Neurosurgery
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Comparative Study
Virtual Reality Angiogram vs 3-Dimensional Printed Angiogram as an Educational tool-A Comparative Study.
Three-dimensional (3D) visualization of the neurovascular structures has helped preoperative surgical planning. 3D printed models and virtual reality (VR) devices are 2 options to improve 3D stereovision and stereoscopic depth perception of cerebrovascular anatomy for aneurysm surgery. ⋯ In selected cases with challenging cerebrovascular anatomy where stereoscopic depth perception is helpful, VR angiogram should be considered as a viable alternative to the 3D printed models for neurosurgical training and preoperative planning. An immersive virtual environment offers excellent resolution and ability to zoom, potentiating it as an untapped educational tool.
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Single-stage spine-shortening osteotomy without treating spinal cord malformations may have potential advantages for the treatment of severe congenital scoliosis (CS) with type I split spinal cord malformation (SSCM); however, the study of this technique was limited. ⋯ The single-stage spine-shortening PVCR with moderate correction could be applied to the treatment of CS associated with type I SSCM. This strategy can achieve safe spinal deformity correction while obviate the neurological complications brought by the detethering procedures, which merits further clinical investigation.
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Professional societies provide conflicting guidelines on aneurysm screening in patients with polycystic kidney disease (PKD), and the rate of subarachnoid hemorrhage (SAH) is poorly understood. ⋯ Screening in PKD is performed only selectively, though resulting rates of elective treatment were over 10× those of controls. Despite screening and treatment, the rate of SAH remains significantly elevated over that of controls.
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Randomized Controlled Trial
Study Protocol for a Randomized Controlled Trial Evaluating the Efficacy of an Evidence-Based iPad-App for Cognitive Rehabilitation in Patients with Primary Brain Tumors.
Many patients with primary brain tumors suffer from cognitive deficits, which negatively impact their quality of life. However, cognitive rehabilitation programs for these patients are scarce. We developed an iPad-based cognitive rehabilitation program for brain tumor patients, which was based on our effective face-to-face cognitive rehabilitation program. After successful completion of a feasibility study, a randomized controlled trial has been started. ⋯ The iPad-based program allows brain tumor patients to follow a cognitive rehabilitation program from their homes. Forthcoming results may contribute to further improvement of supportive care for brain tumor patients.
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Clinical trials have established subthalamic deep-brain-stimulation (STN-DBS) as a highly effective treatment for motor symptoms of Parkinson disease (PD), but in clinical practice outcomes are variable. Experienced centers are confronted with an increasing number of patients with partially "failed" STN-DBS, in whom motor benefit doesn't meet expectations. These patients require a complex multidisciplinary and standardized workup to identify the likely cause. ⋯ Patients with persistent OFFmotor symptoms after STN-DBS should be screened for levodopa-responsiveness, which can serve as a benchmark for best achievable motor benefit. Even small horizontal deviations of the lead from the optimal position within the dorsolateral STN can cause stimulation responses, which are markedly inferior to the levodopa response. Patients with an image confirmed lead displacement and preserved levodopa response are candidates for lead revision and can expect significant motor improvement from appropriate lead replacement.