Neurosurgery
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Clinical observations of patients with both Chiari Malformation Type I (CIM) and tethered spinal cord (TSC), have led some to speculate that there may be an association between the two entities. However, the level of evidence for this association is anecdotal. We examined a large group of subjects to evaluate the association between CIM and TSC. ⋯ There was no statistically significant association between CIM and low conus position. We conclude that patients with CIM do not have lower conus position compared with matched normals, and that TSC is not associated with CIM for most patients.
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Cell therapies represent a promising alternative treatment for neurodegenerative diseases of the spinal cord, and traumatic spinal cord injury. Cell survival, migration, proliferation and differentiation are intrinsic factors that greatly influence the therapeutic potential of cell therapies. Other factors like local inflammatory and immune response also play an important role. This study analyzed the migration patterns of fetal-derived neural precursors (NPCs) transplanted to the spinal cord of healthy Gottingen minipigs. ⋯ Understanding the migration patterns and other dynamics of different cell lines will allow neurosurgeons to ensure accurate delivery and maximize effectiveness of cell therapeutics in the spinal cord.
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Considerable evidence points to cortico-striato-thalamo-cortical circuits in cognitive, limbic, and motor functions. Specifically, the connections between caudate, nucleus accumbens (NAc), and prefrontal cortex have been implicated in behavioral learning and motivation. Precisely timed stimulation of the caudate during a behavioral task enhances learning beyond baseline in normal primates. We test the overarching hypothesis that combined intermittent stimulation of the caudate and NAc leads to enhanced learning. Our specific hypothesis is that there are 2 streams of information processing in the anterior striatum, dorsal and ventral, that perform complementary but different roles. We believe that the dorsal stream, which includes the caudate, is involved in the executive aspect of associative learning, whereas the ventral stream, which includes the NAc, is involved in providing the motivation for the performance of learned behavior. ⋯ Enhancing visuomotor performance may be beneficial to patients who have cognitive-motor deficits caused by traumatic brain injury. Deep brain stimulation strategies augmenting learning and motivational processes could be used in humans to enhance a broad range of functions including gross motor movements and decision making.
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There is no monitoring from the injured spinal cord to define the optimal values of physiological parameters in ICU. We present a technique for continuously monitoring intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP). ⋯ ISP at the injury site can be measured safely after TSCI. The optimum SCPP varies among TSCI patients.