Thursday, May 30, 2013

Human Intelligence Cannot Be Explained By The Size Of The Brain's Frontal Lobes

Research into the comparative size of the frontal lobes in humans and other species has determined that they are not - as previously thought - disproportionately enlarged relative to other areas of the brain, according to the most accurate and conclusive study of this area of the brain...





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Medical apps for smartphones: lack of evidence undermines quality and safety

Increasing numbers of healthcare professionals are using smartphones and their associated applications (apps) in daily clinical care. While these medical apps hold great potential for improving clinical practice, little is known about the possible dangers associated with their use. Breaches of patient confidentiality, conflicts of interests and malfunctioning clinical decision-making apps could all negatively impact on patient care. We propose several strategies to enhance the development of evidence-based medical apps while retaining their open nature. The increasing use of medical apps calls for broader discussion across medicine's organising and accrediting bodies. The field of medical apps is currently one of the most dynamic in medicine, with real potential to change the way evidence-based healthcare is delivered in the future. Establishing appropriate regulatory procedures will enable this potential to be fulfilled, while at all times ensuring the safety of the patient.






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Citations of scientific results and conflicts of interest: the case of mammography screening

Introduction

In 2001, a Cochrane review of mammography screening questioned whether screening reduces breast cancer mortality, and a more comprehensive review in Lancet, also in 2001, reported considerable overdiagnosis and overtreatment. This led to a heated debate and a recent review of the evidence by UK experts intended to be independent.

Objective

To explore if general medical and specialty journals differed in accepting the results and methods of three Cochrane reviews on mammography screening.

Methods

We identified articles citing the Lancet review from 2001 or updated versions of the Cochrane review (last search 20 April 2012). We explored which results were quoted, whether the methods and results were accepted (explicit agreement or quoted without caveats), differences between general and specialty journals, and change over time.

Results

We included 171 articles. The results for overdiagnosis were not quoted in 87% (148/171) of included articles and the results for breast cancer mortality were not quoted in 53% (91/171) of articles. 11% (7/63) of articles in general medical journals accepted the results for overdiagnosis compared with 3% (3/108) in specialty journals (p=0.05). 14% (9/63) of articles in general medical journals accepted the methods of the review compared with 1% (1/108) in specialty journals (p=0.001). Specialty journals were more likely to explicitly reject the estimated effect on breast cancer mortality 26% (28/108), compared with 8% (5/63) in general medical journals, p=0.02.

Conclusions

Articles in specialty journals were more likely to explicitly reject results from the Cochrane reviews, and less likely to accept the results and methods, than articles in general medical journals. Several specialty journals are published by interest groups and some authors have vested interests in mammography screening.






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Physical Therapy for the Critically Ill in the ICU: A Systematic Review and Meta-Analysis*

imageObjective: The purpose of this systematic review was to review the evidence base for exercise in critically ill patients. Data Sources and Study Selection: Using keywords critical care and physical therapy and related synonyms, randomized controlled trials, meta-analyses, and systematic reviews were identified through electronic database searches and citation tracking. Clinical trials with outcomes of mortality, length of hospital and ICU stay, physical function and quality of life, muscle strength, and ventilator-free days were included. Data Extraction and Synthesis: Two reviewers abstracted data and assessed quality independently. Effect sizes and 95% confidence intervals were calculated. From 3,126 screened abstracts, 10 randomized controlled trials and five reviews were found. The mean Physiotherapy Evidence Database score was 5.4. Overall there was a significant positive effect favoring physical therapy for the critically ill to improve the quality of life (g = 0.40, 95% confidence interval 0.08, 0.71), physical function (g = 0.46, 95% confidence interval 0.13, 0.78), peripheral muscle strength (g = 0.27, 95% confidence interval 0.02, 0.52), and respiratory muscle strength (g = 0.51, 95% confidence interval 0.12, 0.89). Length of hospital (g = –0.34, 95% confidence interval –0.53, –0.15) and ICU stay (g = –0.34, 95% confidence interval –0.51, –0.18) significantly decreased and ventilator-free days increased (g = 0.38, 95% confidence interval 0.16, 0.59) following physical therapy in the ICU. There was no effect on mortality. Conclusion: Physical therapy in the ICU appears to confer significant benefit in improving quality of life, physical function, peripheral and respiratory muscle strength, increasing ventilator-free days, and decreasing hospital and ICU stay. However, further controlled trials of better quality and larger sample sizes are required to verify the strength of these tentative associations.





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Physicist's Tool Has Potential For Brain Mapping

A new tool being developed by UT Arlington assistant professor of physics could help scientists map and track the interactions between neurons inside different areas of the brain. The journal Optics Letters recently published a paper by Samarendra Mohanty on the development of a fiber-optic, two-photon, optogenetic stimulator and its use on human cells in a laboratory...





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Why our patients (and we) need basic science research

In times of fiscal austerity, the tendency is to seek instant, inexpensive gratification. In the case of biomedical research, this means the shortest path to practical clinical implementation. But fueling the translational pipeline with discovery depends critically on allowing the biomedical research community to follow their science where it takes them. Fiscal constraints carry with them the risk of squelching creativity and forfeiting the power of serendipity to provide the substrate for the translational engine in the future.






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Transcranial magnetic stimulation as a tool for understanding neurophysiology in Huntington's diseas

Publication date: Available online 29 May 2013
Source:Neuroscience & Biobehavioral Reviews
Author(s): April L. Philpott , Paul B. Fitzgerald , Tarrant D.R. Cummins , Nellie Georgiou-Karistianis
Structural and functional magnetic resonance imaging modalities have been critical in advancing our understanding of the neuroanatomical and pathophysiological changes that emerge during the premanifest and symptomatic stages of Huntington's disease (HD). However, the relationship between underlying neuropathology and the motor, cognitive and behavioural changes associated with the disorder still remain poorly understood. Less conventional technologies, such as transcranial magnetic stimulation (TMS) and electroencephalography (EEG), provide a unique opportunity to further investigate the causal relationships between targeted neural circuits and objective neurophysiological responses together with overt behaviours. In this review, we discuss previous successful applications of TMS in other neurological disorders and its prospective use in HD. We also address the added value of multimodal TMS techniques, such as TMS-EEG, in investigating the integrity of neural networks in non-motor regions in HD. We conclude that neurophysiological outcome measures are likely to contribute towards characterising further the trajectory of decline across functional domains in HD, enhance understanding of underlying neural mechanisms, and offer new avenues for elucidating sensitive endophenotypic biomarkers of disease progression.






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Scientists Link Brain Cell Types To Behavior

You are sitting on your couch flipping through TV channels trying to decide whether to stay put or get up for a snack. Such everyday decisions about whether to "stay" or to "go" are supported by a brain region called the anterior cingulate cortex (ACC), which is part of the prefrontal cortex...





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Preterm Birth Affects Ability To Solve Complex Cognitive Tasks

Being born preterm goes hand in hand with an increased risk for neuro-cognitive deficits. Psychologists from the Ruhr-Universitat Bochum and the University of Warwick, UK have investigated the relation between the duration of pregnancy and cognitive abilities under varying work load conditions...





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Utility of the CO2 Laser in the Microsurgical Resection of Cavernous Malformations

Publication date: May–June 2013
Source:World Neurosurgery, Volume 79, Issues 5–6
Author(s): Giac D. Consiglieri , Brendan D. Killory , Rasha S. Germain , Robert F. Spetzler
Objective The CO 2 laser has a long record of use in neurosurgery. However, its utility has been limited by its bulky design and the challenge of using it with the operating microscope. With the development of the OmniGuide fiber, a technology that delivers the beam through flexible hollow-core photonic bandgap mirrors, the laser can now be held and used with greater ease and accuracy. Methods We retrospectively analyzed a prospectively maintained database to assess the utility of the laser in 23 consecutive patients (10 male, 13 female; mean age, 40.8 years; range, 9-64 years) with a cavernous malformation treated by the senior author (R.F.S.). Results Four lesions were located in noneloquent areas, 13 were in the brain stem, four were in the spinal cord, and two were in the thalamus. The usefulness of the laser was rated on a scale of 1 to 5, with 5 defined as "extremely helpful." The mean utility score was 3.5 ± 0.94 (range, 2-5). The laser was judged most useful in creating cortisectomies in eloquent areas and in "shrinking" cavernous malformations away from adjacent hemosiderin-stained tissue. The laser was ineffective against calcification and in obtaining hemostasis. Conclusions The CO 2 laser is a useful addition to the neurosurgical armamentarium for treating lesions in the brainstem, thalamus, and spinal cord. Its primary utility lies in its ability to create focused cortisectomies safely and to shrink cavernous malformations away from eloquent hemosiderin-stained brain.






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Wednesday, May 29, 2013

Acute Normovolemic Hemodilution Is Safe in Neurosurgery

Publication date: May–June 2013
Source:World Neurosurgery, Volume 79, Issues 5–6
Author(s): Paulo P. Oppitz , Marco A. Stefani
Objective To determine the safety of acute normovolemic hemodilution (ANH) for patients undergoing neurosurgical procedures. Methods A group of 100 patients undergoing neurosurgical procedures was assigned prospectively to receive ANH. A group of 47 patients who underwent craniotomy for aneurysm clipping and standard anesthetic management was used as a control. Procedures conducted under ANH were performed without significant variations in physiologic parameters. Results Compared with controls, intraoperative blood loss, operative time, incidence and grade of complications, and length of hospital stay were similar between the two groups. Although the ANH group showed a difference in prothrombin levels before and after hemodilution procedures, the levels were still considered within physiologic parameters. Platelet counts and partial thromboplastin time (PTT) levels indicated no significant variations in either group. During the ANH procedure, a considerable reduction of brain oxygen extraction was observed in individuals with worse preoperative neurologic status (P < 0.05), indicating potential benefit. Among patients with cerebral aneurysm, patients with good initial clinical grades had better clinical results as indicated by Glasgow Outcome Scale scores (P < 0.02). Conclusions ANH is a safe procedure for patients undergoing neurosurgical procedures. Further studies are necessary to confirm the improvement in brain oxygen extraction and the clinical impact. Nonetheless, patients undergoing aneurysm clipping with good clinical grades seem to profit from ANH.






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Surgical Treatment and Long-Term Outcomes of Thalamic Cavernous Malformations

Publication date: May–June 2013
Source:World Neurosurgery, Volume 79, Issues 5–6
Author(s): Da Li , Junting Zhang , Shuyu Hao , Jie Tang , Xinru Xiao , Zhen Wu , Liwei Zhang
Objective Resection of thalamic cavernous malformations (CMs) is controversial. The goals of this study were to evaluate the outcome of thalamic CMs after surgical resection, assess predictors of prognosis, and review the literature. Methods The authors used the modified Rankin scale (mRS) to retrospectively evaluate the presentation, surgery, and outcomes of 27 consecutive patients who underwent thalamic CMs microresection using six different approaches between 1998 and 2010. Results Forty-eight hemorrhages occurred in 27 patients (13 men, 14 women; mean age 33.9 years) with a preoperative mRS score of 2.6 ± 1.0 and a preoperative bleeding rate per patient year of 5.2%. Complete resection was achieved in 26 patients (96.3%) without surgical mortality. The postoperative mRS score at discharge was 1.9 ± 1.0. One lesion rebled 1 month after complete surgical resection. After a mean follow-up duration of 48.7 ± 43.2 months, the mean mRS score was 1.2 ± 1.2 and the postoperative rebleeding rate was 0.91% per patient-year. With regard to neurological function, 81.5% of patients improved, 11.1% stabilized, and 7.4% worsened. Good outcomes (mRS score ≤2, living independently) were achieved in 21 patients (77.8%). Long-term surgical morbidity was observed in five patients (18.2%). A multivariate logistic regression analysis identified age (<40 years) as the only predictor of the postoperative mRS score (≤ 2) (odds ratio, 1.24, 95% confidence interval, 1.02–1.52; P = 0.035). Conclusions To our knowledge, this is the largest case series reported in the literature to date. Patients with thalamic CMs can obtain a favorable prognosis using microsurgery; an appropriate microsurgical approach contributes to an excellent outcome.






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Surgical Resection of Cavernous Malformations of the Brainstem: Evolution of a Minimally Invasive Te

Publication date: May–June 2013
Source:World Neurosurgery, Volume 79, Issues 5–6
Author(s): Jeffrey C. Mai , Dinesh Ramanathan , Louis J. Kim , Laligam N. Sekhar
Objective The purpose of this study is to provide an institutional retrospective review of surgically treated brainstem cavernous malformations. Methods Between 2005 and 2010, 22 consecutive patients with brainstem cavernous malformations (15 female and 7 male) with a mean age of 43 years underwent surgical treatment. Mean volume of the resected cavernous malformations was 0.65 cm3. A minimally invasive resection technique was used for these cases, in conjunction with skull base approaches. Results The mean follow-up period was 26.6 months (range, 4-68 months). Of the 22 patients, 9% did not have clear evidence of hemorrhage at the time of presentation. Of the remainder, 22% had two or more instances of hemorrhage documented by magnetic resonance imaging. After resection and during follow-up, 54% of patients had an improvement in their modified Rankin scale, whereas 14% were worse compared with their preoperative presentation; 32% were unchanged and 9% of patients were found to have residual cavernoma post-surgery. Conclusion Our longitudinal experience has guided us to emphasize minimally invasive approaches during resection of the brainstem cavernous malformations, occasionally at the expense of achieving a complete resection, to improve patient outcomes.






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INTERACT2: Intensive Blood Pressure Lowering Benefits ICH

Early intensive blood pressure lowering in patients with intracerebral hemorrhage appears to be related to less long-term disability, according to the results of the INTERACT2 trial.
Medscape Medical News





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Seizures After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review of Outcomes

Publication date: May–June 2013
Source:World Neurosurgery, Volume 79, Issues 5–6
Author(s): Daniel M.S. Raper , Robert M. Starke , Ricardo J. Komotar , Rodney Allan , E. Sander Connolly Jr.
Objective The risk for early and late seizures after aneurysmal subarachnoid hemorrhage (aSAH), as well as the effect of antiepileptic drug (AED) prophylaxis and the influence of treatment modality, remain unclear. We conducted a systematic review of case series and randomized trials in the hope of furthering our understanding of the risk of seizures after aSAH and the effect of AED prophylaxis and surgical clipping or endovascular coiling on this important adverse outcome. Methods We performed a MEDLINE (1985–2011) search to identify randomized controlled trials and retrospective series of aSAH. Statistical analyses of categorical variables such as presentation and early and late seizures were carried out using χ2 and Fisher exact tests. Results We included 25 studies involving 7002 patients. The rate of early postoperative seizure was 2.3%. The rate of late postoperative seizure was 5.5%. The average time to late seizure was 7.45 months. Patients who experienced a late seizure were more likely to have MCA aneurysms, be Hunt/Hess grade III, and be repaired with microsurgical clipping than endovascular coiling. Conclusions Despite improved microsurgical techniques and antiepileptic drug prophylaxis, a significant proportion of patients undergoing aneurysm clipping still experience seizures. Seizures may occur years after aneurysm repair, and careful monitoring for late complications remains important. Furthermore, routine perioperative AED use does not seem to prevent seizures after SAH.






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AANS Neurosurgeon - Negotiating the Neurosurgical Learning Curve



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ELEKTA Leksell Gamma Knife Perfexion
  May 2013, Volume 22, Number 2
Visit www.aansneurosurgeon.org to read the latest edition of the AANS Neurosurgeon — the American Association of Neurological Surgeons' (AANS) quarterly online magazine. View a more detailed Table of Contents for the May 2013 issue of AANS Neurosurgeon by following this link.  twitter
Click to read this article
In This Issue
Negotiating the Neurosurgical Learning Curve
The field of neurosurgery comes with a steep and ever-changing learning curve. The May 2013 issue of AANS Neurosurgeon examines some of the necessary steps needed to negotiate this always-evolving constant in the specialty. Physicians both home and abroad offer unique perspectives on how best to handle that curve, whether you are a resident just beginning a neurosurgical career or an established neurosurgeon expanding your practice and acquiring new techniques. Our Point-Counterpoint features an ethical discussion about whether or not we inform our patients where we are on the learning curve and how we ensure patient safety in the process. Are we obligated to disclose? If so, how much? Fundamental to the conversation is the underlying question: How do we as neurosurgeons gain expertise? Read on and join the lively debate.

Features
Adopting New Techniques in Private-practice Neurosurgery 
by Mark Spatola, MD, FAANS

Dealing with the Learning Curve 
by Michael Lawton, MD, FAANS

Making the Neurosurgical Transition From Private to Hospital Employment
by James Bean, MD, FAANS

Point: A Physician Has an Obligation to Disclose
by Peter Nakaji, MD, FAANS; and Nicole Nakaji, RN, JD

Counterpoint: Learning Curve Ethics — How Much Must You Disclose? 
by Harold Rekate, MD, FAANS

Peer-Reviewed Research
Neurosurgeon and Student Perspective on the Current Medical Education in Neurosurgery 
Julie Pilitsis, MD, PhD, FAANS; Sandra Beverly, BA; Catherine Mazzola, MD, FAANS; William W. Ashley, Jr., MD, PhD, MBA; Chaim Colen, MD, PhD; Kaveh Asadi, MD, PhD; and Michael Steinmetz, MD, FAANS

Survey: Gray Matters
Cerebral Aneurysm Clipping: Like Riding a Bike, Once It's Learned, It Cannot be Forgotten? 
by Andrew H. Jea, MD, FAANS; and Robert J. Bollo, MD

Archives
Follow this link to read past issues of AANS Neurosurgeon.
Departments
Editorial License: Curve-y
New Letters to the Editor: The True Personality of a Neurosurgeon
Education: A Flattened Curve: Results of Duty-hour Restrictions
Timeline: A Learning Curve with n = 1 + 14 
Financial Forethought: Smart Decisions: Managing Your Debt and Finances After Residency and Fellowship
InfoTech Impact: Evolution of a Dual-trained Vascular Neurosurgeon
Face-Time: Interview with Dr. Robert Solomon
International: A Brazilian Look at the Neurosurgical Learning Curve
International: A Greek View of the Neurosurgical Learning Curve
International: A Russian Perspective on the Learning Curve in Neurosurgery
Bookshelf: How We Present Evidence
Medicolegal: Before You Get Carried Away: The Legal and Ethical Considerations of Physician "Drift"
Ethics in Practice: Ethical Considerations of the Learning Curve
Patient Safety: Patient Safety Within a Changing Field of Neurosurgery
Coding Clarity: Coding and the Learning Curve
Inside Neurosurgeon
Neuros in the News: Who's Making Headlines?
AANS President's Perspective: The AANS' Commitment to Neurosurgery
Washington Watch: Working for You in Washington: A Snapshot of Neurosurgery's Advocacy Successes
AANS News: The 81st AANS Annual Scientific Meeting: Putting Patient Safety on Center Stage
NPA Update: National Neurosurgery Quality and Outcomes Database: One-year Preliminary Data
CSNS Report: Fond Farewell
AANS Governance: Notice of Disciplinary Actions: Member Censure
Multimedia Operative and Instructional Videos
In the Loupe: A Right Far-lateral Approach
Video: Exposure of Posterolateral Mesencephalon
Random Sample
Should an attending neurosurgeon perform unfamiliar surgical procedures to gain experience? Vote here.
Newsline: Headlines posted daily. Read more...
  Coming Soon:
  Our upcoming issue will highlight the importance of Patient Safety
  and Today's Neurosurgeon.Visit www.aansneurosurgeon.org in late
  August to read all about it.
Neuros in the News
Have you or a colleague been recognized with an award or appointed to a new position, or have other celebratory news to share? Celebrate the accomplishment and send the news to us for publication in AANS Neurosurgeon! Please include a hi-res headshot or relevant image, if possible.
 About AANS Neurosurgeon
AANS Neurosurgeon is your online source for neurosurgical news and information, written BY those involved in the neurosurgical specialty FOR those practicing in the field. It is published quarterly by the American Association of Neurosurgeons. More >> 
AANS Neurosurgeon is published by the
American Association of Neurological Surgeons
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Tuesday, May 28, 2013

Neuroinfect App – iOS and Android (English and Portuguese)

Captura de Tela 2013-02-13 às 21.45.02

CLICK HERE ( iOS)
CLICK HERE (andoid)

Description

Infectious diseases of the central nervous system are very due it`s morbidity and mortality when not diagnosed precisely. Know of this reality it`s imperative that all health professionals, specially the medicine students, generalist doctors, neurologists and intensivists master the subject.
The app Neuroinfect, aims to help in the learning of this complex subject on medicine. The content was developed by a team of neurosurgeons that work at Santa Casa de Belo Horizonte – MG – Brazil and members of Neurosurgery Blog. Composed by the medics: Dr. Mauro Cruz Machado Borgo, Dr. Lucas Alverne Freitas de Albuquerque, Dr. Júlio Leonardo Barbosa Pereira, Dr. José Lopes Filho, Prof. Dr. Gervásio Teles Cardoso de Carvalho, Dr. Paulo Pereira Christo.
The app Neuroinfect has illustrations, MRI and cranial CT to facilitate the learning process.
Covered subjects on the app:
1. Meningitis
2. Bacterial brain abscess
3. Cranial subdural empyema
4. Viral encephalitis
5. SNC infections in AIDS
6. Neurocysticercosis
7. Neuroschistosomiasis
8. Spinal epidural abscess
9. Spondylodiscitis
10. Spinal tuberculosis (Pott`s disease)
11. Operative wound infection
12. Infection of the ventricular shunt system

iPhone Screenshots

iPhone Screenshot 1
iPhone Screenshot 2
iPhone Screenshot 3
iPhone Screenshot 4
iPhone Screenshot 5
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Monday, May 27, 2013

A Simple Protocol to Prevent External Ventricular Drain Infections

imageBACKGROUND: External ventricular drains (EVDs) are associated with high rates of infection, and EVD infections cause substantial morbidity and mortality. OBJECTIVE: To determine whether the introduction of an evidence-based EVD infection control protocol could reduce the rate of EVD infections. METHODS: This was a retrospective analysis of an EVD infection control protocol introduced in a tertiary care neurointensive care unit. We compared rates of cerebrospinal fluid culture positivity and ventriculitis for the 3 years before and 3 years after the introduction of an evidence-based EVD infection control protocol. A total of 262 EVD placements were analyzed, with a total of 2499 catheter-days. RESULTS: The rate of cerebrospinal fluid culture positivity decreased from 9.8% (14 of 143; 11.43 per 1000 catheter-days) at baseline to 0.8% (1 of 119; 0.79 per 1000 catheter-days) in the EVD infection control protocol period (P = .001). The rate of ventriculitis decreased from 6.3% (9 of 143; 7.35 per 1000 catheter-days) to 0.8% (1 of 119; 0.79 per 1000 catheter-days; P = .02). CONCLUSION: The introduction of a simple, evidence-based infection control protocol was associated with a dramatic reduction in the risk of EVD infection. ABBREVIATION: EDV, external ventricular drain





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Treatment of Ruptured Intracranial Aneurysms: Comparison of Stenting and Balloon Remodeling

imageBACKGROUND: Stent-assisted coiling (SAC) and balloon-assisted coiling (BAC) are 2 well-established techniques for the treatment of complex and wide-necked intracranial aneurysms. Most clinicians are reluctant to perform SAC in the setting of subarachnoid hemorrhage because of the need for dual antiplatelet therapy. OBJECTIVE: To compare the safety and efficacy of SAC and BAC in acutely ruptured complex and wide-necked aneurysms. METHODS: Forty-four patients underwent SAC and 40 underwent BAC. Patients treated with SAC received antiplatelet medications. Perioperative adverse events and outcomes at follow-up (mean, 7.4 months) were retrospectively studied. RESULTS: The 2 groups were statistically comparable with respect to all baseline characteristics except for older age in SAC patients (65.6 vs 56.5 years; P = .009). A higher proportion of SAC patients also had poor Hunt and Hess grades (III-V; 70.5% vs 55%; P = .l4). Hemorrhagic, thromboembolic, and overall procedural complications occurred in 6.8%, 11.4%, and 18.2% of the SAC group vs 2.5%, 7.5%, and 10% of the BAC group, respectively (P = .5, P = .6, P = .3, respectively). Favorable outcomes (modified Rankin Scale score 0-2) at follow-up were seen in 61.0% of the SAC group vs 77% of the BAC group (P = .1). In multivariable analysis, after controlling for differences in baseline characteristics, the type of treatment was not a predictor of procedural complications or clinical outcome. CONCLUSION: In this study, procedural complications and clinical outcomes did not differ significantly between SAC and BAC in patients with acutely ruptured aneurysms. SAC may be an acceptable alternative to BAC for complex aneurysms in the acute phase of subarachnoid hemorrhage. ABBREVIATIONS: BAC, balloon-assisted coiling EVD, external ventricular drain HH, Hunt and Hess mRS, modified Rankin Scale SAC, stent-assisted coiling SAH, subarachnoid hemorrhage VPS, ventriculoperitoneal shunt





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Experience with transforaminal interbody fusion in corrective surgery for adolescent idiopathic scol

Publication date: Available online 20 May 2013
Source:Journal of Clinical Neuroscience
Author(s): Kaveh Barami , Todd Lincoln , Ravinder Bains
One of the surgical goals during the treatment of adolescent idiopathic scoliosis (AIS) is to preserve segments and thus mobility while achieving a well-balanced spine on all planes. The transforaminal interbody fusion (TLIF) technique allows for a significant degree of rotational correction and thus may allow for preservation of more mobile segments. This retrospective study analyzed the use of TLIF in AIS patients who underwent surgery between 2006 and 2009 at a single center, and discusses the degree of curve correction, complications and outcomes. All curves were classified using the Lenke classification system. Standing posterior-anterior Cobb angle, sagittal and coronal balance, percent correction, and end/stable/neutral/apical vertebra were determined on preoperative, postoperative and follow-up radiographs. Nine patients were identified (eight women and one man) ranging in age from 11.6–18years. All TLIF procedures were performed at the L2/3 level. Lenke curves included 5CN (n=5), 5BN (n=2), and 6CN (n=2). Average follow-up was 27.4months (range, 12–57months). Average postoperative curve correction was 79%. One patient underwent revision surgery. All patients remained stable from a clinical and radiographic standpoint on their last follow-up visit. TLIF is an important adjunct in the surgical management of select AIS patients. By allowing for greater rotational correction, it may be possible to preserve one more mobile segment without decompensation or overcorrection. To our knowledge, this is the first report on the role of TLIF in AIS. Future studies are warranted in determining those who will maximally benefit from this technique.






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Stroke-Related Disabilities May Be Improved By Regenerating Spinal Cord Fibers

A study by researchers at Henry Ford Hospital found "substantial evidence" that a regenerative process involving damaged nerve fibers in the spinal cord could hold the key to better functional recovery by most stroke victims. The findings may offer new hope to those who suffer stroke, the leading cause of long-term disability in adults...





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