Neurosurgery
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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.
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Sports-related concussion (SRC) represents an important cause of morbidity in young athletes. Baseline and postconcussive neurocognitive testing is useful in managing concussed athletes. The Concussion in Sport Group has postulated that the use of psychotropic medications is a modifying factor in the management of SRC. About 7% of US adolescents are prescribed psychotropics in a given year. Our aim was to investigate whether psychotropic medication use or history of depression and/or anxiety affects baseline neurocognitive test scores. ⋯ This pilot study suggests that the effect of psychotropic medications on baseline ImPACT test scores may be dependent on medication subclass. Our preliminary results support the inclusion of psychotropic medications, specifically psychostimulants and antidepressants, as well as history of depression/anxiety as potential concussion modifiers.
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Nonfunctioning pituitary macroadenomas frequently invade the cavernous sinus and many cannot be completely resected without undue risk. Gamma knife radiosurgery (GKRS) is highly effective for treating residual and recurrent adenomas. However, there is no consensus as to whether GKRS should be used early to treat residual adenoma or after a set period of clinical observation during which adenoma growth is demonstrated. Given the high incidence of adenoma progression after subtotal resection over time, the present study examines the potential utility of GKRS performed shortly after transsphenoidal surgery vs expectant management with delayed GKRS treatment. ⋯ Early treatment with GKRS appears to decrease the rate of radiographic and symptomatic progression of subtotally resected nonfunctioning pituitary macroadenomas compared with late GKRS treatment after a period of expectant management. Delaying radiosurgery may place patients at increased risk for adenoma progression and endocrinopathy.
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Anatomic and functional hemispherectomies are relatively infrequent and technically challenging. The literature is limited by small samples and single institution data. ⋯ This is the largest study to date examining hemispherectomy and associated in-hospital complication rates. This study supports early surgery in patients with medically intractable epilepsy and severe hemispheric disease.
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Direct cellular reprogramming has emerged as an innovative alternative to generating neurons in the brain after injury. We were among the first to recently demonstrate in vivo reprogramming of nonneuronal cells into neurons in the brain of rodents following stroke. Human clinical trails will require an adeno-associated virus (AAV) with a greater safety profile. ⋯ We have demonstrated for the first time the capacity to generate reactive astrocyte cultures in vitro from adult canine neocortex after stroke. Using this culture model we have found that AAV8 has the highest transduction efficiency.