Journal of neurosurgery
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Journal of neurosurgery · Apr 2018
Frequency and characteristics associated with inherited thrombophilia in patients with intracranial dural arteriovenous fistula.
The pathogenesis of dural arteriovenous fistulas (DAVFs) remains poorly defined. Prior studies on thrombophilia as a risk factor for DAVF development are limited by small sample sizes and poor generalizability. ⋯ This study is one of the largest of thrombophilia and DAVF to date. The frequency of mutations associated with thrombophilia in this study was higher than that in the general population.
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Journal of neurosurgery · Apr 2018
Barriers to participation in global surgery academic collaborations, and possible solutions: a qualitative study.
There is a global lack of access to surgical care, and this issue disproportionately affects those in low- and middle-income countries. Global surgery academic collaborations (GSACs) between surgeons in high-income countries and those in low- and middle-income countries are one possible sustainable way to address the global surgical need. The objective of this study was to examine the barriers to participation in GSACs and to suggest ways to increase involvement. ⋯ Steps can be taken to address some of these barriers and to increase the involvement of surgeons from high-income countries in GSACs. This could lead to a necessary scale-up of global surgery efforts that may help increase worldwide access to surgical care.
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Journal of neurosurgery · Apr 2018
Exosomes as a biomarker platform for detecting epidermal growth factor receptor-positive high-grade gliomas.
OBJECTIVE High-grade glial brain tumors are often characterized by an elevated expression of the tumorigenic epidermal growth factor receptor variant III ( EGFRvIII). The authors sought to establish a clinically adaptive protocol as a noninvasive diagnostic tool for EGFRvIII detection through serum exosomes. METHODS Purity of serum exosome/RNA was confirmed by electron microscopy and flow cytometry and through an RNA bioanalyzer profile. ⋯ Age, sex, tumor location, and side of the body on which the tumor was located had no effect on the detection rate of exosomal EGFRvIII transcript. EGFRvIII expression either in exosomes or tissue correlated with poor survival. CONCLUSIONS The authors established a serum-based method for detection of EGFRvIII in high-grade brain tumors that might serve as an optimal noninvasive method for diagnosing EGFRvIII-positive high-grade gliomas.
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Journal of neurosurgery · Apr 2018
Evaluation of surgical treatment for neuropathic pain from neuroma in patients with injured peripheral nerves.
OBJECTIVE Chronic neuropathic pain after peripheral nerve injury is a major clinical problem. Its management is difficult, and therapeutic approaches vary and include oral medication, neurostimulation, and surgery. The aim of this study was to assess the adequacy of surgical nerve revision in a large series of patients with long-term follow-up. ⋯ CONCLUSIONS Bearing in mind that medication achieves satisfying pain relief in only 30%-40% of patients with neuropathic pain, surgery must be considered as an effective alternative therapy. No objective criteria were shown to be factors of poor prognosis. Systematic preoperative clinical mapping of the injured nerves and diagnostic nerve blocks could improve the primary success rate of the surgery.
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Journal of neurosurgery · Apr 2018
Patterns of care and outcomes in gliosarcoma: an analysis of the National Cancer Database.
OBJECTIVE The authors compared presenting characteristics and survival for patients with gliosarcoma (GS) and glioblastoma (GBM). Additionally, they performed a survival analysis for patients who underwent GS treatments with the hypothesis that trimodality therapy (surgery followed by radiation and chemotherapy) would be superior to nontrimodality therapy (surgery alone or surgery followed by chemotherapy or radiation). METHODS Adults diagnosed with GS and GBM between the years 2004 and 2013 were queried from the National Cancer Database. ⋯ Gross-total resection also improved survival, and there was a trend toward increased survival with MGMT promoter methylation in GS. The major potential confounder in this study is that patients with poor functional status may not have received aggressive radiation or chemotherapy treatments, leading to the observed outcome. This study should be considered hypothesis-generating; however, due to its rarity, conducting a clinical trial with GS patients alone may prove difficult.