Neurosurgery
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The use of administrative billing data may enable large-scale assessments of treatment outcomes for Chiari Malformation type I (CM-1). However, to utilize such data sets, validated International Classification of Diseases, Ninth Revision (ICD-9-CM) code algorithms for identifying CM-1 surgery are needed. ⋯ ICD-9-CM code Algorithm 2 has excellent PPV and good sensitivity to identify adult CM-1 decompression surgery. These results lay the foundation for studying CM-1 treatment outcomes by using large administrative databases.
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Comparative Study
Comparison of Stent-Assisted Coiling vs Coiling Alone in 563 Intracranial Aneurysms: Safety and Efficacy at a High-Volume Center.
Stent-assisted coiling has been used in both unruptured and ruptured aneurysms, but the safety and efficacy still remain controversial. ⋯ Compared with coiling alone, stent-assisted coiling may achieve lower recurrence rates, with comparable procedure-related complications and clinical outcomes in both ruptured and unruptured aneurysms.
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A randomized controlled trial with appropriate statistical power and long-term outcomes is the hallmark of level 1 clinical evidence. The SENZA-RCT multicenter pivotal study was powered to directly compare highfrequency spinal cord stimulation (SCS) at 10 kHz (HF10 therapy) and traditional lowfrequency (∼50 Hz) SCS. The comparative efficacy of these modalities for the treatment of chronic back and leg pain for 18 months is presented. ⋯ The SENZA-RCT study provides strong level 1 evidence in support of long-term use HF10 therapy compared with traditional low-frequency SCS for the treatment of chronic back and leg pain.
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Smoking has been associated with worse self-reported outcomes in patients undergoing degenerative lumbar spine surgery. Current focus is on decreasing cost and complications while improving outcomes. This potentially can be accomplished by acting on modifiable preoperative patient characteristics such as smoking. However, the impact of smoking on outcomes following degenerative cervical spine surgery is poorly understood. The aim of the study is to understand impact of smoking on patient-reported outcomes after degenerative cervical spine surgery. ⋯ The smoking population was younger and had a higher preoperative narcotic use. Smoking results in lower absolute scores and these patients have less benefit following surgical intervention compared with the nonsmokers, after controlling for confounding variables. Smoking cessation should be strongly considered before surgical intervention so as to optimize outcome.
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The role of reoperation for recurrent glioblastoma is still unclear because of the lack of prospective studies. Here, we report on the association of clinical outcome with surgery for recurrent glioblastoma including the volumetric extent of resection in the well-characterized patient cohort of the DIRECTOR trial. This prospective randomized multicenter study evaluated the effect of 2 different dose-intensified temozolomide regimens at first recurrence of glioblastoma. ⋯ Surgery at first recurrence of glioblastoma seems to improve outcome if complete resection of Gd-enhancing tumor volume is feasible.