Neurosurgery
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The role of reoperation for recurrent glioblastoma is still unclear because of the lack of prospective studies. Here, we report on the association of clinical outcome with surgery for recurrent glioblastoma including the volumetric extent of resection in the well-characterized patient cohort of the DIRECTOR trial. This prospective randomized multicenter study evaluated the effect of 2 different dose-intensified temozolomide regimens at first recurrence of glioblastoma. ⋯ Surgery at first recurrence of glioblastoma seems to improve outcome if complete resection of Gd-enhancing tumor volume is feasible.
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The purpose of this study is to independently review and report the 5-year results of an Investigational Device Exemption study of total disc replacement (TDR) (Mobi-C) vs anterior cervical discectomy and fusion (ACDF) for the treatment of 2-level, contiguous, symptomatic cervical degenerative disc disease. ⋯ Anterior cervical surgery for contiguous 2-level pathology was safe and effective in improving patient outcome and quality of life at 5 years in both groups. There were fewer incidences of index level and adjacent level reoperation in the disc replacement group. Overall, we conclude that TDR was superior to ACDF for treatment of 2-level contiguous pathology at 5 years.
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Dual supraorbital and occipital nerve stimulation (SONS and ONS) have shown promising efficacy in treating primary headaches. However, its functional outcome is not well studied. We report functional outcome of combined SONS and ONS for migraine using verified metrics. ⋯ In patients who had positive response to SONS and ONS, functional status as reflected by MIDAS and BDI had overall improvement in perioperative period. Unfortunately, this effect waned over the long-term follow-up.
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Differences between centers in patient outcome after subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms could be of relevance for the design of multicenter studies, particularly randomized clinical trials (RCTs), and standardization of management practices for improved quality of care for all patients. This study was aimed at investigating whether differences in outcome exist between centers enrolling patients into RCTs in SAH, and, if so, quantifying such center effect. ⋯ The outcomes of patients who are enrolled into multicenter clinical trials in SAH differ considerably between centers and regions. The reasons and implications of these findings should be studied, as such might lead to improvement in some aspects of trial design and management practices.
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Odontoid fracture is a common injury, particularly in elderly, fall-prone patients. Previous studies comparing surgical and nonoperative management have classified elderly patients as all individuals over 65 years, or those 65 to 80 years. We compare surgical and nonoperative management in octogenarians (>79 years), a medically distinct population. ⋯ Type II odontoid fracture is highly morbid among octogenarians, with 1-year mortality approaching 1-in-2. Neither surgical nor nonoperative management is associated with a survival benefit. Cord injury, GCS, AIS, and ISS are significant predictors of poor prognosis.