Journal of neurosurgery
-
Journal of neurosurgery · Apr 2019
Multimodal noninvasive evaluation in MRI-negative operculoinsular epilepsy.
Presurgical evaluation of patients with operculoinsular epilepsy and negative MRI presents major challenges. Here the authors examined the yield of noninvasive modalities such as voxel-based morphometric MRI postprocessing, FDG-PET, subtraction ictal SPECT coregistered to MRI (SISCOM), and magnetoencephalography (MEG) in a cohort of patients with operculoinsular epilepsy and negative MRI. ⋯ This study highlights the individual and combined values of multiple noninvasive modalities for the evaluation of nonlesional operculoinsular epilepsy. The 3-test combination of MAP, MEG, and SISCOM represented structural, interictal, and ictal localization information, and constituted the highest yield. MAP showed the highest yield of unique information when other tests were negative or nonlocalizing.
-
OBJECTIVERemoval of colloid cysts of the third ventricle using a purely endoscopic method has been established as a safe and advantageous technique. It is hypothesized that endoscopic removal in recurrent cases might pose more technical challenges and result in less success. The objective of this study was to assess the feasibility and outcomes of using a purely endoscopic approach for the management of recurrent colloid cysts compared to primary cysts. ⋯ The study's findings did not show a statistically significant difference in the rate of recurrence between the 2 groups. The proportion of patients with symptomatic cysts on presentation was lower in patients with recurrent cysts than in patients with primary cysts. Due to the high rate of complete removal with negligible morbidity, the authors continue to advocate for an endoscopic removal at the time of cyst recurrence.
-
Journal of neurosurgery · Apr 2019
Development of the Subdural Hematoma in the Elderly (SHE) score to predict mortality.
The purpose of this study was to describe the development of a novel prognostic score, the Subdural Hematoma in the Elderly (SHE) score. The SHE score is intended to predict 30-day mortality in elderly patients (those > 65 years of age) with an acute, chronic, or mixed-density subdural hematoma (SDH) after minor, or no, prior trauma. ⋯ The SHE score is a simple clinical grading scale that accurately stratifies patients' risk of mortality based on age, admission GCS score, and SDH volume. Use of the SHE score could improve counseling of patients and their families, allow for standardization of clinical treatment protocols, and facilitate clinical research studies in SDH.
-
Journal of neurosurgery · Apr 2019
Simultaneous explantation and implantation of intrathecal pumps: a case series.
OBJECTIVEIntrathecal drug delivery devices (IDDDs) are a mainstay in the treatment of spasticity and refractory pain. While these devices have been shown to greatly improve the quality of life for patients, they also have a high perioperative complication and failure rate. A major complication of IDDD implantation is infection. ⋯ CONCLUSIONSIDDD infections represent a large portion of morbidity associated with these devices. The current standard of care for deep pump infections requires pump explantation and a course of antibiotics prior to reimplantation of the IDDD. The authors demonstrate the effectiveness of a procedure involving simultaneous explantation of an infected pump and implantation of a new pump on the contralateral side in the treatment of IDDD infections.
-
Journal of neurosurgery · Apr 2019
Comparing two randomized deep brain stimulation trials for Parkinson's disease.
Several randomized studies have compared the effect of deep brain stimulation (DBS) of the subthalamic nucleus with the best medical treatment in large groups of patients. Important outcome measures differ between studies. Two such major studies, the life-quality study of the German Competence Network for Parkinson’s disease (LQ study) and the US Veterans Affairs/National Institute of Neurological Disorders and Stroke trial (VA/NINDS trial), were compared here in order to understand their differences in outcomes. ⋯ ADL = activity of daily living; DBS = deep brain stimulation; HY = Hoehn and Yahr; L-dopa = levodopa; LDR = levodopa responsiveness; LED = levodopa equivalent dose; LQ study = German Competence Network for Parkinson’s disease study; PD = Parkinson’s disease; PDQ-39 = 39-Item Parkinson’s Disease Questionnaire; PDQ-SI = PDQ summary index; STN = subthalamic nucleus; UPDRS-II = Unified Parkinson’s Disease Rating Scale, Activities of Daily Living; UPDRS-III = UPDRS Motor Examination; UPDRS-IV = UPDRS Complications of Therapy; VA/NINDS = Veterans Affairs/National Institute of Neurological Disorders and Stroke.