World Neurosurg
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Dystonia is common in Parkinson disease patients, affecting about 30% of them. Bilateral subthalamic nucleus deep brain stimulation (DBS) can sometimes lead to dystonia, but this relationship is not well understood. Our aim was to provide a better understanding of dystonia's causes and its connection to DBS. ⋯ Patients with off-dystonia before surgery tend to improve after DBS. Otherwise, DBS could have the role of "additive boost" in the process of sensitization of striato-pallidal pathways and lead to on-dystonia in particular patients.
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Opportunity exists for improved local control rates of grade 2 meningiomas that recur despite maximal surgical resection and adjuvant fractionated radiotherapy (RT). We describe a dose escalation strategy of increasing the total tumor radiation dose by adding a stereotactic radiosurgery (SRS) boost targeting gross disease to fractionated RT. ⋯ We found 100% in-field local control at 3 years from an SRS boost to fractionated RT targeting gross disease with an acceptable toxicity profile, suggesting this may be an effective and improved adjuvant treatment strategy in patients with grade 2 meningioma.
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Intracranial solitary fibrous tumor (SFT) is a rare central nervous system (CNS) tumor that lacks a reliable prognostic clinical model. Uncertainty persists regarding the treatment outcomes of surgery and adjuvant radiotherapy (ART). To address this, we investigated the efficacy of ART and applied machine learning (ML) to develop accurate prognostic models. ⋯ Although ART did not lead to a substantial decrease in cancer-specific deaths, it did improve OS. This underscores the broader health benefits of ART, including effective management of comorbid conditions. Caution is advised when interpreting these survival benefits because of potential confounding factors in patient health and treatment management. Our web tool and ML models aid in clinical decision-making.
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Patients with acute ischemic stroke (AIS) have limited evidence regarding the relationship between blood urea nitrogen and albumin. Aiming to investigate the relationship between the blood urea nitrogen to albumin ratio (BUN/ALB ratio) and poor outcomes in AIS patients at 3 months was the purpose of this study. ⋯ The BUN/ALB ratio and poor outcomes in AIS patients show a nonlinear correlation. For AIS patients, a BUN/ALB ratio of approximately 0.326 is associated with the lowest risk of adverse outcomes at 3 months. Specifically, for nonsmoking AIS patients, a BUN/ALB ratio of approximately 0.295 is associated with the lowest risk of adverse outcomes at 3 months.
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We assessed the accuracy of pedicle screws placed during awake minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF) under spinal anesthesia and analyzed outcomes at the 1-year follow-up. ⋯ Our study shows a high accuracy (99%) of pedicle screw placement in patients undergoing awake MIS-TLIF under spinal anesthesia and significant improvement of their symptoms at 1-year follow-up.