Notes

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8%) of symptoms was achieved after EBP injection. Nerve root ligation was the most common method of exclusion of CSF-venous fistula. Complete resolution of symptoms was achieved in 69.0% of patients, in 21.4% it was partial and in 9.5% no regress was found. Endovascular treatment was described only in 1 study.

Surgical ligation of fistula is a treatment of choice. In approximately 70% of patients complete long-term resolution of symptoms is achieved after surgery. Endovascular treatment and fibrin glue injections are prospective and evolving options, which require further investigation.
Surgical ligation of fistula is a treatment of choice. In approximately 70% of patients complete long-term resolution of symptoms is achieved after surgery. Endovascular treatment and fibrin glue injections are prospective and evolving options, which require further investigation.
Sport-related concussion (SRC) prevention and management is a focus of the National Football League (NFL). While most prior reports evaluated sport-related concussion incidence, few have studied same-year repeat concussions. This study aimed to evaluate the frequency of same-year repeat concussions in the NFL.

A retrospective, observational cohort study of same-year repeat concussions in the NFL from 2015 to 2019 was performed. The NFL's electronic health record was reviewed for players sustaining concussions and same-year repeat concussions. Wilcoxon rank sum tests were used to calculate same-year repeat concussion rates, and risk ratios and 95% confidence intervals were estimated using log-binomial regression.

From 2015 to 2019, the risk of sustaining a same-year repeat concussion in the NFL was 0.38%-0.69% per season. Among players who sustained a concussion, the risk of a same-year repeat concussion was 5.3%-8.3%, which did not differ significantly from the risk of sustaining a single concussion (6.2%-8.3%). There was a median of 38 participation days between initial and same-year repeat concussion. Players missed more time from same-year repeat concussions (median 12 days) compared with both single (median 9 days; P < 0.0001) and initial (median 9.5 days; P= 0.002) concussions.

The risk of a repeat concussion was similar to the risk of sustaining a single concussion among NFL players. More time was missed following a same-year repeat concussion compared with single or initial concussions. Further research is needed to maximize player safety and minimize same-year repeat concussions.
The risk of a repeat concussion was similar to the risk of sustaining a single concussion among NFL players. More time was missed following a same-year repeat concussion compared with single or initial concussions. Further research is needed to maximize player safety and minimize same-year repeat concussions.
In patients with Pfeiffer syndrome, several corrections are required to correct facial retrusion, maxillary deficiency, or even hypertelorism. The frontofacial monobloc advancement (FFMA) and the facial bipartition (FB) are the gold standard surgeries. We present the correction of this deformity using a simultaneous computer-assisted FFMA and FB.

The 3-dimensional surgical planning defined the virtual correction and bone-cutting guide in view of the FFMA and FB. Coronal and intraoral approaches were combined to perform the osteotomies. Four internal distractors were also placed for the postoperative distraction osteogenesis.

We reported 2 cases of computer-assisted surgery with satisfying outcomes. The sagittal deficiency (fronto-facial retrusion) was corrected by FFMA and the transversal abnormality (i.e., hypertelorism and maxillary deficiency) by the FB, then followed by an internal distraction osteogenesis.

Computer-assisted surgery is helpful and a reliable option for the management of complex faciocraniosynostosis such as hypertelorism and frontofacial retrusion.
Computer-assisted surgery is helpful and a reliable option for the management of complex faciocraniosynostosis such as hypertelorism and frontofacial retrusion.
The limitations of anterior cervical discectomy and fusion (ACDF) are related to mechanical failure of the construct after recurring subsidence and migration. In the present study, we evaluated the effect of the maximum rotation of variable angle screws on the range of motion (ROM), cage migration, and subsidence.

Five finite element models were developed from a C2-C7 cervical spine model. The first model was an intact C2-C7 spine model, and the second model was an altered C2-C7 model with C4-C6 cage insertion and a 2-level static plate. The other three models were altered C2-C7 models with the same C4-C6 cage insertion and a 2-level dynamic plate.

The ROM of C4-C6 in the static plate model was reduced by ∼14° from the intact model but only reduced by ∼9° in the dynamic plate models. The maximum migration and subsidence at the cage-endplate interface in the dynamic plate models were lower than those in the static plate model for all moments. NSC16168 cost The von Mises stress of the C3-C4 and C6-C7 discs in the dynam multilevel applications, regardless of loading.
The overall safety and efficacy of flow diverting stents (FDSs) deployed in small caliber parent arteries (≤2.5 mm) for the treatment of intracranial aneurysms remains unclear. Recent studies have provided additional outcomes data to assess the use of FDSs for such arteries. In the present review, we have summarized the reported clinical and angiographic outcomes of FDS-treated brain aneurysms in small parent arteries.

A systematic literature review was performed for outcomes data related to FDS-treated intracranial aneurysms using PubMed, Ovid Medline, and Web of Science. Procedural data, angiographic outcomes, and clinical outcomes at various time points were collected and summarized.

The 19 studies included 580 patients with 604 aneurysms, of which 6.1% had been acutely ruptured and 28.3% had been previously treated. The procedural complication rate and symptomatic stroke rate was 9.8% and 7.5%. The complete occlusion rate at the last radiographic follow-up (mean, 12.1 months) was 73.6%. At the last tive endovascular approaches are necessary to further define the optimal use of FDS for these aneurysms.
Traumatic brain injury (TBI) poses a particular health risk for the elderly. The recently developed elderly TBI (eTBI) score combines the prognostic information of the risk factors characteristic of the geriatric population. We aimed to determine its validity and reliability on an independent sample.

We present a retrospective analysis of 506 consecutive patients after TBI aged ≥65 years. The previously described nomogram and the eTBI score were used. The primary outcome measure was mortality or vegetative state at 30 days after hospital admission.

Mortality or vegetative state rate was 21.3%. The nomogram and eTBI Score showed similar predictive performance with accuracy of 83.8% (95% confidence interval 80.2%-87%) and 84.4% (95% confidence interval 80.8%-87.6%), respectively. On the basis of the Youden index and C4.5 algorithm, we divided patients according to the 3-tier pattern into low-, high-, and medium-risk groups. The outcome prediction in the first 2 groups was correct in 93.1% (survival in the low-risk group) and 94.4% (mortality in the high-risk group). Patients included in the medium-risk group usually required surgical treatment (85.3%) and were characterized by increased mortality or vegetative state (55%). Among patients with eTBI ≥5 (n= 221), there was no difference in outcome between those treated conservatively and surgically.

This is the first study confirming the validity of the eTBI Score and its close association with outcome of geriatric population after TBI. The novel 3-tier risk stratification scheme was applicable to both conservatively and surgically treated patients.
This is the first study confirming the validity of the eTBI Score and its close association with outcome of geriatric population after TBI. The novel 3-tier risk stratification scheme was applicable to both conservatively and surgically treated patients.
In order to mitigate the challenges in microsurgical skill acquisition and training, especially in the COVID-19 era, we devised a novel microsurgical telementoring protocol for imparting microsurgical skill training in a socially distanced setting. We objectively analyzed its feasibility among neurosurgical trainees.

In a controlled experimental design, 8 residents at different stages of their tenure participated in a lazy glass microsurgical simulator-based telementoring exercise. Microsuturing with 4-0 silk, 10-0 nylon on silastic sheets, and eggshell peeling tasks were performed by the residents prior to and after a telementoring session by a panel of 4 neurosurgical experts. Impact of telementoring was assessed in terms of surgical accuracy, efficiency, and dexterity by providing objective (Performance score [PS]), subjective (Neurosurgery Education and Training School [NETS] score), and cumulative scores (CS). Subgroup analysis was performed to assess the impact at different stages of residency.

PStive tool to augment surgical proficiency and finesse, irrespective of stage of residency.
Project Extension for Community Healthcare Outcomes (ECHO) is a virtual training and capacity building model that uses videoconferencing to link expert interdisciplinary teams with primary care clinicians in local communities. In this study, we evaluated ECHO Ontario Integrated Mental and Physical Health (ECHO-IMPH). This is the first consultation-liaison psychiatrist-led Project ECHO explicitly designed to support health care providers (HCPs) within primary care in delivering better care for patients with co-occurring mental and physical health needs. We assessed the impact of ECHO-IMPH on HCP engagement, learning, and practice change.

Using Moore's Evaluation Framework, we used attendance logs and weekly surveys to investigate HCP engagement and satisfaction with ECHO-IMPH, as well as questionnaires to assess impact on their learning, self-efficacy, and practice change with respect to patient care. A pre-post design was used to assess change in the latter.

A total of 322 HCPs participated in ECHO-IMPHith high engagement and satisfaction.
Health anxiety is a subtype of the older term hypochondriasis, in which there is worry rather than conviction of having an illness. Information on the association between childhood maltreatment and health anxiety in adulthood often comes from retrospective questionnaires that may be subject to recall bias. There are no prospective data studies using reports to statutory agencies.

We therefore assessed the effect on these outcomes at 30-year follow-up using both prospective agency notifications of child abuse and retrospective self-reports in the same birth cohort.

At follow-up, there were 2458 adults with data on health anxiety as measured by the Whiteley Index. We also collected details on self-reported abuse with the Child Trauma Questionnaire and linked this to child maltreatment notifications to statutory agencies.

The prevalence of self- and agency-reported maltreatment was 600 (24.4%) and 143 (5.8%), respectively. Of the participants, 235 were in the top 10% of Whiteley Index scores. On adjusted analyses, self-reported maltreatment of all types showed significant associations with increased health anxiety, while this was limited to sexual abuse in the case of agency-reported childhood maltreatment (adjusted odds ratio=2.
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