World Neurosurg
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Despite the fact that bevacizumab (Bev) has been approved to treat recurrent glioblastoma, patients have failed to demonstrate a significant overall survival (OS) advantage. In recent years, the advent of more Bev combination regimens seems to bring new hope for patients; nevertheless, there is still a lack of intuitive comparison among these therapies. ⋯ Both Bev + CCNU and Bev + rindopepimut could be considered as effective therapies for treating the recurrent glioblastoma according to the network meta-analysis results. Among them, Bev + rindopepimut therapy seems to be safer and more effective. Moreover, we found that Bev + Iri also appeared to be an effective therapy in a retrospective study.
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Multicenter Study
Thrombocytopenia as an Independent Prognostic Indicator Following Extradural Spinal Tumor Resection.
Few studies have examined the prognosis for patients with baseline thrombocytopenia undergoing extradural spine tumor resection. Our objective was to evaluate mortality, readmission, and other 30-day outcomes in patients with varying degrees of preoperative thrombocytopenia undergoing osseous extradural tumor excision. ⋯ In patients undergoing surgery for extradural spine tumor, degree of baseline thrombocytopenia-rather than presence alone-is an independent predictor of several adverse events. Wherever possible, optimization of preoperative platelet count to at least 100,000/μL may improve outcomes.
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The United States is projected to face increasing physician-workforce shortages. However, the shortage in the neurosurgical workforce has not yet been characterized. In the present study, we outlined the current state of the neurosurgical workforce by quantifying the divide between the number of practicing neurosurgeons and the U.S. ⋯ Although the national NPCR has slowly increased during the past 5 years, a more recent decrease occurred within the last 3 years. Additionally, with almost 57% of surgeons having been practicing for >20 years, concern exists regarding whether current practices can sustain increasing patient needs. The results from the present study indicate that further investigation is warranted regarding the factors contributing to this shortage and the steps that can be taken to increase the production of well-trained neurosurgeons.
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Moyamoya disease (MMD) often presents as ischemic stroke in pediatric patients and hemorrhage in adults. This situation raises questions as to whether the phenotype of moyamoya disease changes with age. ⋯ The EDAS procedure can effectively attenuate the dilation and ACVs of the anterior choroidal artery, which may reduce the incidence of further hemorrhage in adulthood.
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To analyze cervical spine injuries resulting from recreational activity in shallow ocean water amid high-energy breaking waves. ⋯ We offer the first description of cervical injuries sustained in water-related recreational activity using the AO-SIS. The morphology of injuries varied significantly and seemed to depend on body position and wave kinetic energy. Patients presenting with cervical injury in this setting and yielding AO-SIS >10 are likely to have poor functional recovery.