Neurosurgery
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The average hospital cost for shunt infection treatment is $50,000, making it the most financially costly implant-related infection in the United States. We set out to determine whether introduction of antibiotic-impregnated shunts (AISs) in our practice has decreased the incidence of shunt infection or decreased infection-related hospital costs at our institution. ⋯ The introduction of AIS catheters in our institutional practice reduced the incidence of shunt infection and resulted in significant hospital cost savings. AIS systems are efficient and cost-effective instruments to prevent perioperative colonization of CSF shunt components.
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Intrathecal infusion using an implantable pump is a common method of delivering medication for spasticity or chronic pain. The classic site for placement of the pump is in the abdominal wall. In some patients, there are confounding factors that make placement of an abdominal pump impractical. The purpose of this study was to report the implantation of Synchromed II pumps (Medtronic, Inc, Minneapolis, Minnesota) in the infraclavicular fossa. ⋯ The infraclavicular fossa is a viable alternative to the abdomen as the site for placement of a drug infusion pump.
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Increased expression angiogenic factors, such as matrix metalloproteinases (MMPs), are associated with the formation of cerebral arteriovenous malformations (AVMs). The objective of this study was to determine plasma levels of MMP-9 of patients with AVMs. ⋯ Plasma MMP-9 levels are significantly elevated over controls at baseline, increase significantly immediately after surgery, and decrease to pretreatment levels during follow-up.
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Language functional magnetic resonance imaging (fMRI) has been used extensively in the past decade for both clinical and research purposes. Its integration in the preoperative imaging assessment of brain lesions involving eloquent areas is progressively more diffused in neurosurgical practice. Nevertheless, the reliability of language fMRI is unclear. To understand the reliability of preoperative language fMRI in patients operated on for brain tumors, the surgical studies that compared language fMRI with direct cortical stimulation (DCS) were reviewed. ⋯ The contradictory results of these studies do not allow consideration of language fMRI as an alternative tool to DCS in brain lesions located in language areas, especially in gliomas because of the pattern of growth of these tumors. However, language fMRI conducted with high magnet fields is a promising brain mapping tool that must be validated by DCS in methodological robust studies.