Neurosurgery
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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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Controversy continues surrounding the optimal surgical approach to Chiari decompression and whether the dura needs to be opened. Assessment of long-term outcomes looking specifically at failure rates, and associated factors, for bone-only decompression vs duraplasty was undertaken. ⋯ Comparison of Chiari failures does not appear to differentiate between open and closed decompression. The most common cause of failure was the presence of arachnoid scaring at the 4th ventricular outflow in both surgical cohorts. Craniofacial comorbidity increased the likelihood of surgical failure, especially when hydrodynamic issues were involved.
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Diffusion magnetic resonance (dMR) imaging is widely used in clinical practice and captures a distinct molecular/cellular features of tumor tissue. The aim of this study is to correlate pretreatment tumor Apparent Diffusion Coefficient (ADC), measured by dMR imaging with overall survival in patients with glioblastoma and determine its association with gene signatures. ⋯ We demonstrate that dMR characteristics can identify highly significant survival differences and specific genomic signatures.
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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.
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Intracerebral hemorrhage (ICH) produces high acute mortality and poor long-term neurological outcomes. Hematoma volume clinically correlates with neurological deterioration; however, no efficacious treatment options exist to improve patient outcomes. Remote limb Ischemic Post-Conditioning (RIC) is the simple, inexpensive, and safe use of repetitive inflation of a blood pressure cuff on a limb to protect distant organs after injury. Ischemic conditioning was efficacious in randomized clinical trials in myocardial infarction, was well tolerated in subarachnoid hemorrhage patients, and showed safety and efficacy, including increased cerebral blood flow, in a small cohort of patients with intracranial stenosis. Herein, we tested the hypothesis that RIC would improve outcomes after experimental ICH. ⋯ RIC may noninvasively accelerate spontaneous hematoma resolution via an immune-mediated mechanism.