Neurosurgery
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Although many clinical risk factors of spastic cerebral palsy (CP) have been identified, the genetic basis of spastic CP is largely unknown. Here, using whole-genome genetic information linked to a deidentified electronic health record (BioVU) with replication in the UK Biobank and FinnGen, we perform the first genome-wide association study (GWAS) for spastic CP. ⋯ To our knowledge, we perform the first GWAS of spastic CP. Our study indicates that genetic variation contributes to CP risk.
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Patients with Thoracolumbar Injury Classification and Severity (TLICS) score of 4 fall into a gray zone between surgical and conservative management. The integrity of posterior ligamentous complex (PLC) evaluated by magnetic resonance imaging (MRI) contributes to surgical decision-making. Load-sharing classification (LSC) may provide a modifier to further guide decision-making in these patients. ⋯ LSC score in neurologically intact patients with isolated thoracolumbar burst fracture with TLICS 4 was independently associated with operative intervention. The application of LSC may further guide decision-making in this patient group.
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Normal pressure hydrocephalus (NPH) is frequently treated with ventriculoperitoneal shunt (VPS) surgery. However, VPS implantation can lead to overdrainage and complications such as headaches, hygroma, and subdural hematoma due to a siphon effect in an upright position. Gravitational valves prevent overdrainage through position-dependent adjustment of valve resistance. Flow-regulated valves that increase resistance in presence of high cerebrospinal fluid flow may provide similar protection against overdrainage and present an alternative to gravitational valves. ⋯ Our data suggest that shunt therapy in NPH patients with a flow-regulated instead of a gravitational valve is safe and effective with a comparable clinical outcome and risk of overdrainage complications. Moreover, patients with flow-regulated valves may need fewer valve adjustments and reoperations.
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Letters of recommendation (LORs) are one of the most important components of the neurosurgical residency application. Studies in other fields and surgical subspecialties have found gender bias. ⋯ Overall, there are more similarities than differences between genders in LORs for neurosurgical applicants. This finding is at odds with what has previously been reported in most other surgical specialties.
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Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is an effective therapy for patients with drug-resistant focal epilepsy. Best practices for surgical targeting of the ANT can be refined as new information becomes available regarding effective stimulation sites. ⋯ Consistent with experience from more established DBS indications, our findings and other recent reports suggest that there may be specific sites within the ANT that are associated with superior clinical outcomes. It will be important to continue to evaluate these relationships and the evolution of other clinical practices (eg, programming) to further optimize this therapy.