Neurosurgery
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To date, there has been no study to comprehensively assess the effectiveness of suboccipital craniectomy (SOC) for Chiari malformation I (CMI) using validated patient-reported outcome measures. ⋯ Surgical management of CMI in adults via SOC provides significant and sustained improvement in pain, disability, general health, and quality of life as assessed by patient-reported outcomes. This patient-centered assessment suggests that suboccipital decompression for CMI in adults is an effective treatment strategy.
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Observational Study
Perioperative complications after carotid artery stenting: a contemporary experience from the university at buffalo neuroendovascular surgery team.
Technological advances have resulted in diminishing perioperative complications reported during carotid artery stenting (CAS) trials. Because trial experience lags behind technological advances, an understanding of the incidence of perioperative complications after CAS remains in flux. ⋯ In this retrospective analysis of consecutive patients treated with CAS, the perioperative incidence of stroke (0.9%), MI (0.6%), and death (1.1%) was favorable.
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Foot drop is a very debilitating condition affecting patients' daily activities, and its treatment has been a challenge for neurosurgeons. Grafting the peroneal or sciatic nerve usually results in poor outcomes. Our previous anatomic study demonstrated the feasibility of transferring a motor branch of the tibial nerve to the deep peroneal nerve at the level of the popliteal fossa. ⋯ The transfer of the nerve of the soleus muscle to the deep peroneal nerve demonstrated poor results in most of the patients, although favorable outcomes were observed in a few subjects. Due to the inconsistency of the results, we do not favor the routine use of this technique for the treatment of foot drop.
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We review our experience with lung cancer patients with newly diagnosed brain metastases treated with Gamma Knife radiosurgery (GKRS). ⋯ Histological subtype of lung cancer appears to predict outcomes. Future trials and prognostic indices should take these histology-specific patterns into account.
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Stroke is a leading cause of death and disability in the United States. Despite the proven benefits of intravenous tissue plasminogen activator (IV-tPA), only a small percentage of patients who have had a stroke (3.4%-5.2%) receive this US Food and Drug Administration-approved therapy. ⋯ Implementing a telestroke system facilitates high rates of intravenous thrombolysis in patients who have had a stroke in community hospitals within a relatively short time frame. These results are higher than the national average rate (3.4%-5.2%) and support the implementation of telestroke networks for wider access to stroke expertise in underserved regions.