Neurosurgery
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Although posterior lumbar interbody fusion (PLIF) has a successful fusion rate, the long-term outcome of PLIF is occasionally below expectations because of adjacent segment degeneration (ASD). ⋯ Hybrid stabilization using DIAM and pedicle screws can be used for patients with facet degeneration at adjacent segments but should be further investigated.
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Comparative Study
Incidence of neurosurgical wrong-site surgery before and after implementation of the universal protocol.
Although exceedingly rare, wrong-site surgery (WSS) remains a persistent problem in the United States. The incidence is thought to be 2 to 3 per 10 000 craniotomies and about 6 to 14 per 10 000 spine surgeries. In July 2004, the Joint Commission mandated the Universal Protocol (UP) for all accredited hospitals. ⋯ A statistically significant reduction in overall WSS was seen after implementation of the UP. This reduction can be attributed to less frequent wrong-level spine surgery. There was no case of wrong procedure or patient surgery and the 1 case of wrong-side surgery occurred after UP implementation.
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The discovery that tumor-derived proteins and nucleic acids can be detected in nano-sized vesicles in the plasma and cerebrospinal fluid of patients afflicted with brain tumors has expanded opportunities for biomarker and therapeutic discovery. Through delivery of their contents to surrounding cells, exosomes, microvesicles, and other nano-sized extracellular vesicles secreted by tumors modulate their environment to promote tumor growth and survival. In this review, we discuss the biological processes mediated by these extracellular vesicles and their applications in terms of brain tumor diagnosis, monitoring, and therapy. We review the normal physiology of these extracellular vesicles, their pertinence to tumor biology, and directions for research in this field.
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Study of the corticosubcortical functional anatomy of reading and picture naming. ⋯ We propose the existence of a dual visual language route in the left dominant hemisphere. The first pathway seems to run basally, from the occipital lobe to the posterobasal temporal cortex, mediated by the left inferior longitudinal fascicle, subserving visual recognition. The second pathway might run superiorly and more medially, from the occipital pole directly to the frontal areas, and could be underlain by the inferior fronto-occipital fascicle, involved in naming (semantic processing). Such a model might have both fundamental and clinical implications for the selection of the tasks during awake mapping as well as for postsurgical rehabilitation.
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Randomized Controlled Trial
Noninvasive language mapping in patients with epilepsy or brain tumors.
Functional magnetic resonance imaging (fMRI) has become part of routine brain mapping in patients with epilepsy or tumor undergoing resective surgery. However, robust localization of crucial functional areas is required. ⋯ The proposed fast fMRI language protocol reliably localized the most relevant language areas in individual subjects. It appears to be a valuable complementary tool for surgical planning of epileptogenic foci and of brain tumors.