational quality. In addition, we categorized each video based on its intended utility and the credentials of the video's commentator. The number of views, average DISCERN scores, and bias scores were compared between search terms and between video categories. RESULTS: There were 131 unique and 29 duplicate videos. The videos received 143,538,363 combined views (1,104,141 average). The average video age was 4.6 years (range, 66 days to 12.5 years). The term "brain surgery" received the most total views (62,339,885), with an average DISCERN score of 1.65 overall and 2 for bias. The average DISCERN score was 2.02 overall and 2.39 for bias. There were 45 advertisements for either hospitals, physicians, or companies, totaling 18,052,873 views and averaging a DISCERN score of 2.04. CONCLUSIONS: YouTube is a frequently viewed but biased source for neurosurgical information. Advertisements are frequently disguised as educational material, and few videos provide references or sources for their information.


Assuntos
Neurocirurgiões/educação , Neurocirurgiões/normas , Procedimentos Neurocirúrgicos/educação , Procedimentos Neurocirúrgicos/normas , Mídias Sociais/normas , Gravação em Vídeo/normas , Humanos , Disseminação de Informação/métodos , Mídias Sociais/tendências , Gravação em Vídeo/métodos
7.
World Neurosurg ; 130: e874-e879, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31301446

RESUMO

INTRODUCTION: Socioeconomic topics such as federal mandates/regulations, conflict of interest, and practice management have become increasingly important for all neurosurgeons. Graduating residents immediately need a host of skills to successfully navigate neurosurgical practice. Surgical and medical skills are closely evaluated through the American Board of Neurological Surgery, and a formal socioeconomic curriculum has been developed with defined milestones. Nevertheless, little has been done to evaluate neurosurgery resident competence in socioeconomic and medicolegal principles. The purpose of this study was to assess the competence of Accreditation Council for Graduate Medical Education neurosurgical residents in socioeconomic knowledge. METHODS: Neurosurgery resident members of the American Association of Neurological Surgeons (N = 1385) were sent a Survey Monkey of 10 questions. The survey covered the most basic of socioeconomic principles. Initial survey responses were collected across a 1-month period from April to May 2018. RESULTS: The response rate was 14% (194/1385). Overall, neurosurgery residents would have received a grade of D, with an average score of 67% on the survey. For 7 of the 10 questions, the majority (>50%) of neurosurgery residents answered correctly. Furthermore, for 3 questions, more than 90% of residents selected the correct answer. However, for one-half of all questions, residents averaged a score of less than 65%. Residents tended to answer questions correctly for physician compensation and compensation models, but incorrectly for topics of informed consent, Controlled Substances Act, and conflicts of interest. CONCLUSION: With the increasing complexity of neurosurgery practice, solid knowledge of socioeconomic topics is essential. The study confirms suspected deficiencies in socioeconomic proficiency among neurosurgery residents, despite the availability of a validated curriculum. This knowledge gap will likely affect career success and satisfaction. Nevertheless, this survey had a significantly low response rate, and it may be an incomplete representation of the neurosurgical resident mind. Focused educational initiatives through the neurosurgical Residency Review Committee and individual training programs must facilitate an action plan that ensures the effective implementation of socioeconomic curricula.


Assuntos
Competência Clínica/normas , Neurocirurgiões/normas , Neurocirurgia/normas , Procedimentos Neurocirúrgicos/normas , Fatores Socioeconômicos , Inquéritos e Questionários , Humanos , Neurocirurgiões/economia , Neurocirurgiões/educação , Neurocirurgia/economia , Neurocirurgia/educação , Procedimentos Neurocirúrgicos/economia , Procedimentos Neurocirúrgicos/educação , Estados Unidos/epidemiologia
8.
World Neurosurg ; 130: e423-e430, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279110

RESUMO

OBJECTIVE: To identify the domains of recovery, as determined by the Quality of Recovery-15 (QoR-15) score, that needed improvement to develop initial interventions for an enhanced recovery after surgery protocol for patients undergoing elective intracranial surgery under general anesthesia. METHODS: A paired-availability design was used to assess 2 groups of 41 patients undergoing elective intracranial surgery. The baseline QoR-15 score and scores 0, 6, 12, and 24 hours after arrival in the intensive care unit characterized the postoperative recovery trajectory. The lowest scoring domains of the QoR-15 score were identified in the preimplementation group, and pharmacologic interventions were initiated in the postimplementation group. RESULTS: Postoperative analgesia and postoperative nausea and vomiting were identified as the lowest scoring domains. The pharmacologic interventions implemented were chosen because they produced minimal sedation and were easy to administer-1 40-mg oral preoperative dose of aprepitant to target postoperative nausea and vomiting and 2 perioperative 1-g doses of intravenous acetaminophen to improve analgesia. We observed a clinically significant as well as statistically significant improvement in analgesia on arrival in the intensive care unit and at the 6-hour postoperative time point. The total QoR-15 score was improved through the 12-hour time point. CONCLUSIONS: In this quality improvement project, the QoR-15 score allowed us to identify domains that slowed the recovery course in this patient population. Two 1-g doses of intravenous acetaminophen improved patients' well-being and analgesia after elective intracranial surgery.


Assuntos
Procedimentos Cirúrgicos Eletivos/normas , Procedimentos Neurocirúrgicos/normas , Período de Recuperação da Anestesia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Manejo da Dor/normas , Medição da Dor , Dor Pós-Operatória/prevenção & controle , Náusea e Vômito Pós-Operatórios/prevenção & controle
9.
Handb Clin Neurol ; 160: 329-344, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277858

RESUMO

Spinal cord surgery carries the risk of spinal cord or nerve root injury. Neurophysiologic monitoring decreases risk of injury by continuous assessment of spinal cord and nerve root function throughout surgery. Techniques include somatosensory evoked potentials (SEPs), transcranial electrical motor evoked potentials (MEPs), and electromyography (EMG). Baseline neurophysiologic data are obtained prior to incision. Real-time signal changes are identified in time to correct compromised neural function. Such monitoring improves postoperative neurologic functional outcomes. Challenges in neurophysiologic intraoperative monitoring (NIOM) include effects of anesthetics, neuromuscular blockade, hypotension, hypothermia, and preexisting neurological conditions, e.g., neuropathy or myelopathy. Technical factors causing poor quality data must be overcome in the electrically noisy operating room environment. Experienced monitoring teams understand tactics to obtain quality recordings and consider confounding variables before raising alarms when change occurs. Once an alert is raised, surgeons and anesthesiologists respond with a variety of actions, such as raising blood pressure or adjusting retractors. In experienced hands, NIOM significantly reduces postoperative neurological deficits, e.g., 60% reduction in risk of paraplegia and paraparesis. A technologist in the operating room sets up the NIOM procedure. An experienced clinical neurophysiologist supervises the case, either in the operating room or remotely on-line continuously in real time.


Assuntos
Potencial Evocado Motor/fisiologia , Potenciais Somatossensoriais Evocados/fisiologia , Monitorização Intraoperatória/métodos , Medula Espinal/fisiologia , Medula Espinal/cirurgia , Humanos , Monitorização Intraoperatória/normas , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/normas
10.
World Neurosurg ; 130: e112-e116, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31176838

RESUMO

INTRODUCTION: Quality assurance (QA) is a way to prevent mistakes in advance. Although it has been previously reported for surgical setup, there is no effective approach for minimizing microsurgical technical errors before an operation is done. Neurosurgery resident operative errors during brain aneurysm surgery could be foreseen by practicing in an ex vivo hybrid simulator with microscopic fluorescein vessel flow image. METHODS: Five vascular neurosurgeons and 8 junior/senior neurosurgical residents voluntarily joined this research initiative. The following methodology was adopted: 1) Identification of the 7 most-common resident operative performance errors during brain aneurysm surgery; 2) Design of exercises to prevent common mistakes in brain aneurysm microsurgery using a placenta simulator; and 3) Blinded staff neurosurgeon evaluation of resident performance during real brain aneurysm microsurgery. RESULTS: All key steps to perform such intervention were accomplished with a simulator that uses 2 placentas, a synthetic cranium, and microscopic fluorescein vessel flow image. Neurosurgery residents trained in this model had better surgical performance with fewer perioperative mistakes (P < 0.05). Fine microsurgical dissection of the arachnoid membrane and aneurysm sac were the most commonly improved tasks among the 7 common operative mistakes. Brain parenchyma traction with secondary bleeding was the only error not prevented after previous simulator training. CONCLUSIONS: There was a left-shift on the quality assurance line with residents who practiced brain aneurysm microsurgical errors in an ex vivo model. A multicentric prospective study is necessary to confirm the hypothesis that real operative error could be reduced after training in a realistic simulator.


Assuntos
Aneurisma Intracraniano/cirurgia , Microcirurgia/educação , Microcirurgia/normas , Neurocirurgia/educação , Neurocirurgia/normas , Procedimentos Neurocirúrgicos/educação , Procedimentos Neurocirúrgicos/normas , Competência Clínica , Humanos , Internato e Residência , Microcirurgia/efeitos adversos , Neurocirurgiões , Procedimentos Neurocirúrgicos/efeitos adversos , Garantia da Qualidade dos Cuidados de Saúde , Treinamento por Simulação
11.
World Neurosurg ; 130: e244-e250, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31207374

RESUMO

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) remains one of the most commonly taught procedures during residency and one of the most frequently performed by neurosurgeons. Neurosurgeons use microscopes to perform surgery and to train other surgeons. Although the microscope provides excellent illumination and magnification, its use will be limited to 2 people: the surgeon and the assistant. Consequently, the scrub nurse and residents watching 2-dimensional images on monitors will have a reduced perception of the surgical field depth and anatomical details. The exoscope has been introduced as an alternative to microscopes and endoscopes. We used a 3-dimensional (3D), high-definition exoscope (3D Vitom [Karl Storz, Tuttlingen, Germany]) in 2 patients undergoing 2-level ACDF for cervical myeloradiculopathy. METHODS: The exoscope was used during soft tissue dissection, discectomy, osteophytectomy, and cage insertion. Microsurgical drilling of the posterior osteophytes, which will usually require adequate magnification and proper microscope angulation, was also performed using the exoscope. RESULTS: The exoscope provided a 3D view of the surgical field similar to that provided by a microscope and allowed us to effectively and safely perform the required surgical steps. The main advantage of 3D exoscope-assisted surgery, compared with microscope-assisted surgery, is the possibility to generate videos with a similar view and image quality as perceived by the surgeon. Therefore, the didactic capabilities of exoscopic videos are greater than those provided by microscopic videos. Exoscopes are also smaller compared with microscopes, allowing for comfortable use from the early surgical steps to device implantation. CONCLUSION: We believe that exoscope-assisted surgery could become a safe and effective alternative to microscope-assisted surgery in ACDF.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/normas , Imagem Tridimensional/normas , Microcirurgia/normas , Neuroendoscopia/normas , Fusão Vertebral/normas , Adulto , Vértebras Cervicais/diagnóstico por imagem , Discotomia/métodos , Feminino , Humanos , Imagem Tridimensional/métodos , Microcirurgia/métodos , Pessoa de Meia-Idade , Neuroendoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/normas , Radiculopatia/diagnóstico por imagem , Radiculopatia/cirurgia , Reprodutibilidade dos Testes , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Fusão Vertebral/métodos
12.
Spine (Phila Pa 1976) ; 44(13): E782-E787, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205174

RESUMO

STUDY DESIGN: A retrospective review of prospectively collected data. OBJECTIVE: The purpose of this study is to compare and validate several preoperative scores for predicting outcomes following spine tumor resection. SUMMARY OF BACKGROUND DATA: Preoperative risk assessment for patients undergoing spinal tumor resection remains challenging. At present, few risk assessment tools have been validated in this high-risk population. METHODS: The 2008 to 2014 National Surgical Quality Improvement database was used to identify all patients undergoing surgical resection of spinal tumors, stratified as extradural, intradural extramedullary, and intramedullary based on CPT codes. American Society of Anesthesiologists (ASA) score, modified Charlson Comorbidity Index (CCI), and modified Frailty Index (mFI) were computed. A binary logistic regression model was used to explore the relationship between these variables and postoperative outcomes, including mortality, major and minor adverse events, and hospital length of stay (LOS). Other significant variables such as demographics, operative time, and tumor location were controlled for in each model. RESULTS: Two thousand one hundred seventy patients met the inclusion criteria. Higher CCI scores were independent predictors of mortality (OR = 1.24, 95% CI: 1.14-1.36, P < 0.001), major adverse events (OR = 1.07, 95% CI: 1.01-1.31, P = 0.018), minor adverse events (OR = 1.15, 95% CI: 1.10-1.20, P < 0.001), and prolonged LOS (OR = 1.14, 95% CI: 1.09-1.19, P < 0.001). Patients' mFI scores were significantly associated with mortality and LOS, but not major or minor adverse events. ASA scores were not associated with any outcome metric when controlling for other variables. CONCLUSION: The CCI demonstrated superior predictive capacity compared with mFI and ASA scores and may be valuable as a preoperative risk assessment tool for patients undergoing surgical resection of spinal tumors. The validation of assessment scores is important for preoperative risk stratification and improving outcomes in this high-risk group. LEVEL OF EVIDENCE: 3.


Assuntos
Anestesiologistas/normas , Fragilidade/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Cuidados Pré-Operatórios/normas , Sociedades Médicas/normas , Neoplasias da Coluna Vertebral/diagnóstico , Adulto , Idoso , Feminino , Fragilidade/epidemiologia , Fragilidade/cirurgia , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/normas , Complicações Pós-Operatórias/epidemiologia , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Melhoria de Qualidade/normas , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/normas , Fatores de Risco , Neoplasias da Coluna Vertebral/epidemiologia , Neoplasias da Coluna Vertebral/cirurgia
13.
Spine (Phila Pa 1976) ; 44(13): 959-966, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205177

RESUMO

STUDY DESIGN: The enhanced perioperative care (EPOC) program is an institutional quality improvement initiative. We used a historically controlled study design to evaluate patients who underwent major spine surgery before and after the implementation of the EPOC program. OBJECTIVE: To determine whether multidisciplinary EPOC program was associated with an improvement in clinical and financial outcomes for elective adult major spine surgery patients. SUMMARY OF BACKGROUND DATA: The enhanced recovery after surgery (ERAS) programs successfully implemented in hip and knee replacement surgeries, and improved clinical outcomes and patient satisfaction. METHODS: We compared 183 subjects in traditional care (TRDC) group to 267 intervention period (EPOC) in a single academic quaternary spine surgery referral center. One hundred eight subjects in no pathway (NOPW) care group was also examined to exclude if the observed changes between the EPOC and TRDC groups might be due to concurrent changes in practice or population over the same time period. Our primary outcome variables were hospital and intensive care unit lengths of stay and the secondary outcomes were postoperative complications, 30-day hospital readmission and cost. RESULTS: In this highly complex patient population, we observed a reduction in mean hospital length of stay (HLOS) between TRDC versus EPOC groups (8.2 vs. 6.1 d, standard deviation [SD] = 6.3 vs. 3.6, P < 0.001) and intensive care unit length of stay (ILOS) (3.1 vs. 1.9 d, SD = 4.7 vs. 1.4, P = 0.01). The number (rate) of postoperative intensive care unit (ICU) admissions was higher for the TRDC n = 109 (60%) than the EPOC n = 129 (48%) (P = 0.02). There was no difference in postoperative complications and 30-day hospital readmissions. The EPOC spine program was associated with significant average cost reduction-$62,429 to $53,355 (P < 0.00). CONCLUSION: The EPOC program has made a clinically relevant contribution to institutional efforts to improve patient outcomes and value. We observed a reduction in HLOS, ILOS, costs, and variability. LEVEL OF EVIDENCE: 3.


Assuntos
Procedimentos Neurocirúrgicos/normas , Assistência Perioperatória/normas , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos/economia , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Humanos , Tempo de Internação/economia , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/economia , Procedimentos Neurocirúrgicos/métodos , Readmissão do Paciente/economia , Readmissão do Paciente/tendências , Satisfação do Paciente , Assistência Perioperatória/economia , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/economia , Melhoria de Qualidade/normas , Resultado do Tratamento
14.
J Neurointerv Surg ; 11(10): 1055-1062, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31103994

RESUMO

BACKGROUND: The aim of this publication is to provide a detailed update on the diagnosis, treatment, and endovascular techniques for posterior circulation emergent large vessel occlusion (pc-ELVO). METHODS: We performed a review of the literature to specifically evaluate this disease and its treatments. RESULTS: Data were analyzed, and recommendations were reported based on the strength of the published evidence and expert consensus. CONCLUSION: While many questions about pc-ELVO remain to be studied, there is evidence to support particular practices in its evaluation and treatment.


Assuntos
Transtornos Cerebrovasculares/cirurgia , Procedimentos Endovasculares/normas , Procedimentos Neurocirúrgicos/normas , Guias de Prática Clínica como Assunto/normas , Sociedades Médicas/normas , Acidente Vascular Cerebral/cirurgia , Transtornos Cerebrovasculares/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Humanos , Procedimentos Neurocirúrgicos/métodos , Relatório de Pesquisa , Acidente Vascular Cerebral/diagnóstico por imagem
15.
Neurol Sci ; 40(9): 1813-1819, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31041610

RESUMO

INTRODUCTION: In carpal tunnel release, it is yet unclear whether a learning curve exists among surgeons. The aim of our study was to investigate if outcome after carpal tunnel release is dependent on surgeon's experience and to get an impression of the learning curve for this procedure. METHODS: A total of 188 CTS patients underwent carpal tunnel release. Patients completed the Boston Carpal Tunnel Questionnaire at baseline and 6-8 months postoperatively together with a six-point scale for perceived improvement. RESULTS: Patients operated by an experienced resident or certified surgeon reported a favorable outcome more often than patients operated by an inexperienced resident (adjusted OR 3.23 and adjusted OR 3.16, respectively). In addition, a negative association was found between surgeon's years of experience and postoperative Symptom Severity Scale and Functional Status Scale scores. DISCUSSION: Outcome after carpal tunnel release seems to be dependent on surgical experience, and there is a learning curve in residents.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Competência Clínica , Descompressão Cirúrgica , Internato e Residência , Curva de Aprendizado , Procedimentos Neurocirúrgicos , Avaliação de Resultados da Assistência ao Paciente , Cirurgiões , Adulto , Idoso , Competência Clínica/normas , Descompressão Cirúrgica/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurocirurgiões/normas , Procedimentos Neurocirúrgicos/normas , Cirurgiões Ortopédicos/normas , Cirurgiões/normas
16.
World Neurosurg ; 127: 63-71, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30930320

RESUMO

BACKGROUND: An increasing body of literature describing use of high-fidelity surgical training models is challenging long-held dogma that cadavers provide the best medium for postgraduate surgical skills training. The purpose of this study was to describe a surgical skills course comprising entirely synthetic training models developed by resident and attending neurosurgeons and to evaluate their perceptions of the overall usefulness of this course and its usefulness compared with cadaveric courses. METHODS: Ten high-fidelity neurosurgical training models were developed. A neurosurgical skills course for residents was structured to include 7 spinal and 3 cranial learning stations, each with its own model and assigned attending expert. Resident and attending neurosurgeons were asked to complete surveys on their overall impressions of the course and models and on workload comparisons between models and real cases. Student t tests were used for statistical comparisons. RESULTS: Survey responses were collected from 9 of 16 participating residents (56.3%) and 3 of 10 attending neurosurgeons (30.0%). Both groups believed that the course was very helpful overall to resident education. Respondents furthermore believed that the course was more helpful overall than cadaveric courses. Task load index testing showed no significant workload difference between models and real cases (P ≥ 0.17), except in temporal demand (P < 0.001). CONCLUSIONS: Resident and attending neurosurgeons subjectively believe that high-fidelity synthetic models were superior to cadavers as a surgical skills teaching platform. This study raises the question of whether cadavers should remain the gold standard for surgical skills courses. Expanded use of these teaching models and further study are warranted.


Assuntos
Competência Clínica , Neurocirurgia/educação , Procedimentos Neurocirúrgicos/educação , Procedimentos Neurocirúrgicos/normas , Cadáver , Humanos , Internato e Residência/métodos , Modelos Anatômicos , Neurocirurgiões/educação , Neurocirurgia/normas , Inquéritos e Questionários
17.
World Neurosurg ; 127: e717-e721, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30947003

RESUMO

BACKGROUND: Three-dimensional (3D) endoscopy is an emerging tool in ear-nose-throat (ENT) and skull base surgery with the benefit of providing real-time depth perception. Several investigators have reported that the field of view (FOV) is reduced in 3D endoscopes compared with regular 2-dimensional (2D) endoscopes. Thus, we objectively compared the FOV of 2D and 3D endoscopes. METHODS: Using a standard 2D and 2 different 3D ENT endoscopes, images were captured of 1-mm graph paper from a set distance of 6 cm. The FOV was calculated from these images and compared among the endoscopes. RESULTS: The VisionSense 3D endoscope had a slightly smaller FOV (9.1 cm vs. 10.1 cm; -9.9%), and the Karl Storz 3D endoscope showed a slightly larger FOV (10.4 cm vs. 10.1 cm; +3.0%). However, the results were complicated by the different-shaped images produced by the 3D endoscopes. CONCLUSION: The differences in the FOV between the 2D and 3D endoscopes used in ENT surgery were not clinically significant. Thus, the FOV should not be considered a limitation of 3D technology.


Assuntos
Percepção de Profundidade , Imagem Tridimensional/normas , Neuroendoscopia/normas , Humanos , Imagem Tridimensional/métodos , Neuroendoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/normas , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia
18.
World Neurosurg ; 127: e707-e716, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30947014

RESUMO

OBJECTIVE: Historically, medical student education in neurological surgery has generally limited student involvement to assisting in research projects with minimal formal clinical exposure before starting sub-internships and application for the neurosurgery match. Consequently, students have generally had little opportunity to acquire exposure to clinical neurosurgery and attain minimal proficiency. A medical student training camp was created to improve the preparation of medical students for the involvement in neurological surgery activities and sub-internships. METHODS: A 1-day course was held at Weill Cornell Medicine, which consisted of a series of morning lectures, an interactive resident lunch panel, and afternoon hands-on laboratory sessions. Students completed self-assessment questionnaires regarding their confidence in several areas of clinical neurosurgery before the start of the course and again at its end. RESULTS: A significant increase in self-assessed confidence was observed in all skill areas surveyed. Overall, rising fourth year students who were starting sub-internships in the subsequent weeks reported a substantial increase in their preparedness for the elective rotations in neurosurgery. CONCLUSIONS: The preparation of medical students for clinical neurosurgery can be improved. Single-day courses such as the described training camp are an effective method for improving knowledge and skill gaps in medical students entering neurosurgical careers. Initiatives should be developed, in addition to this annual program, to increase the clinical and research skills throughout medical student education.


Assuntos
Competência Clínica/normas , Currículo/normas , Neurocirurgia/educação , Neurocirurgia/normas , Estudantes de Medicina , Educação Médica/métodos , Educação Médica/normas , Humanos , Internato e Residência/métodos , Internato e Residência/normas , Neurocirurgia/métodos , Procedimentos Neurocirúrgicos/educação , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/normas , Inquéritos e Questionários/normas
19.
Rev Bras Enferm ; 72(1): 73-80, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30916270

RESUMO

OBJEVECT: To evaluate the Nutritional Status (NS) and follow the Enteral Nutritional Therapy (ENT) of patients in neurosurgical intervention. METHOD: Cohort study in emergency or elective surgery patients with exclusive ENT. Anthropometric measurements (Arm Circumference (AC and Triceps Skinfold (TSF)) were measured on the first, seventh and 14th day. For the ENT monitoring, caloric/protein adequacy, fasting, inadvertent output of the enteral probe and residual gastric volume were used. RESULTS: 80 patients, 78.7% in emergency surgery and 21.3% in elective surgery. There was a reduction in AC and Body Mass Index (BMI) (p>0.01), especially for the emergency group. The caloric/protein adequacy was higher in the emergency group (86.7% and 81.8%). CONCLUSION: The EN change was greater in the emergency group, even with better ENT adequacy. Changes in body composition are frequent in neurosurgical patients, regardless of the type of procedure.


Assuntos
Nutrição Enteral/métodos , Procedimentos Neurocirúrgicos/métodos , Estado Nutricional , Idoso , Antropometria/métodos , Índice de Massa Corporal , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/normas , Nutrição Enteral/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/normas , Escores de Disfunção Orgânica , Estudos Prospectivos , Estatísticas não Paramétricas
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