Journal of neurosurgery
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Journal of neurosurgery · Dec 2023
Observational StudyReal-world benefit of intracranial pressure monitoring in the management of severe traumatic brain injury: a propensity score matching analysis using a nationwide inpatient database.
Intracranial pressure (ICP) monitoring is recommended for the management of severe traumatic brain injury (TBI). The clinical benefit of ICP monitoring remains controversial, however, with randomized controlled trials showing negative results. Therefore, this study investigated the real-world impact of ICP monitoring in managing severe TBI. ⋯ ICP monitoring was associated with lower in-hospital mortality in the real-world management of severe TBI. The results suggest that active ICP monitoring is associated with improved outcomes after TBI, while the indication for monitoring might be limited to the most severely ill patients.
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Journal of neurosurgery · Dec 2023
Brain plasticity and age after restoring elbow flexion with distal nerve transfers in neonatal brachial plexus palsy and nonneonatal traumatic brachial plexus injury using the plasticity grading scale.
Ulnar and/or median nerve fascicle to musculocutaneous nerve (MCN) transfers are used to restore elbow flexion following severe neonatal and nonneonatal brachial plexus injuries (BPIs). Restoring volitional control requires plastic changes in the brain. To date, whether the potential for plasticity is influenced by a patient's age remains unknown. ⋯ The extent of plastic changes that occur for patients to regain volitional control over elbow flexion after upper arm distal nerve transfers following BPI is influenced by patient age, with complete plastic rewiring more likely in younger patients and virtually ubiquitous in infants. Older patients should be informed that elbow flexion after an ulnar or median nerve fascicle transfer to the MCN might require simultaneous wrist flexion.
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Journal of neurosurgery · Dec 2023
Synergistic effects of immune checkpoint inhibitors in combination with stereotactic radiosurgery for patients with lung cancer and brain metastases: a propensity score-matched analysis.
Stereotactic radiosurgery (SRS) is the mainstay treatment for brain metastases (BMs) from lung cancer. In recent years, immune checkpoint inhibitors (ICIs) have been applied to metastatic lung cancer and have contributed to improved outcomes. The authors investigated whether SRS with concurrent ICIs for lung cancer BMs prolongs overall survival (OS), improves intracranial disease control, and raises safety concerns. ⋯ The present study found that SRS with concurrent ICIs for patients with lung cancer BMs was associated with longer survival and durable intracranial disease control, with no apparent increase in treatment-related adverse events.
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Journal of neurosurgery · Dec 2023
Does tumoral cavernous carotid stenosis predict an increased risk of future stroke in skull base meningiomas?
Skull base meningiomas (SBMs) involving the cavernous sinus encase the internal carotid artery (ICA) and may lead to stenosis of the vessel. Although ischemic stroke has been reported in the literature, there are to the authors' knowledge no reported studies quantifying the risk of stroke in these patients. The authors aimed to determine the frequency of arterial stenosis in patients with SBMs that encase the cavernous ICA and to estimate the risk of ischemic stroke in these patients. ⋯ Acute stroke in patients with ICA encasement by SBMs is rare despite the propensity of these tumors to stenose the ICA. Patients with ICA stenosis secondary to their SBM did not have a higher incidence of stroke than those with ICA encasement without stenosis. The results of this study demonstrate that prophylactic intervention to prevent stroke is not necessary in ICA stenosis secondary to SBM.
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Journal of neurosurgery · Dec 2023
Developing interdisciplinary research teams in neurosurgery: key elements to success in brachial plexus and peripheral nerve surgery.
The highest-impact medical literature is increasingly produced by interdisciplinary teams. The field of neurosurgery, which involves complex pathologies and recoveries, is particularly amenable to interdisciplinary research approaches. However, research in the medical context regarding the characteristics of effective teams, as well as how to develop and maintain interdisciplinary teams, remains lacking. ⋯ They then used the University of Michigan Brachial Plexus and Peripheral Nerve Program, founded under the leadership of the late Dr. Lynda Yang, as a case study for how these principles can be applied to build and operationalize a successful interdisciplinary team. They suggest that these same techniques can be used to create interdisciplinary research groups in other areas of neurosurgery.