Neurosurgery
-
Better ways to predict motor outcome following hemispherectomy are necessary to implement the informed consent process in patients with hemispheric epilepsy. The volumetric analysis of cerebral peduncles and cerebellar hemispheres in patients who had undergone hemispherectomy may determine prognostic implications for postoperative hemiparesis. ⋯ While patients who undergo hemispherectomy are heterogeneous, we report a method of predicting postoperative hemiparesis only using a standard volumetric MRI. This information could be used in the preoperative discussions with patients and families to help better understand that chance of retaining baseline motor function.
-
Stereotactic radiosurgery (SRS) is a well-accepted treatment for patients with intracranial metastases, but outcomes with volumetric modulated arc radiosurgery (VMAR) are poorly described. ⋯ Single-isocenter, frameless VMAR for multiple intracranial metastases is a promising technique that may provide similar clinical outcomes compared with conventional radiosurgery.
-
Diffuse intrinsic pontine gliomas (DIPGs) represent a particularly lethal type of pediatric brain cancer with no effective therapeutic options. Our laboratory has previously reported the development of genetically engineered DIPG mouse models by using the RCAS/tv-a system, including a model driven by PDGF-B, H3.3K27M, and p53 loss. These models can serve as a platform in which to test novel therapeutics before the initiation of human clinical trials. ⋯ In summary, an unbiased in vitro drug screen identified BMS-754807 as a potential therapeutic agent in DIPG, but BMS-754807 treatment in vivo by systemic delivery did not significantly prolong survival of DIPG-bearing mice.
-
Controversy continues surrounding the optimal surgical approach to Chiari decompression and whether the dura needs to be opened. Assessment of long-term outcomes looking specifically at failure rates, and associated factors, for bone-only decompression vs duraplasty was undertaken. ⋯ Comparison of Chiari failures does not appear to differentiate between open and closed decompression. The most common cause of failure was the presence of arachnoid scaring at the 4th ventricular outflow in both surgical cohorts. Craniofacial comorbidity increased the likelihood of surgical failure, especially when hydrodynamic issues were involved.
-
Comparative effectiveness of spinal fusion vs revision discectomy for lumbar recurrent disc herniation (RDH) has yet to be evaluated. By analyzing nationwide longitudinal patient-reported outcomes spine registry, we characterized utilization of arthrodesis for lumbar RDH and analyzed its associated outcomes vs discectomy alone. ⋯ Arthrodesis is associated with greater healthcare utilization and morbidity, but also with a trend of reduced 3 month re-operation with equivalent 1-year outcomes. Revision discectomy alone may be most efficient treatment option for patients experiencing recurrent disc herniation without listhesis or instability, particularly in those without back dominant symptoms.