Neurosurgery
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EGFRvIII, a constitutively active EGFR deletion driver mutation, is associated with poor long-term survival in glioblastoma (GB). The investigational vaccine rindopepimut consists of a peptide sequence unique to EGFRvIII conjugated to keyhole limpet hemocyanin (KLH), delivered intradermally with granulocyte macrophage colony-stimulating factor. Three phase II studies in newly diagnosed, resected, EGFRvIII+ GB demonstrated encouraging progression-free survival (PFS), overall survival (OS), and safety profile. Compassionate-use experience suggests that rindopepimut may also provide benefit in relapsed GB, particularly with agents such as bevacizumab (BV). ⋯ These near-final data show that rindopepimut induces potent EGFRvIII-specific immune response and tumor regression, and appears to significantly prolong survival when administered with BV in patients with relapsed GB.
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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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MRI-guided stereotactic laser amygdalohippocampotomy (SLAH) is a minimally invasive and effective alternative to open temporal lobe surgery in appropriately selected patients. We have previously demonstrated SLAH to be most effective for patients with mesial temporal sclerosis (MTS) on preoperative MRI. Nevertheless, patients who do not achieve seizure freedom may benefit from additional procedures. The feasibility, safety, and efficacy of repeat laser ablation of remaining mesial temporal structures have not been reported. ⋯ While SLAH alone is effective for select patients with mesial temporal lobe epilepsy, this preliminary study indicates that additional extended ablation of extrahippocampal mesial temporal structures may provide additional relief from recurrent seizures. Additional subjects, longer outcomes, and neurocognitive assessments are pending.
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Quality improvement projects have begun to standardize surgical work flow as a component to optimize operative room (OR) efficiency. Removing special cause variability resulting from nonsurgical waste is an obvious target; however, surgical resident education must be maintained even in the setting of process improvement. There are no published data describing the impact on operative time of resident-identified risky or uncomfortable procedural steps during posterior instrumented fusion (PIF). Self-identification of risk or discomfort in surgical steps may allow for shorter OR time and reduced cost, without sacrificing resident education. ⋯ Resident perception of surgical complexity can be evaluated for procedural steps using a risk matrix survey. For PIF, residents assign more risk and are less comfortable performing steps in a training-dependent manner. Identification of particular high-risk steps, which are uncomfortable, should prompt strict faculty oversight to improve patient safety, monitor resident education, and reduce operative time.
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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.