World Neurosurg
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Acute spinal cord injury (ASCI) is a catastrophic event that can profoundly affect the trajectory of a patient's life. Debate continues over the pharmacologic management of ASCI, specifically, the widespread but controversial use of the steroid methylprednisolone (MP). Treatment efforts are impeded because of limitations in understanding of the pathobiology of ASCI and the difficulty in proving the efficacy of therapies. ⋯ ASCI is a devastating event with a complex aftermath of secondary damaging processes that worsen the initial injury. Although the results of NASCIS (National Acute Spinal Cord Injury Study) II and III trials led to the widespread adoption of a high-dose MP regimen for patients treated within 8 hours of injury, subsequent studies have called into question the validity of NASCIS conclusions. Further evidence of the ineffectiveness of the MP protocol has led to declining confidence in the treatment over the last decade. At the present time, high-dose MP cannot be recommended as a standard of care, but it remains an option until supplanted by future evidence-based therapies.
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Comparative Study
Skull base chordoma and chondrosarcoma: influence of clinical and demographic factors on prognosis: a SEER analysis.
Chordomas and chondrosarcomas are rare skull base tumors, with similar radiographic and clinical presentations. We investigated factors influencing long-term survival in these 2 tumors using the Surveillance Epidemiology and End Results (SEER) database. ⋯ Consistent with previous case series, skull base chordomas have significantly worse prognosis than chondrosarcomas. Patients in the SEER database had worse survival overall compared with existing case series for both chordomas and chondrosarcomas, suggesting selection bias in the existing literature.
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Plasticity is fundamental to normal central nervous system function and its response to injury. Understanding this adaptive capacity is central to the development of novel surgical approaches to neurologic disease. These innovative interventions offer the promise of maximizing functional recovery for patients by harnessing targeted plasticity. ⋯ Such synergistic approaches will create therapeutic options for patients previously outside of the scope of neurosurgery, such as those with permanent disability after traumatic brain injury or stroke. In this review, we synthesize the rapidly evolving field of plasticity and explore ways that neurosurgeons may enhance functional recovery in the future. We conclude that understanding plasticity is fundamental to modern neurosurgical education and practice.