Introduction: Tumors that invade or compress the venous sinuses have the potential to impair venous drainage. Rarely, this may be so severe as to induce intracranial hypertension. Other studies have previously described venous sinus stenting (VSS) for the treatment of these symptomatic lesions. In this report, we present our series of eight cases of VSS for symptomatic tumor-induced venous sinus stenosis and review the existing literature. Cases: Eight patients with mostly intracranial tumors were found to have symptomatic venous sinus stenosis with the most common presenting symptom being elevated intracranial pressure. Six of the eight (75%) patients presented with papilledema on neuro-ophthalmological exam. The most affected locations were the transverse and sigmoid sinuses in four patients, followed by the superior sagittal sinus in three patients. All eight patients underwent VSS with no adverse events. In total, 6 out of 8 (75%) of patients had complete resolution of their symptoms, while the remaining patients experienced at least partial improvement. Conclusion: Tumors that cause symptomatic venous sinus stenosis may be successfully managed with VSS to improve venous drainage. This may facilitate continued conservative management of meningiomas or allow for treatment with noninvasive means, such as stereotactic radiosurgery. Depending on the size of the target stenosis, balloon-mounted coronary stents may be a suitable option to treat these lesions.

BACKGROUND AND OBJECTIVES: Intraoperative neurophysiological monitoring plays a pivotal role in modern neurosurgery, aiding in real-time assessment of eloquent neural structures to mitigate iatrogenic neural injury. This study represents the largest retrospective series to date in monitoring corticospinal tract integrity during intracranial surgery with transcranial motor-evoked potentials (TCMEPs), focusing on the influence of demographic factors, comorbidities, and preoperative motor deficits on the reliability of intraoperative neurophysiological monitoring. While the impact of patient-specific factors affecting TCMEP monitoring in spine surgery is well-documented, similar insights for intracranial surgery are lacking. METHODS: A total of 420 craniotomy patients were retrospectively analyzed from electronic medical records from December 2017 to February 2023, excluding patients without preoperative Medical Research Council scores or medical histories. Using intrinsic hand muscles as a robust data set, 840 hand TCMEPs acquired during intracranial surgery were assessed. Demographic and clinical factors, including preoperative motor scores, were analyzed to identify associations with TCMEP acquisition and amplitude. Nonparametric statistics and multivariate regression analysis were employed. RESULTS: TCMEPs were successfully acquired in 734 (87.7%) patient hands, even in the presence of preoperative motor deficits in 13.9% of total patient hands. Preoperative motor scores did not predict the ability to acquire baseline TCMEPs (P = .6). Notably, older age (P < .001) and hypertension (P = .01) were independent predictors of lower TCMEP acquisition rates. Preoperative motor scores significantly influenced TCMEP amplitudes, with higher scores correlating with higher amplitudes (1771 [SD = 1550] eve vs 882 [SD = 856] μV, P < .0001). Older age (P < .001) and chronic kidney disease (P = .04) were also associated with reduced TCMEP amplitudes. CONCLUSION: Our investigation into TCMEPs during intracranial surgery demonstrated a notably high acquisition rate in hand muscles, irrespective of preoperative motor deficits. Preoperative motor scores reliably correlated with TCMEP amplitudes in a linear fashion while advanced age and renal disease emerged as independent predictors of lower TCMEP amplitudes.

Cardiac rehabilitation (CR) has been categorized as a class Ia recommendation for secondary prevention after major cardiac interventions or in patients with certain cardiac comorbidities. The benefits of CR have been established and range from reducing readmissions to improving quality of life. Given the increasing amount of literature on CR over the past few years and the evolution of this field, there is a need to synthesize these data. Thus, this review aims to combine the latest research findings to provide a comprehensive review of CR literature. We discuss the components needed to create a successful CR program, including individualized training plans, routine clinical assessments, exercise supervision, and nutritional assessments. Overall rates of CR utilization remain low. Therefore, we explore potential reasons for this underutilization observed in the literature, including CR deserts, under-referral, and the lack of education on benefits, time, and transportation. Moreover, we discuss solutions for underutilization that have been analyzed in the literature, including motivational interviewing, gender-specific regimens, transportation assistance, and automatic referrals. Realizing the underutilization of CR, we also assess virtual CR (VCR) and variations in various regimens within the programs. We compare exercise and body metrics, patient outcomes, feasibility, and patient preferences between VCR and traditional CR published in the literature. VCR does not appear to be inferior to conventional CR in many metrics, although more research is needed to compare the two modalities. We recommend that providers explain the outcomes of the two modalities and allow patients to choose the regimen that works best for them. We discuss how VCR may be better suited to patient populations with specific barriers to care. We also discuss the ongoing current CR trials, many of which are focused on solutions to underutilization. Lastly, we further discuss the remaining gaps in the CR literature and areas where future research could be beneficial, such as establishing large-scale VCR studies and studies focused on expanding CR indications.

Introduction: Chronic wounds affect approximately six million people in the United States. Despite established multidisciplinary wound care protocols, patient adherence to follow-up care remains suboptimal. We aimed to understand the impact of social drivers of health on patient decision-making for improving wound care follow-up adherence. Methods: We conducted a retrospective review of all hospitalized patients who consulted in-house wound care staff at a tertiary care center between August 2017 and June 2020, regardless of primary admission diagnosis. Referred patients received standardized care from a multidisciplinary team at an outpatient wound care facility. Primary endpoints were pre-discharge scheduling and follow-up rates. Follow-up efficacy was assessed through 90-day hospital readmission rates. Results: Of 444 patients, 205 (46.2%) were readmitted or expired within 90 days. Adjusted analysis identified lack of follow-up care reception as an independent predictor of hospital readmission (hazard ratio 2.39; 95% CI, 1.45–3.89; p < 0.001). Among 156 (35.1%) patients who scheduled follow-up, 110 (70.5%) adhered to their appointment. Patients not scheduling follow-up were older (median age 79 vs. 70 years, p < 0.001), longer hospital stays (median 9 vs. 6 days, p < 0.0001), and more frequently discharged to skilled nursing facilities (47.6% vs. 26.3%, p < 0.0001). Among scheduled patients, skilled nursing home residents demonstrated lower follow-up adherence (OR 0.3; 95% CI, 0.14–0.65; p < 0.01). Conclusions: Pre-hospital discharge communication for scheduling follow ups serves as a critical intervention point in patient decision-making for wound follow-up. Considering the limitations of a retrospective single-center study, we find that pre-discharge education about follow-up scheduling for high-risk groups, including patients ≥ 80 years and skilled nursing facility residents, may improve follow-up adherence and reduce readmissions.