Neurosurgery
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Moyamoya disease (MMD) is a steno-occlusive disease treated with revascularization surgery. Craniotomy and multiple burr hole encephalogaleoperiosteal-synangiosis (EGPS) are used for revascularization of the anterior cerebral artery territory. The aim of this study was to compare the clinical outcome between the 2 surgical methods in pediatric patients with MMD. ⋯ Bifrontal multiple burr hole EGPS has benefits over craniotomy with shorter surgical time, less intraoperative bleeding, fewer postoperative complications, and comparable perfusion and functional outcomes. Multiple burr hole EGPS is a safe and effective method that might be considered for revascularization of the anterior cerebral artery territory in pediatric patients with MMD.
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Review
Digital Biomarkers and the Evolution of Spine Care Outcomes Measures: Smartphones and Wearables.
Over the past generation, outcome measures in spine care have evolved from a reliance on clinician-reported assessment toward recognizing the importance of the patient's perspective and the wide incorporation of patient-reported outcomes (PROs). While patient-reported outcomes are now considered an integral component of outcomes assessments, they cannot wholly capture the state of a patient's functionality. There is a clear need for quantitative and objective patient-centered outcome measures. ⋯ The patterns emerging from these data, so-called "digital biomarkers," can accurately describe characteristics of a patient's health, disease, or recovery state. Broadly, the spine care community has thus far concentrated on digital biomarkers related to mobility, although the researcher's toolkit is anticipated to expand in concert with advancements in technology. In this review of the nascent literature, we describe the evolution of spine care outcome measurements, outline how digital biomarkers can supplement current clinician-driven and patient-driven measures, appraise the present and future of the field in the modern era, as well as discuss present limitations and areas for further study, with a focus on smartphones (see Supplemental Digital Content , http://links.lww.com/NEU/D809 , for a similar appraisal of wearable devices).
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Diffuse World Health Organization grade II glioma (GIIG) is a slow-growing brain cancer that migrates along the white matter (WM) tracts. Neuroplastic changes were described in reaction to GIIG progression, opening the window to extensive cerebral surgical resection in patients able to resume an active life with no functional consequences. However, atlases of cortico-subcortical neural plasticity emphasized the limited potential of axonal reorganization. ⋯ In this model, 2 parts of the WM tracts are considered: (1) the stem of the bundle that represents the actual limitation of plastic potential, as supported by reproducible behavioral disorders elicited by intraoperative axonal electrostimulation mapping (ESM) and (2) the terminations/origins of the bundle that may no longer be critical in case of functional reallocation of the cortex to/from which these WM fibers run-thus inducing no behavioral troubles during direct ESM. Understanding that a certain degree of axonal compensation in specific portions of the tracts is driven by cortical remodeling may enable to rethink the concept of WM plasticity and to refine the preoperative estimation of extent of resection for GIIG. Identifying eloquent fibers by ESM, especially their convergence in the depth, is essential to achieve an individualized connectome-based resection.