Neurosurgery
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The availability of stents has widened the indications of endovascular intervention for cerebral aneurysms. ⋯ In this propensity score-matched analysis, stent implantation reduced the overall recanalization of the coiled cerebral aneurysms. However, the use of stents should be carefully decided upon.
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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.
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Poststroke brain stimulations are promising neurorestorative techniques because they allow direct manipulation of the target area's excitability. Previously, we demonstrated that optogenetic neuronal stimulation of the ipsilesional primary motor cortex promotes functional recovery. To determine an optimal brain stimulation target, we tested whether optogenetic neuronal stimulation of the contralesional cerebellar dentate nucleus (cDN) can promote recovery. We hypothesized that stimulation of cDN may be more effective, because it sends excitatory outputs to multiple cerebral regions. ⋯ Our data suggest that cDN stimulations poststroke can promote functional recovery and this prorecovery effect is persistent. Recovery of cDN-stimulated stroke mice is associated with upregulation of plasticity marker GAP43 and downregulation of CREB signaling. Current studies examine the effects of cDN stimulations on axonal sprouting and the contribution of CREB in recovery. cDN could be a promising brain stimulation target for stroke recovery.
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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.
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Prospective longitudinal outcomes registries are at the center of evidence-driven health care reform. Obtaining real-world outcomes data at 12 months can be costly and challenging. We analyze whether 3-month outcome measurements suffice to identify effective vs noneffective care for degenerative lumbar surgery. ⋯ The 3-month ODI scores do not accurately estimate the 12-month ODI scores at the individual patient level regardless of the diagnosis and treatment. There is a greater uncertainty in predicting 12-month outcomes when the 3-month outcome is negative. Many patients who do not benefit from surgery by 3 months do so by 12 months, and many report loss of benefit. Prospective longitudinal registries need to span at least 12-months to determine effectiveness of spine care for over 20% of the patients.