Neurosurgery
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Depression has been associated with poor outcomes in neurosurgical patients, with increased pain, poorer functional recovery, delayed return to work, and decreased patient satisfaction. No reports exist regarding the association of psychiatric diagnoses with outcomes following brachial plexus reconstruction. As outcomes and patient satisfaction become increasingly important to payers and physician reimbursement, assessing modifiable preoperative risk factors for their association with poor outcome and patient satisfaction is imperative. We retrospectively analyzed patients undergoing brachial plexus reconstruction to restore elbow flexion to assess the relationship of depression/anxiety disorders with functional outcome. ⋯ Preoperative depression is common in patients after brachial plexus injury. The presence of depression is associated with reduced elbow flexion recovery following reconstruction. These data suggest assessment and treatment of preoperative mental health is important in designing a comprehensive postoperative management plan to optimize outcomes and patient satisfaction.
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Intracerebral hemorrhage (ICH) produces high acute mortality and poor long-term neurological outcomes. Hematoma volume clinically correlates with neurological deterioration; however, no efficacious treatment options exist to improve patient outcomes. Remote limb Ischemic Post-Conditioning (RIC) is the simple, inexpensive, and safe use of repetitive inflation of a blood pressure cuff on a limb to protect distant organs after injury. Ischemic conditioning was efficacious in randomized clinical trials in myocardial infarction, was well tolerated in subarachnoid hemorrhage patients, and showed safety and efficacy, including increased cerebral blood flow, in a small cohort of patients with intracranial stenosis. Herein, we tested the hypothesis that RIC would improve outcomes after experimental ICH. ⋯ RIC may noninvasively accelerate spontaneous hematoma resolution via an immune-mediated mechanism.
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Several studies have examined correlates between imaging features of neoplasm and patient survival or tumor genetic composition; however, few have generated predictive models robust enough to enter clinical practice. In this study, we use advanced pattern analysis and machine learning to identify a combination of imaging features on initial magnetic resonance (MR) images to predict overall survival and molecular subtype in patients with glioblastoma (GB). ⋯ Unlike prior studies, we analyzed the entirety of imaging data in an integrative fashion, leveraging the power of pattern analysis and machine learning to predict survival and molecular subtype with high accuracy and reproducibility in GB. Our noninvasive model utilizes multiparametric imaging obtained routinely for GB patients, making it readily translatable to the clinic.
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Controversy continues surrounding the optimal surgical approach to Chiari decompression and whether the dura needs to be opened. Assessment of long-term outcomes looking specifically at failure rates, and associated factors, for bone-only decompression vs duraplasty was undertaken. ⋯ Comparison of Chiari failures does not appear to differentiate between open and closed decompression. The most common cause of failure was the presence of arachnoid scaring at the 4th ventricular outflow in both surgical cohorts. Craniofacial comorbidity increased the likelihood of surgical failure, especially when hydrodynamic issues were involved.
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Poststroke brain stimulations are promising neurorestorative techniques because they allow direct manipulation of the target area's excitability. Previously, we demonstrated that optogenetic neuronal stimulation of the ipsilesional primary motor cortex promotes functional recovery. To determine an optimal brain stimulation target, we tested whether optogenetic neuronal stimulation of the contralesional cerebellar dentate nucleus (cDN) can promote recovery. We hypothesized that stimulation of cDN may be more effective, because it sends excitatory outputs to multiple cerebral regions. ⋯ Our data suggest that cDN stimulations poststroke can promote functional recovery and this prorecovery effect is persistent. Recovery of cDN-stimulated stroke mice is associated with upregulation of plasticity marker GAP43 and downregulation of CREB signaling. Current studies examine the effects of cDN stimulations on axonal sprouting and the contribution of CREB in recovery. cDN could be a promising brain stimulation target for stroke recovery.