Neurosurgery
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: Triple decompression surgery has been advocated as a treatment for diabetic peripheral neuropathy (DPN). A practice advisory published in 2006 by the American Academy of Neurology concluded that "this treatment alternative should be considered unproven." Since then, multiple cohort studies involving several thousands of patients and 1 nonblind, randomized, controlled trial have been published, suggesting that surgical treatment of DPN has become commonplace in many centers globally. The results of these observational studies suggest that decompressive surgery could result in a substantial reduction of pain and the restoration of sensation in patients with DPN. ⋯ This design would eliminate a large number of possible confounders and would therefore require only a small number of patients. Such a trial is currently being performed at the University of Texas. The true beneficiaries will be patients with DPN: either decompressive surgery will be established as an evidence-based treatment for millions of patients or they will be spared from potentially harmful surgery with no significant benefit.
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Review Case Reports
Functional Gonadotroph Adenomas: Case Series and Report of Literature.
Functional gonadotroph adenomas (FGAs) are rare tumors of the pituitary gland that secrete biologically active gonadotropins. ⋯ FGA, functional gonadotroph adenomaFSH, follicle-stimulating hormoneLH, luteinizing hormoneTSH, thyroid-stimulating hormone.
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The value of maximal safe cytoreductive surgery in recurrent high-grade gliomas (HGGs) is gaining wider acceptance. However, patients may harbor recurrent tumors that may be difficult to access with open surgery. Laser interstitial thermal therapy (LITT) is emerging as a technique for treating a variety of brain pathologies, including primary and metastatic tumors, radiation necrosis, and epilepsy. ⋯ BBB, blood-brain barrierFDA, US Food and Drug AdministrationGBM, glioblastoma multiformeHGG, high-grade gliomaLITT, laser interstitial thermal therapy.
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Recurrent malignant glioma continues to be a clinical challenge, and repeat surgery is an option in only select patients. Stereotactic laser ablation, a new minimally invasive technique, can be used as an alternative to surgery. We review the current literature on laser ablation for recurrent malignant gliomas as well as discuss practical and theoretical advantages and disadvantages of this emerging technique in comparison with repeat surgery or radiation. We also discuss the potential for laser ablation to augment adjuvant therapies, namely, chemotherapy, radiation, and immunotherapy.
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Pediatric blunt cerebrovascular injury (BCVI) lacks accepted treatment algorithms, and postinjury outcomes are ill defined. ⋯ ATT, antithrombotic therapyBCVI, blunt cerebrovascular injuryCTA, computed tomography angiographyGCS, Glasgow Coma Scale.