NEUROSURGERY Report

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Posts Tagged ‘neurosurgery

Free Article with CME: The Impact of Sedation on Brain Mapping

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Background: During awake craniotomies, patients may either be awake for the entire duration of the surgical intervention (awake-awake-awake craniotomy, AAA) or initially sedated (asleep-awake-asleep craniotomy, SAS).

Objective: To examine whether prior sedation in SAS may restrict brain mapping, we conducted neuropsychological tests in patients by means of a standardized anesthetic regimen comparable to an SAS.

Methods: We prospectively examined patients undergoing surgery either under total intravenous anesthesia (TIVA) or under regional anesthesia with slight sedation (RAS). The tests included the DO40 picture-naming test, the digit span, the Regensburg Word Fluency Test, and the finger-tapping test. Each test was conducted 3 times for every patient in the TIVA and RAS groups, once before surgery and twice within about 35 minutes after the end of sedation. Patients undergoing AAA were examined preoperatively and intraoperatively.

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Written by NEUROSURGERY® Editorial Office

July 29, 2014 at 8:00 AM

Free Article: Demystifying Process Mapping: Neurosurgical Quality Improvement Initiatives

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Screen Shot 2014-07-28 at 7.52.13 AMReliable delivery of optimal care can be challenging for care providers. Health care leaders have integrated various business tools to assist them and their teams in ensuring consistent delivery of safe and top-quality care. The cornerstone to all quality improvement strategies is the detailed understanding of the current state of a process, captured by process mapping. Process mapping empowers caregivers to audit how they are currently delivering care to subsequently strategically plan improvement initiatives. As a community, neurosurgery has clearly shown dedication to enhancing patient safety and delivering quality care. A care redesign strategy named NERVS (Neurosurgery Enhanced Recovery after surgery, Value, and Safety) is currently being developed and piloted within our department. Through this initiative, a multidisciplinary team led by a clinician neurosurgeon has process mapped the way care is currently being delivered throughout the entire episode of care. Neurosurgeons are becoming leaders in quality programs, and their education on the quality improvement strategies and tools is essential.

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Written by NEUROSURGERY® Editorial Office

July 28, 2014 at 8:00 AM

Free Editor Choice with CME: Fractionated Radiosurgery for Brain Metastases

Background: Several studies have demonstrated that omitting the routine use of adjuvant whole-brain radiation therapy for patients with newly diagnosed brain metastases may be a reasonable first-line strategy. Retrospective evidence suggests that fractionated stereotactic radiotherapy (fSRT) may have a lower level of toxicity with equivalent efficacy in comparison with radiosurgery.

Objective: To study the phase II efficacy of using a focally directed treatment strategy for symptomatic brain metastases by the use of fSRT with or without surgery and omitting the routine use of adjuvant whole-brain radiation therapy.

Methods: We used a Fleming single-stage design of 40 patients. Patients were eligible if they presented with 1 to 3 newly diagnosed symptomatic brain metastases, Karnofsky performance scale (KPS) greater than 60, and histological confirmation of primary disease. Patients underwent fSRT with the use of a dose of 30 Gy in 5 intensity-modulated fractions as primary or adjuvant treatment after surgical resection. The primary end point was the proportion of patients who experienced neurological death. Secondary end points were overall survival, time to KPS <70, and progression-free survival.

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Written by NEUROSURGERY® Editorial Office

May 28, 2014 at 8:00 AM

Free Editor Choice with CME: Resting-State fMRI: Review of Neurosurgical Applications

Screen Shot 2014-04-25 at 9.57.45 AMRecent research in brain imaging has highlighted the role of different neural networks in the resting state (ie, no task) in which the brain displays spontaneous low-frequency neuronal oscillations. These can be indirectly measured with resting-state functional magnetic resonance imaging, and functional connectivity can be inferred as the spatiotemporal correlations of this signal. This technique has proliferated in recent years and has allowed the noninvasive investigation of large-scale, distributed functional networks. In this review, we give a brief overview of resting-state networks and examine the use of resting-state functional magnetic resonance imaging in neurosurgical contexts, specifically with respect to neurooncology, epilepsy surgery, and deep brain stimulation. We discuss the advantages and disadvantages compared with task-based functional magnetic resonance imaging, the limitations of resting-state functional magnetic resonance imaging, and the emerging directions of this relatively new technology.

From: Resting-State Functional Magnetic Resonance Imaging: Review of Neurosurgical Applications by Lang et al.

Free full text access.

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Written by NEUROSURGERY® Editorial Office

April 25, 2014 at 9:58 AM

Posted in CME, Editor Choice, Free

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Ahead of Print: Tracking and Sustaining Improvement Initiatives

Increasingly, hospitals and physicians are becoming acquainted with business intelligence strategies and tools to improve quality of care. In 2007, the University of California Los Angeles (UCLA) Neurosurgery Department created a quality dashboard to help manage process measures and outcomes and ultimately enhance clinical performance and patient care. At that time, the dashboard was in a platform that required data to be entered manually. It was then reviewed monthly to allow the department to make informed decisions. In 2009, the Department leadership worked with the UCLA Medical Center to align mutual quality improvement priorities. The content of the dashboard was redesigned to include three areas of priorities: quality and safety, patient satisfaction, as well as efficiency and utilization. Throughout time, the Neurosurgery quality dashboard has been recognized for its clarity and its success in helping management direct improvement strategies and monitor impact. Read the rest of this entry »

Written by NEUROSURGERY® Editorial Office

January 17, 2014 at 8:00 AM

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