Neurosurgery
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EORTC/NCIC, European Organisation for Research and Treatment of Cancer/National Cancer Institute of CanadaGBM, glioblastomaOS, overall survivalPFS, progression-free survivalSEER, Surveillance, Epidemiology, and End ResultsTMZ, temozolomide.
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The use of administrative billing data may enable large-scale assessments of treatment outcomes for Chiari Malformation type I (CM-1). However, to utilize such data sets, validated International Classification of Diseases, Ninth Revision (ICD-9-CM) code algorithms for identifying CM-1 surgery are needed. ⋯ ICD-9-CM code Algorithm 2 has excellent PPV and good sensitivity to identify adult CM-1 decompression surgery. These results lay the foundation for studying CM-1 treatment outcomes by using large administrative databases.
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A randomized controlled trial with appropriate statistical power and long-term outcomes is the hallmark of level 1 clinical evidence. The SENZA-RCT multicenter pivotal study was powered to directly compare highfrequency spinal cord stimulation (SCS) at 10 kHz (HF10 therapy) and traditional lowfrequency (∼50 Hz) SCS. The comparative efficacy of these modalities for the treatment of chronic back and leg pain for 18 months is presented. ⋯ The SENZA-RCT study provides strong level 1 evidence in support of long-term use HF10 therapy compared with traditional low-frequency SCS for the treatment of chronic back and leg pain.
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The comparative efficacy of microscopic and fully endoscopic transsphenoidal surgery for pituitary adenomas has not been well studied despite the adoption of fully endoscopic surgery by many pituitary centers. We compared the extent of tumor resection (EOR) and the endocrine outcomes of 1 very experienced surgeon performing a microscopic-transsphenoidal surgery technique (1800 independent cases) with those of a less experienced surgeon using a fully endoscopic-transsphenoidal surgery technique (100 independent cases) for nonfunctioning pituitary adenomas in a concurrent series of patients. ⋯ A less experienced surgeon using a fully endoscopic technique was able to achieve similar outcomes compared with a very experienced surgeon using a microscopic technique in a cohort of patients with nonfunctioning tumors. These data suggest that certain advantages afforded by the fully endoscopic technique help address the learning curve in pituitary surgery.
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In patients undergoing interventional treatment for acute ischemic stroke (AIS), proximal arterial stenosis may hinder access to the arterial occlusive lesion (AOL), compromise inflow during the intervention and prolong events leading to cerebral reperfusion. We examined proximal arterial stenosis in the Interventional Management of Stroke (IMS)-III trial, hypothesizing that it would impede successful endovascular therapy for AIS and worsen outcomes. ⋯ In patients receiving combined IV/IA treatment for AIS within the IMS-III trial, ipsilateral EC-ICA stenosis of =70% significantly delayed reperfusion by an average of 26 minutes. This resulted in trends favoring larger infarct volumes with worse clinical outcomes despite a lower rate of sICH. This substantial treatment delay likely stems from a combination of difficult microcatheter access across the stenosis, the addition of intermediate steps to manage the stenosis (ie, balloon angioplasty), and the restrictive effect of the stenosis on inflow in patients treated by thrombolysis.