Improving patient care in neurosurgery through postoperative telephone calls: a systematic review and lessons from all surgical specialties.

OBJECTIVE: Postoperative telephone calls are a simple intervention that can be used to improve communication with patients, potentially affecting patient safety and satisfaction. Few studies in the neurosurgical literature have examined the effect of a postoperative telephone call on patient outcomes, although several exist across all surgical specialties. The authors performed a systematic review and analyzed studies published since 2000 to assess the effect of a postoperative telephone call or text message on patient safety and satisfaction across all surgical specialties. METHODS: A search of PubMed-indexed articles was performed on June 12, 2021, and was narrowed by the inclusion criteria of studies from surgical specialties with > 50 adult patients published after 1999, in which a postoperative telephone call was made and its effects on safety and satisfaction were assessed. Exclusion criteria included dental, medical, and pediatric specialties; systematic reviews; meta-analyses; and non-English-language articles. Dual review was utilized. RESULTS: Overall, 24 articles met inclusion criteria. The majority reported an increase in patient satisfaction scores after a postoperative telephone call was implemented, and half of the studies demonstrated an improvement in safety or outcomes. CONCLUSIONS: Taken together, these studies demonstrate that implementation of a postoperative telephone call in a neurosurgical practice is a feasible way to enhance patient care. The major limitations of this study were the heterogeneous group of studies and the limited neurosurgery-specific studies.

Insights into potential targeted nonsurgical therapies for the treatment of moyamoya disease.

Since its initial description in 1957 as an idiopathic disease, moyamoya disease has proved challenging to treat. Although the basic pathophysiology of this disease involves narrowing of the terminal carotid artery with compensatory angiogenesis, the molecular and cellular mechanisms underlying these changes are far more complex. In this article, the authors review the literature on the molecular and cellular pathophysiology of moyamoya disease with an emphasis on potential therapeutic targets.

Hemorrhagic spinal melanotic schwannoma presenting as acute chest pain: A case report and literature review.

BACKGROUND: Melanotic schwannoma (MS) is a rare variant of peripheral nerve sheath tumor. MS commonly arises along the spinal nerve sheath. Patients most often experience pain along the dermatome of the affected nerve root. Symptoms development is usually insidious. About half of MS cases are associated with Carney complex, a multi-neoplastic disorder. The remaining cases arise spontaneously. About 10-44% of these tumors undergo malignant transformation. CASE DESCRIPTION: We describe a case of hemorrhagic MS presenting as acute chest pain mimicking myocardial infarction, a presentation which has not yet been described in the literature. Neurologic examination did not reveal any abnormalities. Myocardial infarction was ruled out in the ER, and a chest CT angiogram was ordered for evaluation of PE or aortic dissection which revealed an intradural extramedullary dumbbell-shaped mass extending through the left vertebral foramen at the level of T8. MRI revealed a heterogenous mass that was hyperintense with T2 and hypointense with T1-weighted imaging. The patient underwent an open laminectomy of the left T8 and T9 vertebrae and gross total resection (GTR) of a hemorrhagic black tumor. Microscopic examination showed fascicles and nests of plump spindle cells with variable intracellular melanin. Immunohistochemistry showed the cells to be positive for S100, SOX10, HMB-45, and MART-1, confirming diagnosis of MS. Two months after the operation, the patient was doing well and is free of recurrence. CONCLUSION: GTR is considered the optimal treatment for MS; radiotherapy and chemotherapy may be considered but have not been shown to improve patient outcomes.

Hospital Venous Thromboembolism Prevention: A Year-Long Case Based Caprini Score Risk Analysis with Findings Suggesting Optimal Care.

INTRODUCTION: Venous thromboembolism (VTE) is a common cause of hospital morbidity and mortality. VTE risk assessment can provide a reduction in these events if optimal prophylactic interventions are taken. The Caprini Risk Assessment (CRA) score is a validated VTE risk scoring system available for hospitalized patient risk stratification. Implementation of risk assessment in an effective and systematic way could improve prevention of VTE events. METHODS: Patients were selected from a one-year retrospective chart review of adults in our hospital EMR who acquired a VTE during hospitalization. Periodic review of identified patients and determination of preventable causes of VTE were performed followed by application of the modified CRA scoring system at specific clinical event occurrences. Statistical analysis was performed via independent T-test of calculated CRA scores at the time of admission, VTE event, and discharge, comparing preventable and non-preventable groups. RESULTS: We identified 38 patients who acquired a VTE during hospitalization and 16 were determined to be preventable. A significant rise in CRA scores was observed from the time of admission, to the time of VTE, and at discharge. When comparing the preventable and non-preventable groups, there was no significant difference in CRA scores or trends. CONCLUSIONS: The CRA score is an important clinical tool that facilitates the optimal application of VTE prophylaxis. Our analysis emphasizes the importance of systematic VTE risk assessment and of improving the accuracy of the underlying clinical data. The study findings also suggest two higher risk groups that may benefit from more aggressive prophylaxis.

Pineal Cyst Apoplexy in an 8-Year-Old Girl: Case Report and Literature Review.

BACKGROUND: Pineal cysts are common, typically asymptomatic, and are usually found incidentally in adults. In rare cases, pineal cyst apoplexy occurs as a result of an acute cystic hemorrhage. This situation can result in acute onset of severe headaches, acute obstructive hydrocephalus, mass effect on the midbrain, and even death. Pineal apoplexy is most common in women of reproductive age, whereas pediatric cases continue to be less prevalent. Pineal cyst apoplexy remains a rare entity with ≥30 cases presented in the literature to date. CASE DESCRIPTION: We present the youngest case in the literature (an 8-year-old girl with a pineal cyst that resulted in apoplexy), her diagnostic workup, management, and follow-up. We supplement our case study with a literature review of pineal cyst apoplexy. CONCLUSIONS: Pineal cyst apoplexy remains a rare clinical event in the pediatric population. Our case details the diagnosis and management of an 8-year-old girl with pineal cyst apoplexy. We also discuss our findings from our literature search for all reported cases of pineal cyst apoplexy.