Neurosurgery
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Ependymoma and chordoma are 2 tumors that occur throughout the craniospinal axis, and for which the extent of neurosurgical resection has a key prognostic role. Both tumors have distinctive pathologic features, yet can present significant diagnostic challenges to pathologists in cases without classical histology. The molecular understanding of ependymoma has had significant advances in the past decade, with the identification of 9 molecular groups with significant prognostic and clinical implications, while a comprehensive study of chordoma further emphasized the key role of brachyury overexpression in its pathogenesis. In this review, we discuss the pathogenesis, radiology and gross pathology, histology, and molecular features of these 2 tumors, as well as active research into targeted therapies, with an emphasis on practical diagnostic challenges, and the use of immunohistochemical and molecular tests in routine diagnostic practice.
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Obstructive sleep apnea (OSA) is typically associated with an increased risk of cardiovascular and cerebrovascular disease. Recent studies, however, have suggested that hypercapnia and chronic intermittent hypoxia may potentially provide protection against ischemic events like stroke. ⋯ SAH patients with OSA are significantly less likely to have a poor outcome when compared to non-OSA patients, despite having an increased risk of several comorbidities.
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The introduction of intra-arterial chemotherapy (IAC) for treatment of retinoblastoma considerably changed the paradigm by which this disease is managed, with event-free survival rates being above 70%. ⋯ IAC is a safe and effective treatment option for retinoblastoma. Chemotherapy delivery using alternative techniques is as effective as selective OAC.
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Mentorship can be a powerful and life-altering experience during residency training, but there are few articles discussing mentorship models within neurosurgery. In this study, we surveyed US neurosurgical department mentorship practices and linked them to resident outcomes from the Accreditation Council for Graduate Medical Education (ACGME), including resident survey responses, board pass rates, and scholarly activity. A 19-question survey was conducted from October to December 2017 with the assistance of the Society of Neurological Surgeons. ⋯ Programs with well-established mentorship programs were found to have superior ACGME resident survey results, board pass rates, and more scholarly activity. There was not a significant difference among outcomes and the different models of formal mentorship practices. Barriers to mentorship, such as time and faculty/resident "buy-in," are identified.
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At least 25% of patients with idiopathic generalized epilepsy do not obtain adequate seizure control with medication. This report describes the first use of responsive neurostimulation (RNS), bilaterally targeting the centromedian/ventrolateral (CM/VL) region in a patient with drug-refractory Jeavons syndrome (eyelid myoclonia with absences). ⋯ RNS decreased daily absence seizures from a mean of 60 to ≤10 and maintained the patient's level of consciousness during the occurring episodes. This therapy should be evaluated further for its potential to treat patients with pharmaco-refractory generalized epilepsy.