Neurosurgery
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Newborns with a myelomeningocele are often brought to the operating room for surgical repair within the first few days of life. Wound infection in this population may represent a devastating outcome in the immature nervous system. No studies have evaluated infection as a function of surgical timing at a national level. We hypothesized an increase in wound infection in those patients with delays in myelomeningocele repair when evaluated from a national database. ⋯ Myelomeningocele repair, when delayed more than 1 day after birth, is associated with increased rates of infection. High-volume centers are associated with fewer delays in procedure. Although constrained by limitations of a national coded database, results suggest that appropriate attention to timely myelomeningocele repair decreases the infection rate.
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Biochemical alterations associated with mechanical stress have been explored as an initiating step in the pathological progression of ligamentum flavum hypertrophy (LFH); however, this mechanism remains poorly understood. Recently, the inflammation induced after mechanical stress and the subsequent response of ligamentum flavum (LF) cells have been implicated in LFH pathology. ⋯ The LSCS group showed greater segmental motion, higher VEGF concentrations, and more CD34-positive capillaries than the control group. These data indicate that VEGF-mediated angiogenesis following mechanical stress may be a critical step within the series of pathological events in LFH.
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Radiation exposure from diagnostic imaging is a significant concern, particularly in the care of pediatric patients. Computed tomography (CT) scanning is a significant source of radiation. ⋯ Although replacing a CT with magnetic resonance imaging is ideal to completely avoid ionizing radiation, this is not always practical or preferred. Therefore, it is important to have CT protocols in place that minimize radiation dose without sacrificing diagnostic quality. The protocols in place at our institution could be replicated at other academic and community hospitals and imaging centers.
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The optimal site for placement of tissue oxygen probes following traumatic brain injury (TBI) remains unresolved. We studied brain tissue oxygen tension (PbtO2) at the sites of contusion, proximal and distal to contusion, and in the contralateral hemisphere to determine the effect of probe location on PbtO2 and to assess the effects of physiological interventions on PbtO2 at these different sites. ⋯ PbtO2 measurements are strongly influenced by the distance from the site of focal injury. Physiological alterations, including hyperoxia, hyperventilation, and hypoventilation substantially affect PbtO2 values distal to the site of injury, but have little effect in and around the site of contusion.
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Neurosurgical treatments for refractory psychiatric disorders such as obsessive-compulsive disorder (OCD) are rapidly increasing. The National Institute of Mental Health has reclassified mental health disorders according to neurobiological mechanisms rather than traditional diagnostic categories. According to this Research Domain Criteria matrix, OCD would be classified as a disorder of cognitive control, with additional contributions from other axes. We bring together the neuroscientific literature on cognitive control and dorsal anterior cingulate cortex (dACC) function with human functional MRI (fMRI) and EEG data to demonstrate (1) the central role of the dACC in cognitive control; and (2) the relevance of this framework for the neurosurgical treatment of OCD. ⋯ We collect a breadth of data to illustrate the following points: (1) the dACC is central to cognitive control; (2) cognitive control is dysfunctional in OCD; (3) neuromodulatory treatment of OCD normalizes physiological measures of cognitive control. We discuss these findings within the framework of the recently proposed Expected Value of Control (EVC) model of dACC function. The development of neurobiological conceptualizations such as these will be critical to the advancement of our network-level understanding of neuropsychiatric disorders and their neurosurgical treatments.