Neurosurgery
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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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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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Intractable focal epilepsy is a devastating disorder with profound effects on cognition and quality of life. Epilepsy surgery can lead to seizure freedom in patients with focal epilepsy; however, sometimes it fails owing to an incomplete delineation of the epileptogenic zone (EZ). Brain networks in epilepsy can be studied with resting-state functional connectivity (RSFC) analysis, yet previous investigations using functional MRI or electrocorticography have produced inconsistent results. Magnetoencephalography (MEG) allows noninvasive whole-brain recordings, and can be used to study both long-range network disturbances in focal epilepsy and regional connectivity at the EZ. ⋯ Widespread global decreases in functional connectivity are observed in patients with focal epilepsy and may reflect deleterious long-term effects of recurrent seizures. Furthermore, enhanced regional functional connectivity at the area of resection may help predict seizure outcome and aid surgical planning.
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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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Failed Back Surgery Syndrome (FBSS) is notoriously refractory to treatment resulting in high health care utilization and high health care costs. Given the recent emphasis of cost-conscious care in the United States, we examined the trends in imaging use in FBSS over the past decade. Furthermore, the role of different types of imaging modalities MRI vs non-MRI is of interest when considering potential therapeutic interventions, including spinal cord stimulation (SCS), a common therapy for treating neuropathic pain in the FBSS population. ⋯ We found a trend for increased imaging use between 2000 and 2009 in FBSS patients, a population with already immense health care utilization and health care costs. Rates of both MRI and non-MRI imaging increased by 35% to 40% in a period of 10 years. The role of frequency and type of imaging modality utilized in evaluating FBSS patients will have a significant impact on overall health care expenses and therapeutic options, including SCS, going forward.