Journal of neurosurgery
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Journal of neurosurgery · Nov 2023
Trends in successfully matched neurosurgery residency applicants.
The United States Medical Licensing Examination (USMLE) Step 1 recently transitioned to a pass/fail outcome, renewing interest in how programs select neurosurgical residents. This study investigates the association between match status and key academic metrics over time. ⋯ From 2009 to 2022, neurosurgical residency applicants grew in their achievements across many metrics. In the advent of Step 1 becoming pass/fail, this study suggests that Step 2 is not viewed by programs as an adequate replacement. However, the Step 1 grading transition may serve as an opportunity for other factors to be considered that may better predict success in neurosurgical residency.
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Journal of neurosurgery · Nov 2023
CommentLong-term outcomes after responsive neurostimulation for treatment of refractory epilepsy: a single-center experience of 100 cases.
Despite antiepileptic drugs, more than 30% of people with epilepsy continue to have seizures. Patients with such drug-resistant epilepsy (DRE) may undergo invasive treatment such as resection, laser ablation of the epileptogenic focus, or vagus nerve stimulation, but many are not candidates for epilepsy surgery or fail to respond to such interventions. Responsive neurostimulation (RNS) provides a neuromodulatory option. In this study, the authors present a single-center experience with the use of RNS over the last 5 years to provide long-term control of seizures in patients with DRE with at least 1 year of follow-up. ⋯ Responsive neurostimulator implantation achieved 50% or more seizure reduction in approximately 80% of patients. Even in patients who did not achieve seizure freedom, significant improvement in seizure duration, severity, or postictal state was reported in more than 68% of cases. Infection (7%) was the most common complication. Patients with prior resective or ablative procedures and those who had been treated with RNS for more than 3 years achieved better outcomes.
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Journal of neurosurgery · Nov 2023
ReviewClinical trial implementation: a primer for neurosurgeons.
In the current landscape of evidence-based medicine, prospective clinical trials are an important avenue through which to establish the efficacy and safety of biomedical treatments compared with standard-of-care interventions. Depending on their scope and aims, clinical trials can be extremely costly and time intensive, and significant coordination is needed to ensure optimal utilization of healthcare resources, adherence to the principles of biomedical ethics, and appropriate interpretation of study results. This review highlights the core principles for designing and implementing clinical trials within neurosurgery, with the aim to provide clinicians with a framework for implementing both investigator-initiated and industry-sponsored trials.
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Journal of neurosurgery · Nov 2023
Initial experience with transcarotid arterial revascularization with flow reversal in the management of symptomatic carotid stenosis.
The aim of this study was to evaluate the efficacy of transcarotid arterial revascularization (TCAR) as a viable intervention in the treatment of symptomatic carotid artery stenosis. ⋯ The authors' initial experience with TCAR suggests that it might provide an effective alternative to carotid endarterectomy and carotid artery stenting in the management of symptomatic carotid stenosis in patients with high-risk anatomical and medical characteristics.
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Journal of neurosurgery · Nov 2023
BOLD frequency-dependent alterations in resting-state functional connectivity by pallidal deep brain stimulation in patients with Parkinson's disease.
Functional MRI (fMRI) has been used to investigate the therapeutic mechanisms underlying deep brain stimulation (DBS) for Parkinson's disease (PD). However, the alterations in stimulation site-seeded functional connectivity induced by DBS at the internal globus pallidus (GPi) remain unclear. Furthermore, whether DBS-modulated functional connectivity is differentially affected within particular frequency bands remains unknown. The present study aimed to reveal the alterations in stimulation site-seeded functional connectivity induced by GPi-DBS and to examine whether there exists a frequency band effect in blood oxygen level-dependent (BOLD) signals related to DBS. ⋯ These findings indicate that the alterations in functional connectivity from the stimulation site to the cortical motor areas, as well as multiple connectivities among the motor-related network, were associated with the efficacy of GPi-DBS for PD. Furthermore, the changing pattern of functional connectivity within the 4 BOLD frequency subbands is partially dissociable.