Neurosurgery
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Deep brain stimulation (DBS) is a highly efficacious treatment for appropriately selected patients with advanced, medically refractory Parkinson's disease (PD). It is severely underutilized in Black patients-constituting a major treatment gap. The source of this disparity is unknown, but its identification and correction are necessary to provide equitable care. ⋯ The known underuse of DBS in Black patients with PD was replicated in this sample from a center in a racially diverse metropolitan area, but was not attributable to the presurgical workup. Future work should examine the transition from medical management to surgical evaluation where drivers of disparity are potentially situated. Surgical practices should increase outreach to physicians managing PD in underserved areas.
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Steroids are used ubiquitously in the preoperative management of patients with brain tumor. The rate of improvement in focal deficits with steroids and the prognostic value of such a response are not known. ⋯ A response to steroids before surgery is highly predictive of long-term improvement postoperatively in brain metastasis patients with focal neurological deficits. Lack of a response portends a somewhat less favorable prognosis. Duration and intensity of therapy do not seem to affect the likelihood of response.
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Ukrainian health care before 2021 was like that in comparable middle-income countries. The conflict with Russia over the last 8 months has added significant burden to the already resource-constrained system. We describe the current neurosurgical situation in Ukraine as well as remote and in-person efforts to provide needed assistance to Ukrainian neurosurgical colleagues.
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The increase in use of targeted systemic therapies in cancer treatments has catalyzed the importance of identifying patient- and tumor-specific somatic mutations, especially regarding metastatic disease. Mutations found to be most prevalent in patients with metastatic breast cancer include TP53, PI3K, and CDH1. ⋯ The results of this study demonstrate that there is an increased prevalence of PI3K mutations in patients with MBCS and there are a significant survival benefit and delay in progression of motor symptoms associated with using targeted systemic therapies for adjuvant treatment.
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Improvements in the modern helmet have demonstrated beneficial effects in reducing concussion risk in football players. However, previous studies yield conflicting results regarding the protective quality of leatherhead football helmets. There is limited research comparing the modern football helmet and the modern hockey helmet, with one previous study demonstrating the football helmet as providing a lower risk of concussion. ⋯ The leatherhead football helmet was the least protective, and the hockey helmet was the most protective, with the football helmet being intermediate. This study provides additional insight into the inconclusive evidence regarding the safety of leatherhead football helmets and into the design of football and hockey helmets in the future.