World Neurosurg
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Multicenter Study
Persistently high serum substance P levels and early mortality in patients with severe traumatic brain injury.
Substance P is a neuropeptide belonging to the tachykinin family and is involved in neuroinflammation. In a previous study by our team, we found higher serum substance P levels on day 1 of traumatic brain injury (TBI) in nonsurviving than in surviving patients. Thus, the objective of this study was to determine whether serum substance P levels during the first week of TBI could predict early mortality. ⋯ The new finding of our study is that the presence of elevated serum substance P levels during the first week of TBI is associated with increased mortality.
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Randomized Controlled Trial
Time to and Possible Risk Factors for Recurrence after Burr-hole Drainage of Chronic Subdural Hematoma - A Subanalysis of the cSDH-Drain Randomized Controlled Trial.
The randomized controlled Chronic Subdural Hematoma (cSDH)-Drain-Trial showed comparable recurrence rates after placing a subperiosteal drain (SPD) or a subdural drain (SDD) for surgically drained cSDH, although SDD was associated with higher rates of infection and iatrogenic brain injury. This subanalysis examines the time to recurrence and possible risk factors for recurrence after burr-hole drainage of cSDH and placement of a SPD compared with a SDD. ⋯ The inserted drain type after burr-hole drainage of cSDH does not seem to influence time to recurrence. SPD may be warranted in routine clinical practice, independent of individual patient, surgical, or hematoma characteristics.
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Improved life expectancy and advanced diagnostic tools including computed tomography and magnetic resonance imaging have increased the awareness and diagnosis of intracranial meningiomas in the elderly population. The risk/benefit ratio of surgery in elderly patients with intracranial meningioma has not been clearly defined because of the lack of objective measurement tools. We aimed to understand the risk factors associated with postsurgical outcomes and how these risk factors affected postsurgical outcomes in elderly patients with intracranial meningioma. ⋯ Even though elderly patients operated on for intracranial meningioma had higher morbidity and mortality compared with younger patients, surgery is still much more beneficial than wait-and-see strategy in elderly patients.
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Spinal alignment, particularly with respect to spinopelvic parameters, is highly correlated with morbidity and health-related quality-of-life outcomes. Although the importance of spinal alignment has been emphasized in the deformity literature, spinopelvic parameters have not been considered in the context of spine oncology. Because the aim of oncologic spine surgery is mostly palliative, consideration of spinopelvic parameters could improve postoperative outcomes in both the primary and metastatic tumor population by taking overall vertebral stability into account. This review highlights the relevance of focal and global spinal alignment, particularly related to spinopelvic parameters, in the treatment of spine tumors.
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Review Historical Article
Brain lobotomy: a historical and moral dilemma with no alternative?
Pioneered in 1936 by Portuguese neurologist and politician Egas Moniz, lobotomy was a definitive lesional surgery on the brain, which consisted of splitting the white fibers in the frontal lobes. Sixteen years later, the first antipsychotic medication appeared at Sainte-Anne Mental Hospital in Paris, drastically reducing the number of surgical lobotomies in France and worldwide. Lobotomy has been one of the most criticized medical procedures in history, with thousands of patients lobotomized around the world and causing serious consequences to their personalities and intellectual function. ⋯ We have discussed the psychiatric, societal, and media contexts that led to the emergence of lobotomy. Our aim was to highlight this period in the history of medicine and place the medical practice into perspective.