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Before performing surgery for pain relief, it is important to ask the patient to describe the minimum level of pain improvement after surgery that he or she would consider acceptable.

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In The Loupe

This soundless video of surgery for hemifacial spasm shows retrosigmoid exposure and microvascular decompression of the ectatic basilar artery with stepwise mobilization and packing. The patient is a 61-year-old woman who had experienced progressive left hemifacial spasm and left facial weakness for several years. After surgery the patient reported complete remission of hemifacial spasm and return of her facial strength. For additional reading, click here. Contributed by Richard W. Byrne, MD, Chicago, Ill.



But, He Told Me I ‘Needed’ Surgery

Doing “good” for patients goes beyond the competent execution of technical surgical skills. Surgical success determined by achievement of outcome targets is an obvious means of evaluation. However, success measured by physiological parameters alone may bear little relationship to the expectations patients had when they agreed to surgical therapy during the informed consent process. In order to fulfill the intent of informed consent, physicians must carefully consider what success means to us and what it means to patients burdened with an illness. Physicians have an ethical obligation to communicate clearly with patients. This includes careful attention to the language used. Consider how the word “need” can be misunderstood or misused in an informed consent process. “Need” entails a professional judgment and a strong recommendation to a particular patient that the procedure under discussion is required for health. Because patients are likely to perceive “need” as a strong recommendation from the surgeon, they might not fully weigh the risks and benefits…


Inside Neurosurgeon

New Frontiers: AANS in Denver

Intrepid Denver, the gateway to Colorado’s breathtaking Rocky Mountains, is a fitting site for the 79th AANS Annual Scientific Meeting, “Discovering Neurosurgery: New Frontiers.” “From April 9–13 in Denver, we’ll explore the new frontiers we have attained in neurosurgery,” said AANS President James T. Rutka, MD. Working with Dr. Rutka and Annual Meeting Committee Chair Matthew A. Howard III, MD, AANS members have been planning all year to present a stellar and entertaining educational event. The meeting features 20 scientific sessions, 66 breakfast seminars, 175 oral abstract presentations, and more than 500 electronic posters, offering up to 42.75 AMA PRA Category 1 credits. Guest speakers include Cushing Orator Nathaniel Philbrick, and honorees include A. John Popp, MD, Barth A. Green, MD, Thomas A. Marshall, and Shigeaki Kobayashi, MD. For the second year, meeting content will be delivered digitally via each attendee’s iPod touch. Before the meeting, the 2011 AANS Annual Scientific Meeting application should be downloaded from iTunes.


Peer-Reviewed Research

Malpractice Litigation: Closed Claims Reviewed

Medical malpractice is a topic that weighs heavily on the minds of most neurosurgeons. A thorough understanding of factors that underlie malpractice cases may help neurosurgeons and the neurosurgical profession in several ways. This information might prospectively help neurosurgeons understand which types of cases represent a litigation risk. It also is possible that specific nuances in patient care exist and could be heeded to help avoid potential patient safety risks. Knowing which patients tend to pursue malpractice claims additionally might help prove or dispel misperceptions about those patients, particularly under what types of situations they tend to present. In this review we seek to evaluate the epidemiological profile of neurosurgical malpractice claims and educate neurosurgeons on those issues, including the characteristics of patients who bring malpractice claims, the types of cases most often litigated, the injuries most frequently associated with