Neurosurgery
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Multicenter Study
Experience With the Pipeline Embolization Device for Posterior Circulations Aneurysms: A Multicenter Cohort Study.
The Pipeline Embolization Device (PED; Medtronic) has been used off-label for the treatment of challenging posterior circulation aneurysms. Data on this modality are primarily limited to small retrospective single-center series. ⋯ This multicenter study shows that PED for the treatment of posterior circulation is preferentially used for the treatment of fusiform and dissecting/blister aneurysm morphologies. Despite the challenges presented by these less-common morphologies, flow diversion may be performed with a neurologic complication rate of about 10% and favorable long-term aneurysm occlusion rates.
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In both academic and private practice, noncompete clauses are common in many neurological surgery contracts. Noncompete agreements vary, depending on various factors, including the surgeon's subspecialty, location, and business-related considerations. Each individual state's law on contracts determines the extent to which noncompete clauses are enforceable. ⋯ It is imperative that individuals understand the content of any noncompete clauses in their contract, as well the climate of the state in which they practice. The state's approach determines whether any part or all of the noncompete agreement is enforceable. A review by the Workforce Committee and the Medico-legal Committee of the Council of State Neurosurgical Societies (CSNS) provides explanation of the common elements in restrictive covenants or noncompete clauses and reviews the enforceability of these clauses.
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Tissue growth over covered branches is a leading cause of delayed thrombotic complications after flow-diverter stenting (FDS). Due to insufficient resolution, no imaging modality is clinically available to monitor this phenomenon. ⋯ HF-OCT enables an accurate visualization of tissue growth over time on FDS struts. The use of FDS in bifurcation locations may induce a drastic reduction of the jailed-branch ostium area.
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Obsessive compulsive disorder (OCD) is a complex neuropsychiatric disease characterized by obsessions and compulsions. Deep brain stimulation (DBS) has demonstrated efficacy in improving symptoms in medically refractory patients. Multiple targets have been investigated. ⋯ The striatal area is the most commonly targeted region for OCD-DBS. We recommend a common nomenclature based on this review. To move the field forward to individualized therapy, active contact location relative to stereotactic coordinates and patient specific anatomical and clinical variances need to be reported.