Developing a toolkit for comparing safety in spine surgery.

Safety information in spine surgery is important for informed patient choice and performance-based payment incentives, but measurement methods for surgical safety assessment are not standardized. Published reports of complication rates for common spinal procedures show wide variation. Factors influencing variation may include differences in safety ascertainment methods and procedure types.

Imaging features of invasion and preoperative and postoperative tumor burden in previously untreated glioblastoma: Correlation with survival.

Background: A paucity of data exists concerning the prognostic usefulness of preoperative and postoperative imaging after resection of glioblastoma multiforme (GBM). This study aimed to connect outcome with imaging features of GBM.

Methods: Retrospective computer-assisted volumetric calculations quantified central necrotic (T0), gadolinium-enhanced (T1) and increased T2-weighted signal volumes (T2) in 70 patients with untreated GBM.

Assessing the effects of subthalamic nucleus stimulation on gait and mobility in people with Parkinson disease.

Purpose: To determine the effects of unilateral and bilateral subthalamic nucleus (STN) stimulation on gait and mobility in persons with Parkinson disease (PD).

Method: We examined eight individuals with advanced PD who underwent staged stimulator implantation surgeries. Gait and mobility were assessed in the medication-on state with a variety of clinical and laboratory measures (Unified Parkinson Disease Rating Scale items, Timed Up and Go Test, gait speed) at three time points: prior to surgery, after the first surgery (unilateral stimulation) and after the second surgery (bilateral stimulation).

Useful C8 and T1 function seen immediately after a complete cervical spinal cord injury: report of 2 cases.

Background: Because of the rarity of cervicothoracic spine injuries, detailed reports on the neurologic examination after complete cord injuries are scarce. A few retrospective case series scantily documented the intrinsic hand function after C7-T1 complete cord injuries. A complete cervical cord injury with useful C8 and T1 motor function present immediately after the injury has not been reported to date.

Thrombosis and hemorrhage in the acute period following Gamma Knife surgery for arteriovenous malformation. Case report.

Bleeding of an arteriovenous malformation (AVM) following stereotactic radiosurgery (SRS) is a known risk during the latency interval, but hemorrhage in the 30-day period following radiosurgery rarely has been reported in the literature. The authors present the case of a 57-year-old man who underwent Gamma Knife surgery for a large AVM, and they provide radiographic documentation of a thrombus in the primary draining vein immediately preceding an AVM hemorrhage within 9 days after radiosurgery. They postulate that the pathophysiology of an AVM hemorrhage in the acute period following SRS is related to an association among tissue irradiation, acute inflammatory response, and vessel thrombosis.

Treatment of arteriovenous malformations using Gamma Knife surgery: the experience at the University of Washington from 2000 to 2005.

Object: The purpose of this study was to examine the efficacy and toxicity of treating arteriovenous malformations (AVMs) with the model 3C Gamma Knife at the University of Washington Medical Center.

Methods: Ninety-five evaluable patients with 99 treatable AVMs were treated at the University of Washington Medical Center from April 2000 through June 2005. The median patient age at the time of treatment was 40 years (range 6-68 years).

Development of an index to characterize the "invasiveness" of spine surgery: validation by comparison to blood loss and operative time.

Study Design: Prospective cohort study.

Objective: To create and validate an index describing the extent of spine surgical intervention to allow fair comparisons of complication rates among patients treated by different surgeons, devices, or hospitals.

Summary Of Background Data: Safety comparisons in spine surgery are limited by lack of methods that adjust for important variations in the surgical "case-mix.

Gamma knife stereotactic radiosurgery for salivary gland neoplasms with base of skull invasion following neutron radiotherapy.

Background: Our aim was to examine the outcome of patients treated with a planned gamma knife boost after completion of neutron radiotherapy for salivary gland neoplasms involving the base of skull.

Methods: Thirty-four patients with salivary gland neoplasms involving the base of skull were treated from 2001 to 2005 at our institution. These results were compared with a similar historical group treated at our institution from 1984 to 2000.

Spinal accessory neuropathy after deep brain stimulation for Parkinson's disease.

We report a man with Parkinson's disease who developed right spinal accessory neuropathy after right subthalamic nucleus deep brain stimulator and infraclavicular pulse generator implantation. He complained of right shoulder pain and weakness in the post-operative period. He was subsequently diagnosed with a right spinal accessory nerve injury, confirmed by neuromuscular electrodiagnostic studies - electromyography (EMG) and nerve conduction (NC) -, possibly caused by a stretch injury to the nerve at the time of creation of the subcutaneous tunnel for placement of the extension lead of the deep brain stimulator system.

Treatment of single brain metastasis with resection, intracavity carmustine polymer wafers, and radiation therapy is safe and provides excellent local control.

Purpose: To define the safety and efficacy of carmustine polymer wafers when added to a regimen of surgery and external beam radiotherapy for treatment of a single brain metastasis.

Experimental Design: Adult patients underwent craniotomy for a single brain metastasis, and carmustine polymer wafers were placed in the tumor resection cavity. Patients then received whole-brain radiotherapy and were followed for patterns of recurrence in the central nervous system, toxicity, and survival.

Staged unilateral versus bilateral subthalamic nucleus stimulator implantation in Parkinson disease.

In 17 consecutive patients with Parkinson disease (PD), bilateral subthalamic nucleus (STN) stimulators were implanted during staged surgeries. The Unified Parkinson Disease Rating Scale (UPDRS) and the Dyskinesia Disability Scale were completed both off and on medication prior to any surgery and also OFF and ON stimulation after each surgery. On-medication UPDRS activities of daily living (ADL) and motor examination scores changed little with unilateral or bilateral stimulation.

Gait changes in response to subthalamic nucleus stimulation in people with Parkinson disease: a case series report.

Background And Purpose: For individuals with advanced Parkinson disease (PD), stimulation of the subthalamic nucleus (STN) reduces tremor, rigidity, and bradykinesia, but the effects of stimulation on gait and mobility are not fully understood. The purpose of this paper is to describe the effects of unilateral and bilateral STN stimulation on gait following staged stimulator implantations in a series of individuals with PD.

Case Descriptions: Participants were 6 individuals with PD who underwent staged stimulator implantation surgeries.

Treatment of arteriovenous malformations with linear accelerator-based radiosurgery compared with Gamma Knife surgery.

Object: The authors sought to compare the outcomes of patients with arteriovenous malformations (AVMs) treated by Gamma Knife surgery (GKS) with those of patients treated by linear accelerator-based (LINAC) radiosurgery.

Methods: One hundred and eighty-seven patients with AVMs were treated at our institution between 1992 and 2003. Ninety-one patients were treated with GKS and 96 patients were treated with LINAC radiosurgery.

A simple treatment planning strategy for patients with multiple metastases treated with Gamma Knife surgery.

Object: In a substantial number of patients treated at the authors' facility for brain metastases, additional lesions are identified at the time of Gamma Knife surgery (GKS). These lesions are often widely dispersed and may number over 10, which is the maximal number of matrices that can be currently placed for treatment with Leksell Gamma-Plan 4C. The authors describe a simple planning method for GKS in patients with multiple, widely dispersed central nervous system (CNS) metastases.

Clinical experience with dexmedetomidine for implantation of deep brain stimulators in Parkinson's disease.

The pharmacologic profile of the alpha-2 agonist dexmedetomidine (Dex) suggests that it may be an ideal sedative drug for deep brain stimulator (DBS) implantation. We performed a retrospective chart review of anesthesia records of patients who underwent DBS implantation from 2001 to 2004. In 2003, a clinical protocol with Dex sedation for DBS implantation was initiated.

Towards standardized measurement of adverse events in spine surgery: conceptual model and pilot evaluation.

Background: Independent of efficacy, information on safety of surgical procedures is essential for informed choices. We seek to develop standardized methodology for describing the safety of spinal operations and apply these methods to study lumbar surgery. We present a conceptual model for evaluating the safety of spine surgery and describe development of tools to measure principal components of this model: (1) specifying outcome by explicit criteria for adverse event definition, mode of ascertainment, cause, severity, or preventability, and (2) quantitatively measuring predictors such as patient factors, comorbidity, severity of degenerative spine disease, and invasiveness of spine surgery.

A double-blind, multicenter, parallel-group study of paroxetine, desipramine, or placebo in breast cancer patients (stages I, II, III, and IV) with major depression.

Objective: This study compared the efficacy and safety of paroxetine and desipramine with those of placebo in the treatment of depressive disorders in adult women with breast cancer, stages I-IV.

Method: In a double-blind, placebo-controlled study, 35 female outpatients with breast cancer and DSM-III-R major depression or adjustment disorder with depressed mood were randomly assigned to treatment with paroxetine (N=13), desipramine (N=11), or placebo (N=11) for 6 weeks. Primary efficacy was assessed by change from baseline in score on the 21-item Hamilton Rating Scale for Depression (HAM-D), and the secondary outcome measure was change from baseline in the Clinical Global Impressions-Severity of Illness scale (CGI-S) score.

Sterile recurrent spinal epidural abscess in a patient with Crohn's disease: a case report.

Background: The frequency of SEA is increasing. There are several well-established predisposing factors.

Case Description: Our case presents certain unusual features that include an association with CD, persistent sterile cultures, and multiple recurrences of lesions at adjacent levels.

Deep brain stimulation in a patient on immunosuppressive therapy after renal transplant.

We performed thalamic deep brain stimulation (DBS) surgery to treat severe essential tremor in a 36 year-old woman who had undergone cadaveric renal transplant four years earlier. She was receiving chronic immunosuppressive therapy. Post-operative healing was normal and there have been no infections of the DBS hardware.

Unilateral subthalamic nucleus deep brain stimulation contralateral to thalamic stimulation in Parkinson disease.

The effects of unilateral subthalamic nucleus (STN) stimulation contralateral to thalamic stimulation in Parkinson disease (PD) have not been previously reported. We are reporting a patient who developed left arm tremor in 1994, at age 62, as her first PD symptom. She underwent right thalamic DBS surgery in 1999 that resulted in complete resolution of left arm tremor.

Charcot arthropathy in relation to autonomic dysreflexia in spinal cord injury: case report and review of the literature.

Charcot spinal arthropathy has been described as a late complication of spinal cord injury. In patients with these injuries in whom the spine below the level of injury is insensate, joint trauma can progress until spinal instability ensues. The authors describe the case of a 50-year-old man with complete C-8 tetraplegia who experienced a 4-month history of episodic severe headaches, profuse sweating over his face and arms, and episodic severe hypertension in addition to a "grinding" sensation in the lower back.

Characterization of genetically defined types of Charcot-Marie-Tooth neuropathies by using magnetic resonance neurography.

Object: Charcot-Marie-Tooth (CMT) disease is a collection of related genetic disorders affecting peripheral nerves with an incidence of one in every 2500 individuals. A diagnosis of CMT disease has classically relied on a medical history, examination, and measurement of nerve conduction velocities. Advancements in genetic testing and magnetic resonance (MR) imaging techniques may provide clinicians with a more precise diagnostic armamentarium.

Rotational vertebrobasilar ischemia: hemodynamic assessment and surgical treatment.

Objective: Rotational vertebrobasilar insufficiency is a severe and incapacitating condition. Proper investigation and management are essential to reestablish normal posterior circulation hemodynamics, improve symptoms, and prevent stroke. We present a series of 10 patients with rotational vertebrobasilar ischemia who were treated surgically and emphasize the importance of transcranial Doppler in the diagnosis and management of this condition.

MR neurography: diagnostic utility in the surgical treatment of peripheral nerve disorders.

Advances in MR imaging have improved the visualization of normal and pathologic peripheral nerve structures in various clinical settings. Peripheral nerve imaging has the potential to dramatically change the diagnosis and treatment of peripheral nerve pathology and lead to an improved understanding of peripheral nerve pathophysiology. Currently, MR imaging serves as a problem-solving tool when additional anatomic information is needed to clarify ambiguous electrodiagnostic and clinical examinations.