J Neurosurg Sci
-
Lumbar stenosis patients typically present with neurogenic claudication or radiculopathy. Studies have shown the benefit of surgical management of lumbar stenosis for patients who fail medical management. ⋯ A shorter length of stay and faster return to work after minimally invasive lumbar decompression may result in the minimally invasive approach being more cost effective than an open approach. A literature review was performed to evaluate the clinical outcomes and cost effectiveness associated with minimally invasive decompression of lumbar stenosis.
-
Traumatic brain injury (TBI) is a significant contributing factor to injury-related deaths worldwide. Despite the medical and fiscal importance of this subject, guidelines for the surgical management of closed and penetrating TBI are largely based on Level III evidence. Furthermore, the results of a large, costly trial designed to further elucidate the role of decompressive craniectomy, an important surgical intervention in patients with severe TBI and medically-refractory intracranial hypertension, have limited applicability. ⋯ There will continue to be unresolved controversies regarding decisions pertaining to defining an "optimal" surgical candidate, specific timing, techniques, and post-operative management of TBI patients who undergo surgery. New guidelines for the surgical management of TBI are forthcoming. Regardless, for neurosurgeons involved in the care of individuals with TBI, understanding the pathophysiologic and neurophysiologic consequences of surgical interventions, and gaining an understanding of the extant literature is imperative.
-
Awake surgery is not a new technique: this is a new philosophy. Indeed, in surgery for diffuse gliomas performed in awake patients, the goal is not anymore to remove a "tumor mass" according to oncological boundaries (which in essence do not exist in infiltrating neoplasms), but to resect a part of the brain invaded by a chronic tumoral disease, according to functional limits both at cortical and subcortical levels. Therefore, intraoperative electrical mapping is accepted as the gold standard in order to gain information about the functionality of the underlying tissue when performing neuro-oncological surgery. ⋯ Beyond clinical implications, awake surgery represents a unique opportunity to study neural networks underpinning sensorimotor, visuospatial, language, executive and even behavioral functions in humans. This led to propose new models of connectomics, breaking with the localizationist view of brain processing, and opening the window to the concept of neuroplasticity. In summary, awake mapping enables to make a link between surgical neurooncology and cognitive neurosciences, to improve both survival and quality of life of glioma patients.
-
Proper nutrition is critical for recovery from traumatic brain injury (TBI). Prompt enteral feeding of moderate to severe TBI patients has been associated with significantly lower mortality and rates of infection. Probiotic supplementation has been associated with significantly lower rates of infection in TBI and other trauma patients. ⋯ Animal TBI models have suggested that alpha-lipoic acid, magnesium, taurine, coenzyme Q10, and many phytonutrients (such as resveratrol) are also helpful. Unfortunately, recent human clinical trials with citicoline in TBI and stroke patients have produced disappointing results. Much more research is needed on multifaceted nutritional strategies to treat TBI patients in both the immediate post-injury phase and throughout the patients lifespan.
-
A common cause of low back pain is lumbar spinal stenosis (LSS). The Swiss Spinal Stenosis Score (SSS) is a well-known questionnaire that measures the severity of symptoms, physical functioning and patient's satisfaction in lumbar spinal stenosis. This study aimed to translate and validate the SSS in Iran. ⋯ The Iranian version of Swiss Spinal Stenosis Score performed well and the findings suggest that it is a valid measure of symptoms, physical functioning and satisfaction among patients with lumbar spinal stenosis.