Neurosurgery
-
Surgery for cerebrospinal fluid diversion is the most common procedure performed by pediatric neurosurgeons. The failure rates for shunts remain frustratingly high, resulting in a negative burden to patients, families, providers, and health care systems. The goal of this study was to quantify the risk of a shunt malfunction in patients with an existing shunt who undergo an elective intradural operation. ⋯ This is the first study to quantify the risk of a shunt malfunction after elective intradural surgery. The 90-day all-cause shunt failure rate (per procedure) was 10% with nearly half of the failures occurring within the first 5 postoperative days. Possible risk factors for shunt malfunction after elective intradural surgeries are intraventricular surgical approach, shorter time since last shunt-related surgery, and young age.
-
In Parkinson patients in the OFF medication state, basal ganglia local field potentials exhibit characteristic changes in beta and gamma oscillations that may be directly related to the symptoms of rigidity and bradykinesia. However, magnetoencephalography and low-resolution electrocorticography (ECoG) studies of sensorimotor cortex suggest that changes in cortical oscillations in Parkinson patients may differ from those of the basal ganglia during the OFF medication state. ⋯ Our findings are suggestive of an inverse oscillatory profile in the sensorimotor cortex of Parkinson patients that, in contrast to basal ganglia, may act to facilitate movement in the face of an antikinetic bias inherent in the dopamine-depleted state.
-
There is no proven effective therapy to prevent early brain injury (EBI) after subarachnoid hemorrhage (SAH) despite extensive research efforts. Sphingosine kinase (SphK) 1 has been reported as an important signaling node in antiapoptotic signaling. Heparin is a pleiotropic drug that antagonizes many pathophysiological mechanisms. In this study, we evaluated if heparin prevents EBI after SAH by antiapoptotic mechanisms including SphK1. ⋯ Low-dose heparin posttreatment may decrease the development of post-SAH EBI through anti-apoptotic mechanisms, including sphingosine-related pathway activation, implying its efficacy for early prevention of brain injury after acute aneurysm rupture in a clinical setting.
-
While acute disc herniation-induced radiculopathy most frequently resolves without clinical sequelae, a fraction of patients experience long-term sensory dysfunction. This study examined chronic sensitivity of the rodent hind paw following resolution of acute inflammatory neuropathy. ⋯ Noncompressive disc herniation sensitizes the sciatic nerve distribution in this animal model, despite resolution of acute intraneural macrophage migration. The demonstrated role of TRPV1 may explain how acute inflammatory pain transforms into chronic neuropathic pain. Decreasing TRPV1 expression may prevent the development of the long-term painful phenotype.