World Neurosurg
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For patients undergoing brain surgery, once primary motor and sensory areas are identified by direct electrical stimulation, resection can be performed in the precentral and postsomatosensory areas while monitoring cognition. For this purpose, we developed a real-time neuropsychological testing (RTNT) protocol tapping sensorimotor cognition. ⋯ The sensory-motor RTNT is performed to assist surgery in the precentral and postsomatosensory areas.
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The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and the Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) are used to assess patient psychology, pain, and quality of life. As psychological factors, such as depression and anxiety, are associated with poor perioperative outcomes, we aim to translate MMPI-2-RF values to PROMIS-29 scores and establish cutoff values for PROMIS-29 anxiety and depression domains that might warrant attention preoperatively. ⋯ PROMIS-29 scores of 15 or greater on the depression and anxiety domains may have psychopathologies that warrant addressing, given their increased likelihood of having poor outcomes.
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In 1%-2% of patients with symptomatic vascular compression of a cranial nerve, the compression may be due to a tortuous dolichoectatic vertebrobasilar artery. The most common technique used for microvascular decompression relies on the placement of a polytetrafluoroethylene (Teflon) pledget or other buffer between the root of the nerve and the offending vessel loop, thereby decompressing the cranial nerve. In cases of macrovascular compression by a large tortuous artery, these buffering techniques fail to produce lasting results with risk for cranial nerve compression-related deficit, specifically the facial nerve. ⋯ While this technique completely resolved the compression from the vertebrobasilar artery, there was still a remaining vein contacting the nerve anterior to the artery. A Teflon pledget was placed between the vein and the root entry zone, as it was a pontine vein and we planned to preserve it. The patient recovered well without complication and was completely free from hemifacial spasm at >2 years long-term follow-up.
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Monocyte chemoattractant protein-1 (MCP-1) is an important regulator of the formation and development of intracranial aneurysms. This study explored the molecular mechanisms underlying the induction of MCP-1 and related inflammatory factors in human umbilical vein endothelial cells (HUVECs) under hemodynamic conditions. ⋯ Under impinging flow, MCP-1 and inflammatory factors are regulated through the JNK/c-Jun/p38/c-Fos pathway and participate in EC inflammation.
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Tje objective of this study was to identify factors that are independently associated with increased surgical drain output (ISDO) in patients who have undergone anterior cervical decompression (discectomy/corpectomy) and fusion (anterior cervical discectomy and fusion [ACDF]/anterior cervical corpectomy and fusion [ACCF]). ⋯ Male sex, age 50 years or older, the number of discs involved, and C3 involvement were significant risk factors for ISDO following anterior cervical decompression and fusion. Patients with these risk factors may benefit from surgical drain placement.