World Neurosurg
-
Dynamic Changes in Toll-Like Receptor 4 in Human Perihematoma Tissue after Intracerebral Hemorrhage.
With the increase in the aging population and unhealthy lifestyles, the prevalence of intracerebral hemorrhage (ICH) continues to increase. The secondary injury to brain tissue after ICH might play a significant role in the prognosis of the patient; however, the underlying mechanisms of this process are unclear. This study aimed to explore the function of the toll-like receptor 4 (TLR4)-mediated myeloid differentiation primary response 88 (MyD88)-dependent pathway in inflammatory injury and apoptosis in the perihematoma tissues of patients with ICH. ⋯ The TLR4-mediated MyD88-dependent pathway plays a significant role in the mechanism of tissue injury after ICH in human tissues. Our study sheds light on the regulation of inflammation and apoptosis as potential novel targets to prevent secondary injury after ICH. Moreover, our results indicate that the optimal window for antiinflammation and antiapoptosis treatment is within 6 hours after ICH.
-
Comparative Study
Comparison of the Prognostic Value of Different Quantitative Measurements of Increased Signal Intensity on T2-Weighted MRI in Cervical Spondylotic Myelopathy.
To investigate whether different quantitative measurements of increased signal intensity (ISI) on T2-weighted magnetic resonance imaging are useful for predicting surgical outcome in patients with cervical spondylotic myelopathy (CSM). ⋯ Duration of symptoms, preoperative JOA score, preoperative ISI length, and SCR can reflect surgical outcome in patients with CSM; however, cervical sagittal alignment may not affect surgical outcome. Combining ISI length and SCR to depict ISI on T2-weighted magnetic resonance imaging is optimal and accurate. Patients with ISI length >15.50 mm and SCR >1.56 have fair surgical recovery.
-
Intracranial meningiomas are the most commonly diagnosed brain tumor in the United States. With increasing incidence, efficient allocation of limited health care resources is a critical component of emerging value-based models of care. The purpose of this study was to evaluate the effect of patient and hospital variables on metrics of value-based care. ⋯ This statewide population analysis of readmissions, mortality, length of stay, and hospital charges after intracranial meningioma surgery identified patient predictors of adverse outcomes. These determinants may be used by hospitals to develop improved systems of care in at-risk populations.
-
The results of recent high-profile delict and medical negligence cases now require doctors to take "reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments." Thus, we report the development and evaluation of a procedure-specific online educational resource to support the informed consent process for patients undergoing transsphenoidal excision of pituitary adenomas. ⋯ An interactive educational multimedia website appears to be a helpful adjunct to the informed consent process for patients undergoing transsphenoidal excision of a pituitary adenoma.
-
Anatomic hemispherectomy is an effective surgical treatment for patients with hemispherical intractable epilepsy. Different degrees of brain shifting have been observed, but whether these shifts can predict motor function recovery is unknown. The aim of this study was to analyze the correlation between brain shift ratios of different brain areas and motor function before and after surgery. ⋯ Patients with hemispherical intractable epilepsy with larger presurgical shifts of thalamus and brainstem exhibited improved muscle strength, especially in distal muscles, after anatomic hemispherectomy. This result was more likely in patients who were older at the time of seizure onset. These presurgical shifts of thalamus and brainstem may be used for predicting motor function recovery after hemispherectomy for a subset of patients, which is beneficial for surgical planning.