Neurosurgery
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Smoking has been associated with worse self-reported outcomes in patients undergoing degenerative lumbar spine surgery. Current focus is on decreasing cost and complications while improving outcomes. This potentially can be accomplished by acting on modifiable preoperative patient characteristics such as smoking. However, the impact of smoking on outcomes following degenerative cervical spine surgery is poorly understood. The aim of the study is to understand impact of smoking on patient-reported outcomes after degenerative cervical spine surgery. ⋯ The smoking population was younger and had a higher preoperative narcotic use. Smoking results in lower absolute scores and these patients have less benefit following surgical intervention compared with the nonsmokers, after controlling for confounding variables. Smoking cessation should be strongly considered before surgical intervention so as to optimize outcome.
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A randomized controlled trial with appropriate statistical power and long-term outcomes is the hallmark of level 1 clinical evidence. The SENZA-RCT multicenter pivotal study was powered to directly compare highfrequency spinal cord stimulation (SCS) at 10 kHz (HF10 therapy) and traditional lowfrequency (∼50 Hz) SCS. The comparative efficacy of these modalities for the treatment of chronic back and leg pain for 18 months is presented. ⋯ The SENZA-RCT study provides strong level 1 evidence in support of long-term use HF10 therapy compared with traditional low-frequency SCS for the treatment of chronic back and leg pain.
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The role of reoperation for recurrent glioblastoma is still unclear because of the lack of prospective studies. Here, we report on the association of clinical outcome with surgery for recurrent glioblastoma including the volumetric extent of resection in the well-characterized patient cohort of the DIRECTOR trial. This prospective randomized multicenter study evaluated the effect of 2 different dose-intensified temozolomide regimens at first recurrence of glioblastoma. ⋯ Surgery at first recurrence of glioblastoma seems to improve outcome if complete resection of Gd-enhancing tumor volume is feasible.
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The comparative efficacy of microscopic and fully endoscopic transsphenoidal surgery for pituitary adenomas has not been well studied despite the adoption of fully endoscopic surgery by many pituitary centers. We compared the extent of tumor resection (EOR) and the endocrine outcomes of 1 very experienced surgeon performing a microscopic-transsphenoidal surgery technique (1800 independent cases) with those of a less experienced surgeon using a fully endoscopic-transsphenoidal surgery technique (100 independent cases) for nonfunctioning pituitary adenomas in a concurrent series of patients. ⋯ A less experienced surgeon using a fully endoscopic technique was able to achieve similar outcomes compared with a very experienced surgeon using a microscopic technique in a cohort of patients with nonfunctioning tumors. These data suggest that certain advantages afforded by the fully endoscopic technique help address the learning curve in pituitary surgery.
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The purpose of this study is to independently review and report the 5-year results of an Investigational Device Exemption study of total disc replacement (TDR) (Mobi-C) vs anterior cervical discectomy and fusion (ACDF) for the treatment of 2-level, contiguous, symptomatic cervical degenerative disc disease. ⋯ Anterior cervical surgery for contiguous 2-level pathology was safe and effective in improving patient outcome and quality of life at 5 years in both groups. There were fewer incidences of index level and adjacent level reoperation in the disc replacement group. Overall, we conclude that TDR was superior to ACDF for treatment of 2-level contiguous pathology at 5 years.