Neurosurgery
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Odontoid fracture is a common injury, particularly in elderly, fall-prone patients. Previous studies comparing surgical and nonoperative management have classified elderly patients as all individuals over 65 years, or those 65 to 80 years. We compare surgical and nonoperative management in octogenarians (>79 years), a medically distinct population. ⋯ Type II odontoid fracture is highly morbid among octogenarians, with 1-year mortality approaching 1-in-2. Neither surgical nor nonoperative management is associated with a survival benefit. Cord injury, GCS, AIS, and ISS are significant predictors of poor prognosis.
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The purpose of this study is to independently review and report the 5-year results of an Investigational Device Exemption study of total disc replacement (TDR) (Mobi-C) vs anterior cervical discectomy and fusion (ACDF) for the treatment of 2-level, contiguous, symptomatic cervical degenerative disc disease. ⋯ Anterior cervical surgery for contiguous 2-level pathology was safe and effective in improving patient outcome and quality of life at 5 years in both groups. There were fewer incidences of index level and adjacent level reoperation in the disc replacement group. Overall, we conclude that TDR was superior to ACDF for treatment of 2-level contiguous pathology at 5 years.
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This report describes the stereotactic technique, hospitalization, and 90-day perioperative safety in patients who underwent bilateral deep brain stimulation (DBS) of the fornix for the treatment of mild probable Alzheimer disease. ⋯ Accurate targeting of DBS to the fornix without direct injury to it is feasible across surgeons and centers. At 90 days after surgery, bilateral fornix DBS was well tolerated by patients with mild probable Alzheimer disease.
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Human ether a go-go-related-1 (hERG) is a voltage-dependent K+ channel overexpressed in GBM cell lines, and linked to aberrant proliferation. The FDA mandates all drugs undergo cardiotoxicity profiling that includes hERG inhibition. We analyzed hERG expression in glioblastoma stemlike cell (GSC)-derived tumor models and a clinically annotated human GBM tissue microarray (TMA) to correlate with patient survival after hERG expression stratification. ⋯ We showed that GBM xenografts with higher hERG expression had higher proliferation rates, and the addition of 2 known hERG inhibitors (phenytoin, E-4031) inhibited sphere formation in high hERG-expressing GSC lines. GBM TMA analyses showed significantly better survival in high hERG-expressing GBM patients treated with hERG inhibitory drugs. These data suggest clinical trials for already FDA-approved drugs that also inhibit hERG in high hERG-expressing GBM patients.
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Low-grade gliomas (LGGs) comprise a diverse set of intrinsic brain tumors that correlate strongly with survival. Data on the effect of reoperation are sparse. ⋯ This is among the largest studies to assess variables associated with outcome in patients with reoperated LGG. Reresection appears to provide significant benefit, and extent of resection remains the strongest predictor of OS.