Neurosurgery
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Limited midline myelotomy targets the midline nociceptive pathway for intractable visceral pain. Multiple techniques are available for limited midline myelotomy; however, outcome data for each technique are sparse. ⋯ In our preliminary experience, outcomes for open limited thoracic myelotomy were superior to percutaneous approaches. Given the limited utilization of this technique, multicenter registries are needed to further evaluate the best surgical technique for limited midline myelotomy.
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Surgical-site infections (SSIs) are an important cause of morbidity and mortality in neurosurgical patients. Topical antibiotics are one potential method to reduce the incidence of these infections. ⋯ Topical vancomycin is a safe, effective, and cost-saving measure to prevent SSIs following craniotomy. These results have broad implications for standard of care in craniotomy.
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Interictal epileptiform discharges are an important biomarker for localization of focal epilepsy, especially in patients who undergo chronic intracranial monitoring. Manual detection of these pathophysiological events is cumbersome, but is still superior to current rule-based approaches in most automated algorithms. ⋯ Unsupervised learning offers a powerful approach towards automated identification of recurrent pathological neurophysiological signals, which may have important implications for precise, quantitative, and individualized evaluation of focal epilepsy.
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Navigated transcranial magnetic stimulation (nTMS) enables preoperative mapping of the motor cortex (M1). The combination of nTMS with diffusion tensor imaging fiber tracking (DTI-FT) of the corticospinal tract (CST) has been described; however, its impact on surgery of motor-eloquent lesions has not been addressed. ⋯ nTMS-based mapping enables a tailored surgical approach for motor-eloquent lesions. It may improve the risk/benefit analysis, EOR and outcome, particularly when nTMS-based DTI-FT is performed.
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In degenerative cervical myelopathy (DCM), the dynamics of disease progression and the outcome after surgical decompression vary interindividually and do not necessarily correlate with radiological findings. ⋯ Based on these results, we propose a new concept for functional compensation for DCM on the cortical and spinal level, ie corticospinal reserve capacity. nTMS is a useful tool to noninvasively characterize the pattern of functional impairment and compensatory reorganization in patients suffering from DCM. The change in nTMS parameters might serve as a valuable prognostic factor in these patients in the future.