Latest Articles
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Journal of neurosurgery · Jan 2025
Cost-effectiveness analysis of deep brain stimulation versus treatment as usual for treatment-resistant obsessive-compulsive disorder.
Deep brain stimulation (DBS) is an effective neurosurgical option for patients with treatment-resistant obsessive-compulsive disorder (OCD). Despite being more costly than neuroablative procedures of comparable efficacy, DBS has gained popularity over the years for its reversibility and adjustability. Although the cost-effectiveness of DBS has been investigated extensively in movement disorders, few economic analyses of DBS for psychiatric disorders exist. In this study, the authors present the first cost-effectiveness analysis of DBS for treatment-resistant OCD in the United States. ⋯ Rechargeable DBS models were cost-effective for treatment-resistant OCD compared with TAU. Nonrechargeable DBS models may be cost-effective, especially with improvement in battery longevity and changes in accepted WTP thresholds.
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Journal of neurosurgery · Jan 2025
Neurological and functional outcomes of 32 patients with hemorrhagic brainstem cavernous malformations: a practical guide for surgical planning.
Brainstem cavernous malformations (BSCMs) were once considered inoperable. Microsurgical resection now represents a valuable option for treating patients with hemorrhagic or symptomatic lesions. The aim of this study was to provide a practical guide for surgical planning by analyzing postoperative neurological and functional outcomes. ⋯ Early surgery after the first bleed following systematic surgical planning may be considered as an effective option for managing hemorrhagic BSCMs with acceptable operative morbidity and relatively favorable early- and long-term neurological and functional outcomes.
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Journal of neurosurgery · Jan 2025
Thalamic deep brain stimulation for central poststroke pain syndrome: an international multicenter study.
The effectiveness and optimal stimulation site of deep brain stimulation (DBS) for central poststroke pain (CPSP) remain elusive. The objective of this retrospective international multicenter study was to assess clinical as well as neuroimaging-based predictors of long-term outcomes after DBS for CPSP. ⋯ This comprehensive, multicenter analysis corroborates the efficacy of DBS in treating CPSP for a relevant number of patients. The posterior limb of the internal capsule and the sensorimotor thalamus emerged as potential stimulation sweet spots. The difference in structural connectivity between responders and nonresponders may constitute a biomarker of effective stimulation that can help guide surgical planning in future well-designed prospective trials.
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The use of electronic health records (EHR) for chronic pain phenotyping has gained significant attention in recent years, with various algorithms being developed to enhance accuracy. Structured data fields (e.g., pain intensity, treatment modalities, diagnosis codes, and interventions) offer standardized templates for capturing specific chronic pain phenotypes. This study aims to determine which chronic pain case definitions derived from structured data elements achieve the best accuracy, and how these validation metrics vary by sociodemographic and disease-related factors. ⋯ While our current algorithms provide valuable insights, enhancement is needed to ensure more reliable chronic pain identification across diverse patient populations. PERSPECTIVES: This study evaluates chronic pain phenotyping algorithms using electronic health records, highlighting variability in performance across sociodemographic and disease-related factors. By combining structured data elements, the findings advance chronic pain identification, promoting equitable healthcare practices and highlighting the need for tailored algorithms to address subgroup-specific biases and improve outcomes.
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Limited data is available to evaluate the burden of device associated healthcare infections (HAI) [central line associated bloodstream infection (CLABSI), catheter associated urinary tract infection (CAUTI), and ventilator associated pneumonia (VAP)] in low and-middle-income countries. Our aim is to investigate the population attributable mortality fraction and the absolute mortality difference of HAI in a broad population of critically ill patients from Brazil. ⋯ Device-associated HAI significantly contribute to hospital mortality and impose a high excess risk of death for critically ill patients.