Neurosurgery
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Occipital nerve stimulation (ONS) is utilized to manage chronic migraine (CM) symptoms. Our knowledge of neural activity evoked during optimal (O-ONS) and suboptimal ONS (S-ONS) is limited, and, in this study, we aim to elucidate the differences in central activation patterns during these stimulation conditions using functional positron emission tomography (PET) imaging. ⋯ Difference in central activation by optimal and suboptimal ONS for migraine in this study echoes functional imaging studies demonstrating persistent dysfunctional activity in pons, as well as increased activity during headache attacks in orbitofrontal area, anterior cingulate cortex, and insular/temporal area involved in anticipation and fear/anxiety toward perceived pain. Cerebellum was also previously found to be involved in pain modulation. Occipital nerve stimulation seems to decrease migraine-related headache intensity by modulating activity in areas involved in processing the affective, emotional, and cognitive aspects of pain as well as the anticipation of pain.
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Our goal was to identify and compare the normal occipital-condyle-C1 interval (CCI) in healthy adults with the CCI in adults with atlanto-occipital dislocation (AOD) and establish a highly sensitive and specific cutoff value to diagnose AOD radiographically. ⋯ The revised CCI (1.5 mm) and condylar sum (3.0 mm) cutoff values have the highest sensitivity and specificity for the diagnosis of AOD in the adult population.
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Brain-machine interface neuroprosthetic arms for people with upper limb impairment are developing quickly, but could be improved through intelligent computer-vision-based assistance. Grasping and manipulating objects requires very accurate control of a prosthetic arm and hand, and is required for these limbs to eventually be used clinically. With the computer helping to stabilize the hand during grasping, the user's control would not need to be as accurate, and they would be free to concentrate on the larger goals of the arm movements. ⋯ By integrating brain-machine interface-based high-level control with computer-vision-based low-level control of a robotic arm, people with tetraplegia showed improved functional use of the arm. This result highlights the importance of combining neuroscience- and robotic-based assistive technologies to create a highly flexible and effective neuroprosthetic arm for people with upper limb impairment.
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To examine the microsurgical anatomy of the nucleus accumbens and related structures using fiber dissection technique. ⋯ The nucleus accumbens and its related cortical and subcortical gray matter and fiber pathways play a major role in the etiopathogenesis of psychiatric disorders. Therefore, a better understanding of the neuroanatomical features of the nucleus accumbens and its related structures will enable more accurate surgical treatment of neuropsychiatric disorders.
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Early unplanned readmission is a major source of avoidable morbidity, mortality, and health care expenditure. In neurosurgery, 30-day readmissions are most often due to complications, the majority of which are associated with a decrease in physical activity. Wearable, commercially available motion sensors measure movements over time and transmit these data wirelessly via a smartphone application. These novel devices have the potential to objectively monitor patient recovery and capture complications and resulting readmissions as a single end point of activity. We sought to explore patient mobility patterns after discharge and their relationship to readmission. ⋯ Mobility sensors may be used to track patient recovery after discharge, and are scalable to a large patient population. Incomplete data may indicate poorer health status or poor compliance with wearing the device. Consistent with emerging data from others, poor compliance itself may indicate a higher risk of readmission. Our future efforts will aim to target patients at high risk of readmission and develop appropriate interventions.