Neurosurgery
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Clinical Trial
Exhaustive, one-year follow-up of subthalamic nucleus deep brain stimulation in a large, single-center cohort of parkinsonian patients.
To prospectively assess the impact of subthalamic nucleus (STN) deep brain stimulation (DBS) at 12 months after surgery in a series of 100 consecutive patients treated in a single center. The primary objective was to describe the clinical outcome in terms of efficacy and tolerance in STN-DBS patients. A secondary objective was to discuss presurgery clinical characteristics a posteriori as a function of outcome. ⋯ The efficacy and safety of STN-DBS in our center's large cohort of Parkinsonian patients are generally similar to the results obtained by other groups, albeit at the lower limit of the range of reported values. In contrast to efficacy, the occurrence of adverse events cannot be predicted. Younger patients with Parkinson's disease (i.e., those younger than 60 yr) often show an excellent response to levodopa. However, in view of our data on overall patient satisfaction and the occurrence of adverse events, we suggest that older patients (but not those older than 70 yr) and less dopa-sensitive patients (but not those with a response <50%) should still be offered the option of STN-DBS.
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A new paradigm for the radiotherapeutic management of paraspinal tumors has emerged. Intensity-modulated radiotherapy (IMRT) has gained wide acceptance as a way of delivering highly conformal radiation to tumors. IMRT is capable of sparing sensitive structures such as the spinal cord of high-dose radiation even if only several millimeters away from the tumor. Image-guided treatment tools such as cone beam computed tomography coupled with IMRT have reduced treatment errors associated with traditional radiotherapy, making highly accurate and conformal treatment feasible. ⋯ IG IMRT represents a significant technological advance. Paraspinal IG IMRT is proof of principle, making it possible to give very-high-dose radiation within close proximity to the spinal cord. By reducing treatment-related uncertainties, margins around tumors can be shortened, thereby reducing the volume of normal tissue that must be irradiated to tumoricidal doses, reducing the likelihood of toxicity. Similarly, higher doses of radiation can be administered safely, improving the likelihood of eradication. Dose escalation can be done to increase the likelihood of tumor cell kill without increasing the dose given to nearby sensitive structures.
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Controlled Clinical Trial
Functional brain abnormalities are related to clinical recovery and time to return-to-play in athletes.
The relationship between athlete reports of symptoms, neurophysiological activation, and neuropsychological functioning is investigated in a sample of high school athletes. ⋯ These results demonstrate the relationship between neurophysiological, neuropsychological, and subjective symptom data in a relatively large sample composed primarily of concussed high school athletes. fMRI represents an important evolving technology for the understanding of brain recovery after concussion and may help shape return-to-play guidelines in the future.
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Impacts causing concussion in professional football were simulated in laboratory tests to determine collision mechanics. This study focuses on the biomechanics of concussion in the struck player. ⋯ This study addresses head responses causing concussion in National Football League players. Although efforts are underway to reduce impact acceleration through helmet padding, further study is needed of head kinematics after impact and their contribution to concussion, including rapid head displacement, z-axis rotation, and neck tension up to the time of maximum strain in the midbrain. Neck strength influences head deltaV and head injury criterion and may help explain different concussion risks in professional and youth athletes, women, and children.
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Preoperative embolization in accordance with multimodal therapies for cerebral arteriovenous malformations (AVMs) is generally the first step in treatment and may result in complete obliteration. The Onyx liquid embolic system (Micro Therapeutics, Inc., Irvine, CA) may offer advantages for intranidal targeted embolization and microsurgical resection. We present our experience in the combined treatment of intracranial AVMs using Onyx embolization and neurosurgical resection. ⋯ Preoperative use of the Onyx liquid embolic system in cerebral AVM treatment allows profound occlusion by targeted embolization and provides a basis for safe neurosurgical resection.