Neurosurgery
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Quality improvement, value-based care delivery, and personalized patient care depend on robust clinical, financial, and demographic data streams of neurosurgical outcomes. The neurosurgical literature lacks a comprehensive review of large national databases. ⋯ The improvement of existing large national databases and the establishment of new registries will be crucial to the future of neurosurgical outcomes research.
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Vertebral compression fracture (VCF) is a challenging and not infrequent complication observed following spine stereotactic body radiation therapy (SBRT). ⋯ VCF is an important adverse effect following SBRT. Risk factors have been identified to guide the selection of high-risk patients. Evidence-based algorithms with respect to patient selection and intervention are needed.
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Painful terminal neuromas resulting from nerve injury following amputation are common. However, there is currently no universally accepted gold standard of treatment for this condition. A comprehensive literature review is presented on the treatment of terminal neuromas. ⋯ Such technology has the potential to lead to the future restoration of lost limb function in amputees. Further clinical research employing larger patient groups with high-quality control groups and reproducible outcome measures is needed to determine the most effective and beneficial surgical treatment for terminal neuromas. Primary focus should be placed on investigating techniques that most closely approximate the theoretically ideal neuroma treatment, including targeted muscle reinnervation and regenerative peripheral nerve interfaces.
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Practice Guideline
Stereotactic Radiosurgery in the Management of Limited (1-4) Brain Metasteses: Systematic Review and International Stereotactic Radiosurgery Society Practice Guideline.
Guidelines regarding stereotactic radiosurgery (SRS) for brain metastases are missing recently published evidence. ⋯ A number of well-conducted prospective and meta-analyses studies demonstrate good LC, without compromising survival, using SRS alone for patients with a limited number of brain metastases. Some also demonstrated less impact on neurocognitive function with SRS alone. Practice guidelines were developed using these data with International Stereotactic Radiosurgery Society consensus.
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Traumatic brachial plexus injury (BPI) can result in debilitating sequelae of the upper extremity. Presently, therapeutic decisions are based on the mechanism of injury, serial physical examination, electromyography, nerve conduction, and imaging studies. While magnetic resonance imaging is the current imaging modality of choice for BPI, ultrasound is a promising newcomer that is inexpensive, accessible, and available at point of care. ⋯ Individual studies demonstrate ultrasound as an effective diagnostic tool for traumatic adult BPI. Sensitivity of lesion detection was noted to be greater in the upper and middle (C5-C7) than in the lower spinal nerves (C8, T1). Further standardized studies should be performed to confirm the utility of ultrasound in the diagnosis of traumatic adult BPI.