October 22, 2011, 19:40

After my previous post on epidural hematoma, I now converted the BTF surgical guideline on acute subdural hematoma into a decision supporting system. Following the same steps as described previously, here we go: Step 1: the original text-version of the guideline’s recommendations Step 2: create a flowchart Step 3: convert into an app! Here is one picture, more … Continue reading Decision support for acute subdural hematoma →

October 12, 2011, 0:00

Jason S HauptmanSurgical Neurology International 2011 2(1):147-147

September 30, 2011, 0:00

Luke Tomycz, Neil K Bansal, Catherine R Hawley, Tracy L Goddard, Michael J Ayad, Robert A Mericle

Surgical Neurology International 2011 2(1):134-134

Background : Based on numerous reports citing high sensitivity and specificity of non-invasive imaging [e.g. computed tomography angiography (CTA) or magnetic resonance angiography (MRA)] in the detection of intracranial aneurysms, it has become increasingly difficult to justify the role of conventional angiography [digital subtraction angiography (DSA)] for diagnostic purposes. The current literature, however, largely fails to demonstrate the practical application of these technologies within the context of a "real-world" neurosurgical practice. We sought to determine the proportion of patients for whom the additional information gleaned from 3D rotational DSA (3DRA) led to a change in treatment. Methods : We analyzed the medical records of the last 361 consecutive patients referred to a neurosurgeon at our institution for evaluation of "possible intracranial aneurysm" or subarachnoid hemorrhage (SAH). Only those who underwent non-invasive vascular imaging within 3 months prior to DSA were included in the study. For asymptomatic patients without a history of SAH, aneurysms less than 5 mm were followed conservatively. Treatment was advocated for patients with unruptured, non-cavernous aneurysms measuring 5 mm or larger and for any non-cavernous aneurysm in the setting of acute SAH. Results : For those who underwent CTA or MRA, the treatment plan was changed in 17/90 (18.9%) and 22/73 (30.1%), respectively, based on subsequent information gleaned from DSA. Several reasons exist for the change in the treatment plan, including size and location discrepancies (e.g. cavernous versus supraclinoid), or detection of a benign vascular variant rather than a true aneurysm. Conclusions : In a "real-world" analysis of intracranial aneurysms, DSA continues to play an important role in determining the optimal management strategy.

September 20, 2011, 18:36

The professor stood before the class, his body bent, for time has had its way. His voice, hushed, drew them to him. Its strength reflective of his day. The student tells the patient’s story, as she sits alone within the hall. The professor asks a point or two. Overhead a voice seeks those on call. … Continue reading Shadows →

September 14, 2011, 19:47

Boletin septiembre[1] View more presentations from Surgical Neurology International

September 14, 2011, 8:15

(this is a guest post from DigitalNeurosurgeon.com, slightly modified for Surgical Neurology International) The Brain Trauma Foundation has created and published guidelines on the treatment of brain trauma a few years ago. The Guidelines for the Surgical Management of Traumatic Brain Injury are available as PDF and in a searchable online format. What lacks, is the availability on a mobile … Continue reading Decision support for epidural hematoma →

August 23, 2011, 22:03

Neurocirugía; Julio 2011, Volume 17 View more documents from Surgical Neurology International

August 22, 2011, 19:07

Recently, the New York Times published an editorial reviewing medical errors in the setting of duty hour restrictions. (“The Phantom Menace of Sleep-Deprived Doctors” by Darshak Sanghavi, August 5, 2011). Dr. Sanghavi’s review of this subject noted that duty hour restrictions have not significantly decreased medical errors. He argued that increased sign-off frequencies left gaping … Continue reading Duty hour restrictions →

August 21, 2011, 18:37

Neurocirugía; Marzo 2011, Volume 16 View more documents from Surgical Neurology International

August 17, 2011, 0:00

Nancy E Epstein, Garry S Schwall

Surgical Neurology International 2011 2(1):115-115

Background : INFUSE, bone morphogenetic protein-2 combined with bovine Type I collagen in the lumbar tapered fusion device (LT Cage), is used to promote anterior lumbar interbody fusion (ALIF). In spinal surgery, INFUSE is only Federal Drug Administration (FDA) approved for this "on-label" use. While the efficacy and possible complications due to INFUSE have been debated, we know less about the costs and frequency of "on-label" versus "off-label" use of INFUSE to perform spinal fusions. Methods : At one institution, we determined the costs (with overhead) and frequency of utilizing INFUSE "on-label" and "off-label" in performing spinal fusions during 2010. Results : During 2010, 177 spinal fusions utilized INFUSE. Ninety-six percent, or 170 of 177 spinal fusions, utilized INFUSE in an "off-label" capacity at a cost of $4,547,822. Only 4%, or seven of 177 cases, utilized INFUSE in an "on-label" capacity (ALIF); the total cost was $296,419. Conclusions : In 2010, at one institution, 96% of the spinal fusions utilized INFUSE in an "off-label" capacity (cost $4,547,822), while only 4% were performed "on-label" (cost $296,4194).