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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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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Intracranial-atherosclerotic disease (ICAD) accounts for approximately 10% of ischemic-strokes. The recent SAMMPRIS study displayed a high incidence of perioperative complications (15%) for treatment of ICAD with stenting. Although the incidence of stroke was lower in the medical arm, recurrent stroke was found in 12% of patients despite aggressive medical management, suggesting that intervention may remain a viable option for ICAD if perioperative risk is minimized. Angioplasty without stenting represents an alternative and understudied revascularization treatment for ICAD. Submaximal angioplasty limits the thromboembolism risk, vessel perforation, and reperfusion hemorrhage. We conducted a prospective phase I trial designed to assess the safety of submaximal angioplasty in patients with symptomatic ICAD. ⋯ Submaximal angioplasty for symptomatic ICAD is a safe and effective technique. None of the patients had ischemic stroke in the first 30 days, and only 1 patient presented with symptomatic restenosis leading to ischemic stroke during 1 year of follow-up.
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Neurocognitive changes postsurgical clipping (SC) or endovascular coiling (EC) of unruptured aneurysms is not well studied. We aim to understand whether patients who undergo EC perform better on neurocognitive assessments in comparison with patients who undergo SC, and if such a difference exists how long the difference persists. ⋯ The SC group had greater decline in neurocognitive functioning but were generally able to return to baseline functioning within 3 to 6 months.
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Outcomes research on Chiari malformation type 1 (CM-1) is impeded by a reliance on small, single-center cohorts. ⋯ Complications after CM-1 surgery are common, and surgical complications are more frequent than medical complications. Certain comorbidities and demographic characteristics are associated with increased risk for complications. Beyond harming patients, complications are also associated with substantially higher hospital costs. These results may help guide patient management and inform decision making for patients considering surgery.