Progress in neurological surgery
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Benign adult brain tumors can be managed conservatively or using surgery, radiation, or medicines. While randomized comparisons assessing tumor recurrence, quality of life, or survival are the ideal means of comparing treatments, it can be difficult to recruit patients to such trials and lengthy follow-up periods are needed because of the slowly progressive natural history of these tumors. ⋯ While randomized clinical trials comparing conservative management, surgery, radiation, and medical management of benign adult benign tumors are unlikely to occur, there is some level 3 evidence that can assist in their treatment.
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Chronic pain conditions are a complex and multifactorial problem generally requiring a multidisciplinary-type approach. The central nervous system at some point clearly becomes involved in the processing of these painful conditions with an integration of complex changes in neurophysiology and behavior. Many ablative techniques have been employed in the past to interrupt these signals. ⋯ Neurostimulation, thus, provides the ability of therapeutically dosing electrical current in a variety of pulse forms, amplitudes, pulse widths, and frequencies, to affect that system. Furthermore, it is not destructive, it is reversible, and it can be remotely adjusted and programmed over time; clear advantages to previous surgical therapies. This chapter reports on the current evidence for the use of neurostimulation (i.e. spinal cord stimulation, motor cortex stimulation and deep brain stimulation) in the treatment of chronic pain conditions.
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Minimally invasive spine surgery decompression, arthrodesis, and instrumentation techniques are now being applied in a wide variety of percutaneous, laparoscopic and minimal access procedures. There is currently little longitudinal long-term data on these procedures to document their efficacy, indications, limitations or complications as compared to standard open techniques. Further complicating such direct comparisons is that widely used spine outcomes instruments often do not capture the relative benefits of these new procedures. It is only through randomized trials that the potential benefits of these procedures be substantiated in order to justify the sometimes significant increased costs associated with them.