Neurosurgery
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Both transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are effective surgical interventions for patients with degenerative lumbar spondylosis. We sought to compare health care costs by calculating the incremental cost-effectiveness ratio and, thereby, the difference in the total cost per quality-adjusted life-year (QALY) gained for TLIF vs LLIF for the treatment of degenerative spondylosis. We further calculated the thresholds for minimum clinically important difference (MCID) and minimum cost-effective difference (MCED) for patient-reported outcome measures at 2-year follow-up. ⋯ TLIF and LLIF produced equivalent 2-year patient outcomes at an equivalent cost-effectiveness profile.
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Surgery for cerebrospinal fluid diversion is the most common procedure performed by pediatric neurosurgeons. The failure rates for shunts remain frustratingly high, resulting in a negative burden to patients, families, providers, and health care systems. The goal of this study was to quantify the risk of a shunt malfunction in patients with an existing shunt who undergo an elective intradural operation. ⋯ This is the first study to quantify the risk of a shunt malfunction after elective intradural surgery. The 90-day all-cause shunt failure rate (per procedure) was 10% with nearly half of the failures occurring within the first 5 postoperative days. Possible risk factors for shunt malfunction after elective intradural surgeries are intraventricular surgical approach, shorter time since last shunt-related surgery, and young age.
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A constant conundrum for the surgical educator is the balancing act between resident training and patient safety. Surgical simulators have become attractive, allowing trainees to practice emerging skills without risking patient health. However, many surgical simulators are expensive, complex, and frequently do not offer realistic tissue or instrument manipulation. Residents typically understand the steps and anatomy of a procedure long before they develop the manual skills to perform the operation gracefully. It would therefore be valuable to develop simple surgical simulators that offer decreased complexity and faithfully reproduce the haptic experience of a given procedure. ⋯ Surgical skill simulation is an emerging technology and is useful for safe, effective resident training. However, much work in this field has focused on complex, expensive training models. Here, we demonstrate that surgical simulation can be simple, cheap, and provide realistic haptic feedback, and that residents improve both subjectively and objectively with our simulation platforms.
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Brain Machine Interface (BMI) systems allow patients with neurological injuries to control assistive devices using cortical signals produced during motor imagery (MI). To improve BMI performance, we sought to enhance cortical signals by training subjects in MI techniques that induce activation of mirror neuron networks (MNN). ⋯ Motor imagery training that activates mirror neuron networks enhances cortical signals during MI and during the performance of corresponding movements in healthy subjects. As MI-based signals are used to operate BMIs, our research suggests that MNN-based MI training may improve BMI performance. Additionally, VR-based imagery training may provide a benefit over AO training to induce bilateral activation of MNNs.
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In Parkinson patients in the OFF medication state, basal ganglia local field potentials exhibit characteristic changes in beta and gamma oscillations that may be directly related to the symptoms of rigidity and bradykinesia. However, magnetoencephalography and low-resolution electrocorticography (ECoG) studies of sensorimotor cortex suggest that changes in cortical oscillations in Parkinson patients may differ from those of the basal ganglia during the OFF medication state. ⋯ Our findings are suggestive of an inverse oscillatory profile in the sensorimotor cortex of Parkinson patients that, in contrast to basal ganglia, may act to facilitate movement in the face of an antikinetic bias inherent in the dopamine-depleted state.