Neurosurgery
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Knowledge of the properties of white matter fiber tracts isa crucial and necessary step toward a precise understanding of the functional architecture of the living human brain. Previously, this knowledge was severely limited, as it was difficult to visualize these structures or measure their functions in vivo. The HCP has recently generated considerable interest because of its potential to explore connectivity and its relationship with genetics and behavior. ⋯ From a range of ongoing connectomics related activities, the systematic characterization of brain connectedness and the resulting functional aspects of such connectivity will not only realize the work of Ramón y Cajal and others, but will also greatly expand our understanding of the brain, the mind, and what it is to be truly human. The similarities and differences that mark normal diversity will help us to understand variation among people and set the stage to chart genetic influences on typical brain development and decline during aging. What is more, an understanding of how brains might become disordered will shed light on autism, schizophrenia, Alzheimer’s, and other diseases that exact a tremendous and terrible social and economic toll.
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The natural history of surgically treated intracranial meningiomas can be quite variable. Recurrence and patient outcome cannot currently be predicted with accuracy. ⋯ HIF, VEGF, and MIB-1 are significantly correlated with tumor recurrence. With further study, these molecular markers may be used to predict outcome for patients with intracranial meningiomas.
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Giant invasive spinal schwannoma (GISS) is defined as a lesion that extends over > 2 vertebral levels, erodes vertebral bodies, and extends posteriorly and laterally into the myofascial planes. Because of its rarity, few reports have been issued. ⋯ Total resection is the treatment of choice for patients with GISS and provides functional improvements, low permanent morbidity, and a low rate of recurrence. Total resection of the intraspinal portion and regular follow-up with consideration of the Ki-67 index is recommended when total resection is not achieved.
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The Rotterdam computed tomography (CT) score was developed for prognostic purposes in traumatic brain injury (TBI). ⋯ For head-injured patients undergoing DC, the Rotterdam CT score provides great prognostic discrimination and is an independent predictor of unfavorable outcomes. We suggest that the Rotterdam CT score be included as a prognosticator in the overall assessment of clinical condition of TBI patients before DC.
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Kuntz et al recently introduced a new system for classifying spinal deformities. This classification of spinal deformity was developed from age-dependent deviations from the neutral upright spinal alignment. ⋯ The new Kuntz et al deformity classification system is comparable to the Lenke et al system in terms of reliability. However, the Kuntz et al classification system provides no recommendations for surgical interventions. It is more complex and time-consuming and therefore may be of limited value in daily clinical practice.