Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Neuromodulation using deep brain stimulation (DBS) has become an established therapy for the treatment of certain disorders such as Parkinson's disease and tremors. Recent advances in surgical and imaging techniques further decrease the surgical risk associated with these procedures. Symptoms such as tremor, bradykinesia, rigidity and gait disturbances can be significantly controlled with DBS. ⋯ DBS as a treatment for patients with advanced dementia holds significant promise in delaying or reversing the progressive cognitive decline by enhancing connectivity in the memory networks. In appropriately selected patients this potentially reversible surgical therapy can lead to a significant improvement in the quality of life and reduce the burden on patients, families and the healthcare system. This review focuses on the recent and future studies involving neuromodulation for cognitive disorders such as Alzheimer's disease and Huntington's disease.
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Randomized Controlled Trial
Unilateral versus bilateral pedicle screw instrumentation for single-level minimally invasive transforaminal lumbar interbody fusion.
Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has become an increasingly popular method of lumbar arthrodesis. However, there are few published studies comparing the clinical outcomes between unilateral and bilateral instrumented MIS TLIF. Sixty-five patients with degenerative lumbar spine disease were enrolled in this study. ⋯ The total fusion rate, screw failure, and general complication rate were not significantly different. Results showed that single-level MIS TLIF with unilateral pedicle screw fixation would be sufficient in the management of preoperatively stable patients with lumbar degenerative disease. It seems that MIS TLIF with unilateral pedicle screw instrumentation is a better choice for single-level degenerative lumbar spine disease.
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Comparative Study
Incidence of delayed seizures, delayed cerebral ischemia and poor outcome with the use of levetiracetam versus phenytoin after aneurysmal subarachnoid hemorrhage.
Current guidelines recommend against the use of phenytoin following aneurysmal subarachnoid hemorrhage (aSAH) but consider other anticonvulsants, such as levetiracetam, acceptable. Our objective was to evaluate the risk of poor functional outcomes, delayed cerebral ischemia (DCI) and delayed seizures in aSAH patients treated with levetiracetam versus phenytoin. Medical records of patients with aSAH admitted between 2005-2012 receiving anticonvulsant prophylaxis with phenytoin or levetiracetam for >72 hours were reviewed. ⋯ Choice of anticonvulsant was not associated with any of the outcomes of interest. There was no difference in the rate of delayed seizures, DCI or poor functional outcome in patients receiving phenytoin versus levetiracetam after aSAH. The high rate of crossover from phenytoin suggests that levetiracetam may be better tolerated.
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Comparative Study
Significance of enhanced cerebral gray-white matter contrast at 80 kVp compared to conventional 120 kVp CT scan in the evaluation of acute stroke.
We aimed to determine whether 80 kVp conventional nonenhanced head CT scans have better gray-white matter contrast than standard 120 kVp scans performed on the same patients. Thirty head CT scans acquired at 80 kVp (CT dose index [CTDI]vol 46) were compared to prior studies in the same patients performed at 120 kVp (CTDIvol 59). Signal (Hounsfield units [HU]), noise (sd HU), and contrast-to-noise ratio per dose (CNRD) were assessed in multiple cerebral gray and white matter regions of interest. ⋯ The gray-white matter CNRD was 4.0 ± 1.2 at 80 kVp and 2.8 ± 1 at 120 kVp (p<0.00001). Cerebral gray-white matter CNRD is increased by 40% at 80 kVp compared to conventional 120 kVp CT scans. These findings justify further clinical evaluation in the acute stroke setting.
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This study aims to demonstrate survival rates and treatment patterns among patients with chordomas of the skull base using a large population database. Patients with cranial chordomas between 1973 and 2009 were identified from the USA Surveillance, Epidemiology, and End Results (SEER) public use database. Kaplan-Meier analysis was used to examine the effect of surgery and radiation on overall survival. ⋯ Surgical intervention offers survival benefit for cranial chordomas. Findings of decreased survival in patients receiving radiation may be associated with selection. Studies examining surgical extent of resection data and radiation details are needed to determine the impact of radiotherapy.