World Neurosurg
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Review Historical Article
Cranial Surgery in Italy during the Bronze Age.
Skull vault trepanation is a surgical practice that has been found in prehistoric human remains. We carried out a review of the literature on cranial trepanations performed during the Bronze Age in Italy. In total, 19 individuals, most of whom were adult males, with 33 trepanations have been reported, including a new specimen from the Italian Middle Bronze Age (1700-1400 BCE), found at Grotta della Monaca (Calabria). ⋯ Several trepanation techniques were applied in Italy during this period, where the drilling method was the most common solitary technique utilized. The survival rate of 79.3% in Bronze Age Italy suggests that trepanation was carried out with remarkable success. This analysis gives further insight into ancient human behavior and enhances our knowledge of surgical practices in antiquity, shedding light on the origins of neurosurgery.
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There are numerous innovative and promising approaches aimed at slowing, reversing, or healing degenerative disc disease. However, multiple treatment-specific impediments slow progress toward realizing the benefits of these therapies. First, the exact pathophysiology underlying degenerative disc disease remains complicated and challenging to study. ⋯ Biological treatments are subject to the complex biomechanical environment in which native discs degenerate. The regulatory approval environment for these therapeutics will likely involve a high degree of scrutiny. Finally, patient selection and assessment of outcomes are a particular challenge in this clinical setting.
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Sacral anterior root stimulation (SARS) was developed 40 years ago to restore urinary and bowel functions to individuals with spinal cord injury. Mostly used to restore lower urinary tract function, SARS implantation is coupled with sacral deafferentation to counteract the problems of chronic detrusor sphincter dyssynergia and detrusor overactivity. In this article, we systematically review 40 years of SARS implantation and assess the medical added value of this approach in accordance with the PRISMA guidelines. We identified 4 axes of investigation: 1) impact on visceral functions, 2) implantation safety and device reliability, 3) individuals' quality of life, and 4) additional information about the procedure. ⋯ Despite promising results, a decline in implantations was observed. This decline can be linked to the complication rate, as well as to the development of new therapeutics (e.g., botulinum toxin) and directions for research (spinal cord stimulation) that may have an impact on people. Nevertheless, the lack of alternatives in the short-term suggests that the SARS implant is still relevant for the restoration of visceral functions after spinal cord injury.
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Comparative Study
Single Level Minimally Invasive Transforaminal Lumbar Interbody Fusion vs Anterior Lumbar Interbody Fusion with Posterior Instrumentation at L5/S1.
To compare outcomes between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and anterior lumbar interbody fusion (ALIF) at L5/S1. ⋯ Patients undergoing ALIF showed significantly improved rates of MCID achievement for disability, physical function, and back pain during the early postoperative period. However, the overall MCID achievement rate for leg pain was higher for the MIS-TLIF cohort.
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Decompressive craniectomy (DC) is highly effective in relieving intracranial hypertension; however, patient selection, intracranial pressure threshold, timing, and long-term functional outcomes are all subject to controversy. Recently, recommendations were made to update the Brain Trauma Foundation guidelines in regards to the use of DC based on the DECRA (Decompressive Craniectomy in Patients with Severe Traumatic Brain Injury) and RESCUEicp (Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension) clinical trials. Neither the updated recommendations, nor the aforementioned trials, provide a method in incorporating individualized patient or surrogate decision-maker preferences into decision making. ⋯ The 1-year outcomes from DECRA and RESCUEicp have served as the basis for updated guidelines. However, unaided interpretation of trial data may not be adequate for individualized decision-making; we suggest that the latter can be significantly supported by decision aids such as the one described here and based on expected utility theory.