Neurosurgery
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It remains a challenge to monitor cerebrovascular autoregulation (CA) reliably and dynamically in an intensive care unit. The objective was to build a proof-of-concept active CA model exploiting advances in representation learning and the full complexity of the arterial blood pressure (ABP) and intracranial pressure (ICP) signal and outperform the pressure reactivity index (PRx). ⋯ The present work showed that an active CA model can be built using advanced representation learning and the full complexity of 300-second ABP and ICP segments. On assessment in an experimental data set, relevant CA state information was present in both lower and higher frequencies of ABP and ICP. Improved discriminative ability between CA states was attained regarding PRx, which focuses only on slow-wave ABP and ICP information.
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Extent of resection (EOR) is prognostic for meningioma outcomes. DNA methylation profiling can shed light on biological drivers and therapeutic vulnerabilities. The goal of this study was to re-evaluate the impact of EOR on clinical outcomes across meningioma DNA methylation groups. ⋯ MRI-defined GTR is associated with improved LFFR across all meningioma DNA methylation groups and improved OS for patients with Hypermitotic meningiomas. These data continue to support maximal safe resection when feasible and demonstrate how molecular classification systems complement rather than supersede the prognostic impact of surgery.
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Dr. Joan Venes (1935-2010) is a well-respected pioneer of pediatric neurosurgery. She was the third board-certified female neurosurgeon in the United States and was the first female neurosurgery resident to be accepted by her residency program at Yale University. ⋯ In the latter half of her career, Dr. Venes developed a strong interest in health policy, becoming a Pew Fellow in Health Policy at the University of Michigan and, subsequently, a Robert Wood Johnson Foundation Health Policy Fellow. Her leadership and mentorship laid the groundwork for an exponential increase of female neurosurgeons and her research continues to be impactful today.
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Administration of intraventricular chemotherapy through Ommaya reservoir is indicated for certain forms of leptomeningeal disease. However, ventricular reservoirs carry a substantial risk of infection. The conventional approach to managing reservoir-associated infections involves removal of the reservoir and systemic antibiotic therapy, but this strategy necessitates additional procedures to remove and subsequently replace the device. We evaluated the success rate of standardized, multimodal medical therapy alone in treating reservoir-associated meningitis and factors associated with the need for device removal. ⋯ Most patients who develop a reservoir-associated infection can be successfully treated with a standardized antibiotic regimen alone, without additional surgery for reservoir removal and subsequent replacement. However, CSF leak/reservoir site infection is strongly associated with failure of medical therapy and warrants early device removal.
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Randomized Controlled Trial
Patients May Return to Work Sooner After Laminoplasty: Occupational Outcomes of the Cervical Spondylotic Myelopathy Surgical Trial.
Return-to-work (RTW) is an important outcome for employed patients considering surgery for cervical spondylotic myelopathy (CSM). We conducted a post hoc analysis of patients as-treated in the Cervical Spondylotic Myelopathy Surgical Trial, a prospective, randomized trial comparing surgical approaches for CSM to evaluate factors associated with RTW. ⋯ Most employed patients returned to work within 1 year. LP patients resumed employment earliest, while PCDF patients returned to work latest, with greater disability at follow-up, suggesting that choice of surgical intervention may influence occupational outcomes.