Neurosurgery
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It remains unclear if minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is comparable to traditional, open TLIF because of the limitations of the prior small-sample-size, single-center studies reporting comparative effectiveness. ⋯ For single-level grade 1 degenerative lumbar spondylolisthesis, MI-TLIF was associated with less disability, higher quality of life, and higher patient satisfaction compared with traditional, open TLIF. MI-TLIF was associated with higher rates of RTW, less blood loss, but longer operative times. Though we utilized multivariable adjusted analyses, these findings may be susceptible to selection bias.
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Multivariate risk prediction models individualize prediction of adverse outcomes, assisting perioperative decision-making. There are currently no models specifically designed for the neurosurgical population. ⋯ NZRISK-NEURO is a robust multivariate calculator created specifically for neurosurgery, enabling physicians to generate data-driven individualized risk estimates, assisting shared decision-making and perioperative planning.
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Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) can improve seizure control for patients with drug-resistant epilepsy (DRE). Yet, one cannot overlook the high discrepancy in efficacy among patients, possibly resulting from differences in stimulation site. ⋯ Stimulation at the ANT-MTT junction correlates to increased seizure control. Our findings suggest a relationship between the stimulation site and therapy response in ANT-DBS for epilepsy with a potential role for the MTT. DBS directed at white matter merits further exploration for the treatment of epilepsy.
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Historical Article
Reflections on the History of Nerve Repair - Sir Sydney Sunderland's Final Presentation to the Neurosurgical Society of Australasia.
Sir Sydney Sunderland (1910-1993) was an eminent physician and anatomist who identified the fascicular structure of nerves, and developed the eponymous 5-tiered classification of nerve injuries. Not long before his death, he presented a keynote address to the Annual Scientific Meeting of the Neurosurgical Society of Australasia. ⋯ Sir Sydney discussed nerve injuries sustained during World War I, with the deleterious effects of infection, and following the many nerve injuries sustained during World War II, he discussed his own discoveries of internal topography of nerve fascicles, and the anatomical substrate of nerve fascicles that limit surgery for nerve repair, nerve grafts, and the basic science of spinal cord repair. This paper presents a transcript of Sunderland's presentation and includes many of his original images used to illustrate this tour de force of nerve repair.