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Bone flap preservation versus removal with immediate mesh cranioplasty for post-craniotomy infections: a systematic review and meta-analysis.
No full textMedication Use Evaluation of Intranasal Dexmedetomidine for Procedural Sedation in Pediatric Critical Care Units
No full textImmunogenicity and efficacy of a rabies-based vaccine against highly pathogenic influenza H5N1 virus.
No full textThe recent spillover of highly pathogenic influenza A/H5N1 (HPAI-H5N1) viruses to cattle, other mammals, and humans poses a major risk to animal and human health. Virus adaptation to new species highlights the need for effective vaccines for animals and humans. We recently developed a rabies virus-based H5 vaccine encoding the HPAI-H5 antigen and presenting it on the surface of the rabies virus particle. To test the immunogenicity and efficacy of the vaccine in eliciting systemic and mucosal immune response, we vaccinated mice intramuscularly or intranasally with either live or inactivated and adjuvanted vaccine. The vaccine elicited neutralizing antibodies against RABV and H5N1 Influenza virus and protected mice from a lethal challenge with PR8 recombinants reassorted with the HA of clade 1 (Viet Nam 1203) or clade 2.3.4.4b HPAI-H5N1 viruses, highlighting its potential use in mitigating the risk of HPAI-H5N1 pandemic
Surgical Management of Chronic Subdural Hematomas: An Institutional Analysis of Time to Hematoma Resolution.
No full textBACKGROUND AND OBJECTIVES: Chronic subdural hematoma (CSDH) management is evolving with the increasing use of middle meningeal artery embolization (MMAE). Limited data exist on the time to resolution (TTR) across different interventions. The aim of this study was to establish a baseline TTR for surgically treated CSDHs before MMAE implementation and compare it with TTR of MMAE.
METHODS: A retrospective analysis of 94 surgically treated CSDHs in 75 patients was performed. Kaplan-Meier survival analysis was used to model TTR for patients undergoing burr hole craniostomy (BHC), craniotomy, and twist drill craniostomy/subdural evacuating port system placement. Univariate and multivariate Cox regression analyses were performed to identify predictors of TTR. An unmatched cohort of 43 patients undergoing MMAE alone was underwent TTR analysis and compared with the surgical arm.
RESULTS: The median TTR for surgically treated CSDHs was 11 weeks, without significant difference between BHC and craniotomy groups. The median TTR for MMAE-treated patients was 14 weeks, significantly longer than craniotomy (
CONCLUSION: Resolution of CSDH commonly requires several months regardless of intervention type. Radiographic and clinical follow-up is widely variable. Although decompressive strategies achieve faster relief of mass effect and symptoms, interventions should consider the TTR and ability of patient to follow-up. Recognition of CSDH as a sentinel health event emphasizes the need for individualized treatment and long-term follow-up strategies
The Impact of Extended Procedure Duration on Nasal Morbidity after Endoscopic Endonasal Transsphenoidal Resection of Pituitary Macroadenomas.
No full textOBJECTIVE: Nasal mucosa is susceptible to injury during endoscopic endonasal transsphenoidal resection of pituitary macroadenomas. Prolonged operative times may lead to increased instrumentation-induced injury to nasal mucosa. Influence of operative time on sinonasal morbidity has not been reported previously. Our objective is to determine preoperative drivers extending operative time and the impact of prolonged endoscopic endonasal transsphenoidal resection on nasal morbidity as measured by postoperative SNOT-22 questionnaire.
STUDY DESIGN: SNOT-22 scores were collected at each rhinology visit and intraoperative OR start and stop timestamps as recorded by nursing staff were extracted from the record.
SETTING: Cases of endoscopic endonasal transsphenoidal pituitary adenoma resection at a tertiary care center were identified.
METHODS: Multivariable regression was done analyzing factors influencing SNOT-22 scores and surgical time.
RESULTS: The study included 222 patients. Median preoperative SNOT-22 score was 12.5 (IQR 4.00, 24.25) and median postoperative SNOT-22 score was 9 (IQR 2.00, 19.25), indicating overall improvement at 6 months. Median procedure duration was 200.4 minutes (IQR 164, 249). Multivariable regression of SNOT-22 showed only history of sinus surgery caused increased sinonasal morbidity (
CONCLUSION: Only a history of prior sinus surgery was associated with increased nasal morbidity. Tumor size, functional tumors, surgical approach, reconstructive technique, and subtotal resection all prolonged operative time. Surgeons should consider counseling patients meeting these criteria on potential risk of increased morbidity and increased operative time with endoscopic endonasal transsphenoidal resection
Biomechanically Informed Image Registration for Patient-Specific Aortic Valve Strain Analysis
No full textReframing the Risks of Deep Brain Stimulation: A Comparison of 2.8 Million Elective Surgeries From the NSQIP Database.
No full textOBJECTIVE: Deep brain stimulation (DBS) is an established surgical therapy for movement disorders, epilepsy, and psychiatric conditions, yet remains underutilized due to perceived risks. We therefore endeavored to compare the safety of DBS to other common elective procedures to provide context for its relative risk.
METHODS: This retrospective cohort study utilized the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, encompassing diverse referral and community hospitals across the United States from 2015 to 2021. Patients with DBS were compared with those receiving one of the 16 most common elective procedures. The primary outcome of interest was the weighted odds of any postoperative complication at 30 days. Secondary outcomes included risk of readmission, reoperation, and discharge disposition. Logistic regression with inverse probability of treatment weighting (IPTW) based on propensity scores adjusted for baseline group heterogeneity.
RESULTS: We identified 2,853,662 patients for analysis, including 4,749 DBS procedures. After IPTW adjustment, patients with DBS experienced lower 30-day complication rates compared with other procedures (1.3% vs 4.1%, OR = 0.32, 95% confidence interval [CI] = 0.25-0.41, p \u3c 0.0001). Readmission rates did not differ significantly (2.2% vs 2.6%, OR = 0.84, 95% CI = 0.69-1.02, p = 0.08). DBS cases had higher odds of discharge home (98.7% vs 96.3%, OR = 2.94, 95% CI = 2.27-3.82, p \u3c 0.0001) and lower reoperation rates (0.7% vs 1.3%, OR = 0.50, 95% CI = 0.35-0.72, p = 0.0002).
INTERPRETATION: DBS demonstrates a favorable safety profile with substantially lower complication rates compared with the most widely performed elective surgeries. These findings support broader consideration of surgical referral for appropriate DBS candidates. ANN NEUROL 2026