Neurosurgery
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Acromegaly is a challenging clinical entity. Despite improvements in microsurgery and medical therapy, acromegaly persists or recurs in many patients. We evaluate the long-term results of stereotactic radiosurgery (SRS) for acromegalic patients. ⋯ SRS affords endocrine remission in the majority of acromegalic patients. Delivering a higher radiation dose portends a greater chance of remission. The most common complication after SRS was hypopituitarism, but this occurs in a minority of patients.
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Neurosurgical treatments for refractory psychiatric disorders such as obsessive-compulsive disorder (OCD) are rapidly increasing. The National Institute of Mental Health has reclassified mental health disorders according to neurobiological mechanisms rather than traditional diagnostic categories. According to this Research Domain Criteria matrix, OCD would be classified as a disorder of cognitive control, with additional contributions from other axes. We bring together the neuroscientific literature on cognitive control and dorsal anterior cingulate cortex (dACC) function with human functional MRI (fMRI) and EEG data to demonstrate (1) the central role of the dACC in cognitive control; and (2) the relevance of this framework for the neurosurgical treatment of OCD. ⋯ We collect a breadth of data to illustrate the following points: (1) the dACC is central to cognitive control; (2) cognitive control is dysfunctional in OCD; (3) neuromodulatory treatment of OCD normalizes physiological measures of cognitive control. We discuss these findings within the framework of the recently proposed Expected Value of Control (EVC) model of dACC function. The development of neurobiological conceptualizations such as these will be critical to the advancement of our network-level understanding of neuropsychiatric disorders and their neurosurgical treatments.
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The most common surgical options for trigeminal neuralgia (TN) are microvascular decompression (MVD) and gamma knife surgery (GKS). Currently, there is no definitive consensus as to which of the 2 options is more effective at providing immediate and long-lasting pain relief. This study seeks to better evaluate the differences between these 2 options in terms of rates of complete pain relief and pain-free recurrence. ⋯ MVD may be a more effective intervention than GKS because of the higher rates of initial pain-free outcomes and long-term pain-free outcomes, and lower rates pain-free recurrences.
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Newborns with a myelomeningocele are often brought to the operating room for surgical repair within the first few days of life. Wound infection in this population may represent a devastating outcome in the immature nervous system. No studies have evaluated infection as a function of surgical timing at a national level. We hypothesized an increase in wound infection in those patients with delays in myelomeningocele repair when evaluated from a national database. ⋯ Myelomeningocele repair, when delayed more than 1 day after birth, is associated with increased rates of infection. High-volume centers are associated with fewer delays in procedure. Although constrained by limitations of a national coded database, results suggest that appropriate attention to timely myelomeningocele repair decreases the infection rate.
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Concussion remains a clinical diagnosis with the lack of objective changes on standard brain imaging. Failure to document concussion delays appropriate intervention in this at-risk population. Magnetoencephalography (MEG) is a powerful, noninvasive imaging modality which may offer unique insight into functional brain networks affected in concussed patients. ⋯ These results suggest that short-duration MEG recording may be used to diagnose concussion. MEG can be used to calculate an objective measure quantifying the degree of global dysfunction that potentially can be used to predict functional outcomes or symptom severity. This is the first study to apply graph theory on MEG-acquired data in concussion.