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Tarun D. Singh, Navid Valizadeh, Fredric B. Meyer, John L. D. Atkinson, Dana Erickson and Alejandro A. Rabinstein

Resection was traditionally considered the optimal treatment for patients with pituitary apoplexy. 8 , 12 , 13 , 31 , 34 However, more recent case series have reported good outcomes with conservative medical therapy. 9 , 21 , 23 , 24 No randomized studies have been conducted to compare the two management strategies, and guidelines propose individualizing therapy depending on the severity of presentation. 30 Most of the literature on pituitary apoplexy consists of relatively small case series. Very few series have included more than 50 patients and presented a long

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Scott L. Parker, Anthony L. Asher, Saniya S. Godil, Clinton J. Devin and Matthew J. McGirt

of desired health outcomes.” 17 Safety and effectiveness (quality), patient-centered outcomes, as well as cost of care are each central components of the health care value equation (benefit/cost). The Institute of Medicine, Agency for Healthcare Research and Quality, and the Patient Protection and Affordable Care Act call for prospective, well-designed registries for the measurement of real-world effectiveness to facilitate evidence-based health care reform. Prospective registries are able to provide the necessary statistical power and real-world health delivery

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Matthew J. McGirt, Theodore Speroff, Saniya Siraj Godil, Joseph S. Cheng, Nathan R. Selden and Anthony L. Asher

US health care environment. The IOM defines health care quality as “The degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes.” 29 According to the IOM, quality care is safe, timely, efficient, patient centered, equitable, and effective. In the health care value equation (benefit/cost), effectiveness of care is the numerator and health care costs are the denominator. Without evidence of effectiveness, health care reform may reward cheaper care (cost-based purchasing) rather than more valuable care

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Tej D. Azad, Maziyar Kalani, Terrill Wolf, Alisa Kearney, Yohan Lee, Lisa Flannery, David Chen, Ryan Berroya, Matthew Eisenberg, Jon Park, Lawrence Shuer, Alison Kerr and John K. Ratliff

D egenerative spine disease is a common and debilitating condition with significant economic costs. Direct medical costs due to low-back pain doubled to $102 billion between 1997 and 2005, 14 and the number of lumbar fusion procedures for degenerative lumbar disease has quadrupled in the past 20 years, resulting in increased health care spending. Some authors note that these increases in surgical procedures have not been matched by improved overall patient outcomes. 6 , 10 Although spine surgery has been shown to provide greater value for certain

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Daniel A. Donoho, Timothy Wen, Jonathan Liu, Hosniya Zarabi, Eisha Christian, Steven Cen, Gabriel Zada, J. Gordon McComb, Mark D. Krieger, William J. Mack and Frank J. Attenello

expertise through increased procedural volume, and the training and retention of specialists. 6 , 20 , 24 , 37 The National Association of Children’s Hospitals and Related Institutions (NACHRI) recognizes over 220 specialized pediatric hospitals. To date, no large-scale national studies have examined the effects of pediatric hospital designation on the outcomes of neurosurgical procedures for malignant pediatric brain tumors. For the purpose of assessing this relationship, a national database may be uniquely useful. The largest source of nationwide patient-level pediatric

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Leland Rogers, Igor Barani, Marc Chamberlain, Thomas J. Kaley, Michael McDermott, Jeffrey Raizer, David Schiff, Damien C. Weber, Patrick Y. Wen and Michael A. Vogelbaum

higher risk for tumor growth or symptom development, and whether long-term patient outcomes differ between surveillance and early definitive treatment. Many questions remain regarding the selection and timing of treatment, especially in cases of recurrent meningioma or newly diagnosed high-grade meningioma (WHO Grade II [atypical] or Grade III [malignant] meningioma). For patients undergoing definitive therapy, complete resection has been the standard for meningioma, but there is a significant subset of patients who are not successfully managed by surgery alone, or

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Siri Sahib S. Khalsa, Alan Siu, Tiffani A. DeFreitas, Justin M. Cappuzzo, John S. Myseros, Suresh N. Magge, Chima O. Oluigbo and Robert F. Keating

likelihood of clinical improvements. To answer this question, we aimed to develop a semiautomated 3D volume segmentation program that can be applied to both preoperative and postoperative anatomy. The goal was to efficiently quantify the preoperative and postoperative 3D volumes of the posterior cranial fossa (PCF) using brain MR images for a cohort of pediatric patients with CM-I. These volume changes of the posterior fossa after suboccipital decompression were compared with improvements in clinical and radiographic outcomes. Method Algorithm Overview The computer program

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Owoicho Adogwa, Scott L. Parker, David Shau, Stephen K. Mendelhall, Joseph Cheng, Oran Aaronson, Clinton J. Devin and Matthew J. McGirt

published studies have been small retrospective case series and composed of a heterogeneous cohort of patients with various underlying pathological entities. Additionally, outcome assessment in previous studies has largely relied on physician-assessed outcome instruments. In this era of comparative effectiveness research, the use of validated patient-assessed metrics has become the gold standard in defining the value of spinal surgery. Hence, the effectiveness of revision fusion in the setting of lumbar pseudarthrosis remains poorly quantified. Given the reported

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Vijay Agarwal, Ranjith Babu, Jordan Grier, Owoicho Adogwa, Adam Back, Allan H. Friedman, Takanori Fukushima and Cory Adamson

studies have typically consisted of small cohorts treated over long periods and have demonstrated variable surgical outcomes that are primarily dependent on tumor characteristics. 17 , 20 One such study of 24 patients demonstrated that 46% experienced short-term complications, with 92% of lower CN neuropathies occurring in patients with tumors extending into the jugular foramen. 17 In this current study, we have characterized the outcomes of 34 patients with CPA meningiomas surgically treated for over an 8-year period and have investigated various factors that may

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Paul M. Brennan, Angelos G. Kolias, Alexis J. Joannides, Jonathan Shapey, Hani J. Marcus, Barbara A. Gregson, Patrick J. Grover, Peter J. Hutchinson and Ian C. Coulter

(TDC), bur-hole craniostomy (BHC), and craniotomy. Although all 3 techniques have approximately the same mortality rate (2%–4%), craniotomy has significantly higher morbidity, and TDC has a higher rate of recurrence, suggesting that BHC is the preferred technique. 25 In contrast, a more recent meta-analysis concluded that TDC should be the first-line treatment, with craniotomy reserved for symptomatic recurrence. 8 Other aspects of perioperative and postoperative management may also influence outcome. A randomized controlled trial (RCT) demonstrated that subdural