World Neurosurg
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It is unclear how brain growth with age affects electrode position in relation to target for children undergoing deep brain stimulation surgery. We aimed to model projected change in the distance between the entry point of the electrode into the brain and target during growth to adulthood. ⋯ Electrodes inserted during deep brain stimulation surgery are tethered at the point of entry to the skull. Brain growth, which could result in a relative retraction with respect to the original target position, appears to occur before 7 years of age, suggesting careful monitoring is needed for children undergoing implantation before this age. Reengineering of electrode design could avoid reimplantation surgery in young children undergoing deep brain stimulation.
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To evaluate the effect of important trials on the practice of neurosurgery. ⋯ Randomized clinical trials remain the gold standard in the medical community to demonstrate efficacy, but their true impact relies on rapid and extensive assimilation into everyday medical practice. However, the described methodology establishes a temporal relationship only and does not prove causation. Nonetheless, trends in procedural volume suggest that the results of these select randomized clinical trials had a significant effect on neurosurgical practice affecting Medicare patients within an interval of a few years.
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The ability to understand factors associated with an increased duration of missed work postoperatively could be used to more effectively select patients with the greatest opportunity for a successful outcome. We set out to determine the effect of preoperative depression on postoperative return to work in patients undergoing transforaminal lumbar interbody fusion (TLIF) for degenerative spondylolisthesis. ⋯ Independent of postoperative improvement in pain, disability, and quality of life, the extent of preoperative depression was an independent predictor of time to return to work in patients undergoing TLIF for spondylolisthesis, suggesting that regardless of how successful TLIF surgery may be at improving a patient's pain, disability, or quality of life, greater depression will delay or prohibit their ability to return to work postoperatively.
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To assess the clinical outcome, complications, and angiographic outcomes after surgical disconnection of intracranial dural arteriovenous fistulas (DAVFs). ⋯ Surgical disconnection of CVR for high-grade intracranial DAVFs is highly effective and can be performed with very low complication rates. Where embolization cannot be performed safely, surgical disconnection (rather than stereotactic radiosurgery) is the treatment of choice for high grade DAVFs.
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To evaluate the anatomic distortions of the optic chiasm caused by craniopharyngiomas (CPs) and their influence on preoperative and postoperative visual status. ⋯ The type of chiasm distortion represents a valuable neuroradiologic finding to ascertain the preoperative and postoperative visual status.