Journal of neurosurgery
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Journal of neurosurgery · Jan 2025
Cost-effectiveness analysis of deep brain stimulation versus treatment as usual for treatment-resistant obsessive-compulsive disorder.
Deep brain stimulation (DBS) is an effective neurosurgical option for patients with treatment-resistant obsessive-compulsive disorder (OCD). Despite being more costly than neuroablative procedures of comparable efficacy, DBS has gained popularity over the years for its reversibility and adjustability. Although the cost-effectiveness of DBS has been investigated extensively in movement disorders, few economic analyses of DBS for psychiatric disorders exist. In this study, the authors present the first cost-effectiveness analysis of DBS for treatment-resistant OCD in the United States. ⋯ Rechargeable DBS models were cost-effective for treatment-resistant OCD compared with TAU. Nonrechargeable DBS models may be cost-effective, especially with improvement in battery longevity and changes in accepted WTP thresholds.
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Journal of neurosurgery · Jan 2025
Predictive factors for traumatic cerebral contusion volume, expansion, and outcomes.
Traumatic hemorrhagic cerebral contusions are a well-established cause of morbidity and mortality in neurosurgery. This study aimed to determine prognostic factors for long-term functional outcomes and longitudinal contusion volume changes in traumatic brain injury (TBI) patients. ⋯ Functional outcomes in traumatic cerebral contusion patients may be associated with age and admission GCS score, and verbal GCS score may predict initial contusion volume and contusion expansion. These findings supplement an evolving understanding of factors that influence outcomes in patients with cerebral contusions, and further study into the utility of GCS to guide these decisions could help to guide the clinical management of these highly complex patients.
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Journal of neurosurgery · Jan 2025
Thalamic deep brain stimulation for central poststroke pain syndrome: an international multicenter study.
The effectiveness and optimal stimulation site of deep brain stimulation (DBS) for central poststroke pain (CPSP) remain elusive. The objective of this retrospective international multicenter study was to assess clinical as well as neuroimaging-based predictors of long-term outcomes after DBS for CPSP. ⋯ This comprehensive, multicenter analysis corroborates the efficacy of DBS in treating CPSP for a relevant number of patients. The posterior limb of the internal capsule and the sensorimotor thalamus emerged as potential stimulation sweet spots. The difference in structural connectivity between responders and nonresponders may constitute a biomarker of effective stimulation that can help guide surgical planning in future well-designed prospective trials.