Journal of neurosurgery
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Journal of neurosurgery · Mar 2020
Correlation of perioperative risk scores with hospital costs in neurosurgical patients.
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) online surgical risk calculator uses inherent patient characteristics to provide predictive risk scores for adverse postoperative events. The purpose of this study was to determine if predicted perioperative risk scores correlate with actual hospital costs. ⋯ Previous work has demonstrated that the ACS NSQIP surgical risk calculator can accurately predict mortality after neurosurgery but is poorly predictive of other potential adverse events and clinical outcomes. However, this study demonstrates that predicted high-risk patients identified by the ACS NSQIP surgical risk calculator have a statistically significant moderate correlation to increased actual in-hospital costs. The NSQIP calculator may not accurately predict the occurrence of surgical complications (as demonstrated previously), but future iterations of the ACS universal risk calculator may be effective in predicting actual in-hospital costs, which could be advantageous in the current value-based healthcare environment.
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Journal of neurosurgery · Mar 2020
Natural history of ventriculomegaly in adults: a cluster analysis.
Chronic ventriculomegaly in the absence of raised intracranial pressure (ICP) is a known entity in adult hydrocephalus practice. The natural history and indication for treatment is, however, poorly defined. A highly heterogeneous group, some adults with ventriculomegaly are asymptomatic, while others have life-threatening deteriorations. The authors hypothesized that the various presentations can be subtyped and represent different stages of decompensation. A cluster analysis was performed on a cohort of patients with chronic ventriculomegaly with the aim of elucidating typical clinical characteristics and outcomes in chronic ventriculomegaly in adults. ⋯ Cluster analysis has identified subgroups of adult patients with ventriculomegaly. Such groups may represent various degrees of decompensation. Surgical interventions may not be equally effective across the subgroups, presenting an avenue for further research. The identified subtypes provide further insight into the natural history of this lesser studied form of hydrocephalus.
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Journal of neurosurgery · Mar 2020
Case ReportsSelective motor fascicle transfer and neural-machine interface: case report.
An amputated nerve transferred to a nearby muscle produces a transcutaneously detectable electromyographic signal corresponding to the transferred nerve; this technique is known as targeted muscle reinnervation (TMR). There are 2 issues to overcome to improve this technique: the caliber and the selectivity of the transferred nerve. It is optimal to select and transfer each motor fascicle to achieve highly developed myoelectric arms with multiple degrees-of-freedom motion. ⋯ Electrophysiological and functional tests were conducted in the reinnervated muscles. Functional and electrophysiological improvement was noted, with marked improvement in the identification rate for each digit, forearm, and elbow motion after the selective nerve transfers. The authors note that more selective nerve transfers may be required for the development of prostheses with multiple degrees of freedom.
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Journal of neurosurgery · Mar 2020
Deep brain stimulation of the globus pallidus internus versus the subthalamic nucleus in isolated dystonia.
Surgical procedures involving deep brain stimulation (DBS) of the globus pallidus internus (GPi) or subthalamic nucleus (STN) are well-established treatments for isolated dystonia. However, selection of the best stimulation target remains a matter of debate. The authors' objective was to compare the effectiveness of DBS of the GPi and the STN in patients with isolated dystonia. ⋯ The GPi and STN are both effective targets in alleviating dystonia and improving quality of life. However, GPi stimulation may be better for patients with axial symptoms. Moreover, STN stimulation may produce a larger clinical response within 1 month after surgery and may have a potential economic advantage in terms of lower battery consumption.
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Journal of neurosurgery · Mar 2020
Primary intracranial malignant melanoma: proposed treatment protocol and overall survival in a single-institution series of 15 cases combined with 100 cases from the literature.
The overall survival and pertinent adverse factors for primary intracranial malignant melanoma (PIMM) have not been previously determined. This aim of this study was to determine the rates of progression-free survival (PFS) and overall survival (OS) and identify the adverse factors for PIMM. ⋯ Optimal outcomes could be achieved by radical resection plus postoperative radiotherapy and/or chemotherapy. Patients with diffuse PIMM have a more severe clinical spectrum and poorer survival than patients with solitary PIMM. Immunotherapy and targeted therapy show promise as treatment options for PIMM based on results in patients with brain metastases from extracranial melanoma.