Neurosurgery
-
Endovascular stenting is an effective treatment for patients with clinically significant cerebral venous sinus stenosis. Traditionally, stenting is indicated in elevated intravenous pressures on conventional venography; however, noninvasive monitoring is more desirable. Quantitative magnetic resonance angiography is an imaging modality that measures blood flow noninvasively. Established in the arterial system, applications to the venous sinuses have been limited. ⋯ Venous outflow by qMRV increases after endovascular stenting and correlates with significantly improved intravenous pressures. These findings introduce qMRV as a potential adjunct to measure venous flow after stenting, and as a plausible tool in the selection and postoperative surveillance of the patient who has cerebral venous sinus stenosis.
-
Depression has been associated with poor outcomes in neurosurgical patients, with increased pain, poorer functional recovery, delayed return to work, and decreased patient satisfaction. No reports exist regarding the association of psychiatric diagnoses with outcomes following brachial plexus reconstruction. As outcomes and patient satisfaction become increasingly important to payers and physician reimbursement, assessing modifiable preoperative risk factors for their association with poor outcome and patient satisfaction is imperative. We retrospectively analyzed patients undergoing brachial plexus reconstruction to restore elbow flexion to assess the relationship of depression/anxiety disorders with functional outcome. ⋯ Preoperative depression is common in patients after brachial plexus injury. The presence of depression is associated with reduced elbow flexion recovery following reconstruction. These data suggest assessment and treatment of preoperative mental health is important in designing a comprehensive postoperative management plan to optimize outcomes and patient satisfaction.
-
Comparative effectiveness of spinal fusion vs revision discectomy for lumbar recurrent disc herniation (RDH) has yet to be evaluated. By analyzing nationwide longitudinal patient-reported outcomes spine registry, we characterized utilization of arthrodesis for lumbar RDH and analyzed its associated outcomes vs discectomy alone. ⋯ Arthrodesis is associated with greater healthcare utilization and morbidity, but also with a trend of reduced 3 month re-operation with equivalent 1-year outcomes. Revision discectomy alone may be most efficient treatment option for patients experiencing recurrent disc herniation without listhesis or instability, particularly in those without back dominant symptoms.
-
Symptomatic Metastatic Epidural Spinal Cord Compression (MESCC) afflicts up to 10% of all cancer patients and is associated with shortened survival and worsened quality of life. This study aims to identify the key survival prognostic factors in MESCC patients who were surgically treated for a single symptomatic lesion. ⋯ Slow-growing tumor (Tomita grade 1), absence of visceral metastasis, and lower degree of preoperative physical disability, as reflected by a higher score on the SF-36 physical component questionnaire, are good prognostic factors for survival in selected patients who underwent surgical treatment for a focal symptomatic MESCC lesion.
-
Human ether a go-go-related-1 (hERG) is a voltage-dependent K+ channel overexpressed in GBM cell lines, and linked to aberrant proliferation. The FDA mandates all drugs undergo cardiotoxicity profiling that includes hERG inhibition. We analyzed hERG expression in glioblastoma stemlike cell (GSC)-derived tumor models and a clinically annotated human GBM tissue microarray (TMA) to correlate with patient survival after hERG expression stratification. ⋯ We showed that GBM xenografts with higher hERG expression had higher proliferation rates, and the addition of 2 known hERG inhibitors (phenytoin, E-4031) inhibited sphere formation in high hERG-expressing GSC lines. GBM TMA analyses showed significantly better survival in high hERG-expressing GBM patients treated with hERG inhibitory drugs. These data suggest clinical trials for already FDA-approved drugs that also inhibit hERG in high hERG-expressing GBM patients.