Cost minimization in treatment of adult degenerative scoliosis.

Object: Back pain is an increasing concern for the aging population. This study aims to evaluate if minimally invasive surgery presents cost-minimization benefits compared with open surgery in treating adult degenerative scoliosis.

Methods: Seventy-one patients with adult degenerative scoliosis received 2-stage, multilevel surgical correction through either a minimally invasive spine surgery (MIS) approach with posterior instrumentation (n = 38) or an open midline (Open) approach (n = 33).

Comparison of two minimally invasive surgery strategies to treat adult spinal deformity.

Object: Minimally invasive surgery (MIS) techniques are becoming a more common means of treating adult spinal deformity (ASD). The aim of this study was to compare the hybrid (HYB) surgical approach, involving minimally invasive lateral interbody fusion with open posterior instrumented fusion, to the circumferential MIS (cMIS) approach to treat ASD.

Methods: The authors performed a retrospective, multicenter study utilizing data collected in 105 patients with ASD who were treated via MIS techniques.

"Push-Through" Rod Passage Technique for the Improvement of Lumbar Lordosis and Sagittal Balance in Minimally Invasive Adult Degenerative Scoliosis Surgery.

Of Background Data: Traditional open surgical techniques for correction of adult degenerative scoliosis (ADS) are often associated with increased blood loss, postoperative pain, and complications. Minimally invasive (MIS) techniques have been utilized to address these issues; however, concerns regarding improving certain alignment parameters have been raised.

Objective: A new "push-through" technique for MIS correction of ADS has been developed wherein a rod is bent before its placement into the screw heads and then contoured further to yield improved correction of radiographic parameters.

Comparison of radiographic results after minimally invasive, hybrid, and open surgery for adult spinal deformity: a multicenter study of 184 patients.

Object: Various surgical approaches, including open, minimally invasive, and hybrid techniques, have gained momentum in the management of adult spinal deformity. However, few data exist on the radiographic outcomes of different surgical techniques. The objective of this study was to compare the radiographic and clinical outcomes of the surgical techniques used in the treatment of adult spinal deformity.

Less invasive surgery for treating adult spinal deformities: ceiling effects for deformity correction with 3 different techniques.

Object: Minimally invasive surgery (MIS) options for the treatment of adult spinal deformity (ASD) have advanced significantly over the past decade. However, a wide array of options have been described as being MIS or less invasive. In this study the authors investigated a multiinstitutional cohort of patients with ASD who were treated with less invasive methods to determine the extent of deformity correction achieved.

Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy.

Background Context: Posterior cervical foraminotomy (PCF) with or without microdiscectomy (posterior cervical discectomy [PCD]) is a frequently used surgical technique for cervical radiculopathy secondary to foraminal stenosis or a laterally located herniated disc. Currently, these procedures are being performed with increasing frequency using advanced minimally invasive techniques. Although the safety and efficacy of minimally invasive PCF/PCD (MI-PCF/PCD) have been established, reports on long-term outcome and need for secondary surgical intervention at the index or adjacent level are lacking.

Primary dural repair in minimally invasive spine surgery.

We describe an effective surgical technique in primary repair of the spinal dura during minimally invasive spine surgery (MISS). Objective. Minimally invasive spine surgery includes the treatment of intradural lesions, and proper closure of the dura is necessary.

Management of intracranial hemorrhage in a child with a left ventricular assist device.

Pediatric patients bridged to heart transplant with LVADs require chronic anticoagulation and are at increased risk of hemorrhagic complications, including intracranial hemorrhage. In this population, intracranial hemorrhage is often fatal. We report a case of successful management of a five-yr-old-boy with DCM on an LVAD who developed a subdural hematoma.

Convection enhanced drug delivery of BDNF through a microcannula in a rodent model to strengthen connectivity of a peripheral motor nerve bridge model to bypass spinal cord injury.

Models employing peripheral nerve to bypass spinal cord injury (SCI), although highly promising, may benefit from improved nerve regeneration and motor bridge connectivity. Recent studies have demonstrated that neuronal growth factor-induced enhancement of endogenous neurorestoration may improve neuronal connectivity after severe neurologic injury, particularly if delivered intraparenchymally with zero-order kinetics. We sought to investigate the effect of convection-enhanced delivery of brain-derived neurotrophic factor (BDNF), a neuronal growth factor, on the connectivity of a peripheral motor-nerve bridge in a rodent model using electrophysiology and immunohistochemistry (IHC).

Arteriovenous malformation-associated aneurysms in the pediatric population.

Object: Conventional cerebral angiography and treatment for ruptured arteriovenous malformations (AVMs) in children are often performed in a delayed fashion. In adults, current literature suggests that AVM-associated aneurysms may be more likely to hemorrhage than isolated AVMs, which often leads to earlier angiography and endovascular treatment of associated aneurysms. The nature of AVM-associated aneurysms in the pediatric population is virtually unknown.

Spinal cord bypass surgery with intercostal and spinal accessory nerves: an anatomical feasibility study in human cadavers.

Object: Despite extensive study, no meaningful progress has been made in encouraging healing and recovery across the site of spinal cord injury (SCI) in humans. Spinal cord bypass surgery is an unconventional strategy in which intact peripheral nerves rostral to the level of injury are transferred into the spinal cord below the injury. This report details the feasibility of using spinal accessory nerves to bypass cervical SCI and intercostal nerves to bypass thoracolumbar SCI in human cadavers.

Efficacy of facial nerve-sparing approach in patients with vestibular schwannomas.

Object: The goal of this article was to show that a combination of facial nerve-sparing microsurgical resection and Gamma Knife surgery (GKS) for expansion of any residual tumor can preserve good facial nerve function in patients with recurrent vestibular schwannoma (VS).

Methods: Records of individuals treated by a single surgeon with a facial nerve-sparing technique for a VS between 1998 and 2009 were retrospectively analyzed for tumor recurrence. Of the 383 patients treated for VS, 151 underwent microsurgical resection, and 20 (13.

Alterations in systemic complement component 3a and 5a levels in patients with cerebral arteriovenous malformations.

The role of the complement cascade in the pathophysiology of cerebral arteriovenous malformation (AVM) is largely undefined. Complement subcomponents, C3a and C5a, are potent anaphylatoxins and key mediators of immuno-inflammatory response. Complement activation may contribute to the pro-inflammatory state observed in AVM.

Isoflurane preconditioning affords functional neuroprotection in a murine model of intracerebral hemorrhage.

Introduction: Exposure to isoflurane gas prior to neurological injury, known as anesthetic preconditioning, has been shown to provide neuroprotective benefits in animal models of ischemic stroke. Given the common mediators of cellular injury in ischemic and hemorrhagic stroke, we hypothesize that isoflurane preconditioning will provide neurological protection in intracerebral hemorrhage (ICH).

Methods: 24 h prior to intracerebral hemorrhage, C57BL/6J mice were preconditioned with a 4-h exposure to 1% isoflurane gas or room air.

Complex basilar artery aneurysms treated using surgical basilar occlusion: a modern case series. Clinical article.

Object: Complex aneurysms of the basilar artery (BA) apex can be successfully treated using surgical occlusion of the proximal BA. Since the introduction of the Guglielmi detachable coil in 1991, the focus on treating BA aneurysms has been on using endovascular techniques. Outcomes with endovascular techniques have been less than optimal for large and complex aneurysms.

Surgical management of ventral intradural spinal lesions.

Objective: Access to the ventral intradural spinal canal may be required for treatment of a variety of lesions affecting the spinal cord and adjacent intradural structures. Adequate exposure is usually achieved through a standard posterior laminectomy or posterolateral approaches, although formal anterior approaches are used to access lesions in the subaxial cervical spine. Modifications of the standard posterior exposure as well as ventral or ventrolateral approaches are increasingly being used for treating intradural spinal pathologies.

Advances in neuroprotective strategies: potential therapies for intracerebral hemorrhage.

Intracerebral hemorrhage (ICH) is associated with higher mortality and morbidity than any other form of stroke. However, there currently are no treatments proven to improve outcomes after ICH, and therefore, new effective therapies are urgently needed. Growing insight into ICH pathophysiology has led to the development of neuroprotective strategies that aim to improve the outcome through reduction of secondary pathologic processes.

Polymorphisms in complement component 3 (C3F) and complement factor H (Y402H) increase the risk of postoperative neurocognitive dysfunction following carotid endarterectomy.

Background: Up to 28% of patients undergoing carotid endarterectomy (CEA) are estimated to experience neurocognitive dysfunction following surgery. The complement cascade plays a central role in ischaemia-reperfusion injury. The authors investigated the effect of common polymorphisms in the complement component 3 (C3F) and complement factor H (CFH Y402H) genes on incidence of neurocognitive dysfunction post-CEA.

Mechanical treatment of vasospasm.

Objective: Since cerebral vasospasm (CV) was first described nearly half a century ago, significant progress has been made in understanding its underlying pathophysiology and developing treatment modalities. The purpose of this review is to discuss the rationale behind mechanical interventions for CV as well as the efficacy and complications associated with these treatment options.

Methods: The authors summarize the pertinent literature on the mechanical treatment of CV, focusing first on balloon angioplasty, second on therapy combined with intra-arterial drug infusion, and concluding by briefly discussing intra-aortic balloon counterpulsation.

Transforaminal nerve root stimulation: a technical report.

Objectives. This technical report provides a detailed description of a method of transforaminal nerve root stimulation useful in the treatment of chronic pain conditions. Material and Methods.

Intraoperative magnesium infusion during carotid endarterectomy: a double-blind placebo-controlled trial.

Object: Recent data from both experimental and clinical studies have supported the use of intravenous magnesium as a potential therapy in the setting of cerebral ischemia. This study assessed whether intraoperative magnesium therapy improves neuropsychometric testing (NPT) following carotid endarterectomy (CEA).

Methods: One hundred eight patients undergoing CEA were randomly assigned to receive placebo infusion or 1 of 3 magnesium-dosing protocols.

Spontaneous thrombosis of a giant fusiform aneurysm following extracranial-intracranial bypass surgery.

The authors describe the cases of 2 patients who underwent extracranial-intracranial bypass surgery for a giant fusiform aneurysm but in whom further surgery was then not necessary because the aneurysm spontaneously thrombosed. The authors hypothesize that this thrombosis was caused by alterations in aneurysm's hemodynamics, leading to a decreased rate of blood flow in the aneurysm. In the older of the 2 cases, more than 10 years after surgery the patient has not required further surgical intervention.

Regenerating motor bridge axons refine connections and synapse on lumbar motoneurons to bypass chronic spinal cord injury.

To restore motor control after spinal cord injury requires reconnecting the brain with spinal motor circuits below the lesion. A bridge around the injury is an important alternative to promoting axon regeneration through the injury. Previously, we reported a novel motor bridge in rats.