Neurosurgery
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Mild traumatic brain injury (mTBI) results in variable clinical outcomes, which may be influenced by genetic variation. A single-nucleotide polymorphism in catechol-o-methyltransferase (COMT), an enzyme that degrades catecholamine neurotransmitters, may influence cognitive deficits following moderate and/or severe head trauma. However, this has been disputed and its role in mTBI has yet to be studied. ⋯ COMT Val158Met may exert domain-specific cognitive protection following mTBI.
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Although a transvenous route via the ipsilateral inferior petrosal sinus (IPS) is preferred in treating cavernous sinus dural arteriovenous fistula (CSdAVF), this option may be limited if an occluded ipsilateral IPS undermines microcatheter delivery to the cavernous sinus. ⋯ In patients with CSdAVF and ipsilateral IPS occlusion, various treatment strategies may be applied (given angioanatomic suitability), resulting in excellent procedural and short-term follow-up results. Reopening of an occluded IPS is reasonable as an initial access attempt.
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With rising health care costs, clinical outcome data are becoming increasingly important. The concept of minimally clinical important difference (MCID) has been shown to be effective in spine surgery to differentiate between clinically insignificant and significant improvements and to measure the patient's perspective of quality of life and disability. We sought to determine the MCID for spinal cord stimulation (SCS) therapy for failed neck and back syndromes, which has not been established to date. ⋯ The MCID for SCS placement was calculated by using 4 methods. The results are similar to calculations for the MCID for traditional surgical procedures done for pain. Our results suggest that an improvement of 1.2 to 3.7 points on the VAS scale and 8.2 to 13.3 points on the ODI is clinically meaningful to the patient. Further defining the MCID for SCS therapy will remain of utmost importance in order to justify the cost of the procedure.
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Schwann cell (SC) transplantation demonstrates significant potential for spinal cord injury (SCI) repair and its use as a therapeutic modality has now progressed to clinical trials for subacute and chronic human SCI. Although SC implants provide a receptive environment for axonal regrowth and support functional recovery in various SCI models, axonal regeneration is largely limited to local systems and the behavioral improvements are modest without adjunctive therapies. ⋯ These findings demonstrate that polyamine supplementation, particularly in the acute setting following SCI, can augment the effectiveness of SC transplantation when used as a combined therapeutic approach for subacute SCI repair.
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Surgical site infections (SSI) contribute significantly to patient morbidity and mortality and greatly increase health care costs. It has been postulated that increased traffic through operating rooms (ORs) during procedures increases SSI rates. ⋯ In conclusion, OR traffic can be significantly reduced by using a LT protocol like that used in this study. However, significantly reducing OR traffic does not meaningfully reduce the risk of SSI.