Additional episodes have been added to the English, Spanish, Japanese and Korean Neurosurgery International Podcasts on iTunes. Each podcast episode is the scientific abstract from a published article translated into a foreign language and read by a native speaker. Use iTunes to download new and existing podcasts in your preferred language.
Ahead of Print: Measuring Surgical Outcomes in Subaxial Degenerative Cervical Spine Disease Patients
Background: Though the concept of MCID (minimum clinically important difference) as a measurement of surgical outcome has been extensively studied, there is lack of consensus on the most valid or clinically relevant MCID calculation approach.
Objective: To compare the range of MCID threshold values obtained by different anchor-based and distribution-based approaches in order to determine the best clinically meaningful and statistically significant MCID for our studied group.
Methods: 88 consecutive patients undergoing surgery for subaxial degenerative cervical spine disease were analyzed from a prospective blinded database. Preoperative, 3- and 6-months postoperative Patient Reported Outcome (PRO) scores and blinded surgeon ratings were collected. Four calculation methods were used to calculate MCID threshold values: average change, change difference, minimum detectable change (MDC), and receiver operating characteristic curve (ROC). Three anchors were used to evaluate meaningful improvement post-surgery: HTI (Health Transition Item), Patient Overall Status, and Surgeon Ratings.
Background and Importance: Rarely, corticotrophic pituitary tumors take on an aggressive form characterized by rapid growth, invasion into local structures, compression of cranial nerves, and possible spread to distant sites. When conventional surgery, radiation therapy and hormones fail to control progression and symptoms, alternative therapies are needed. A novel chemotherapeutic regimen of capecitabine and temozolomide (CAPTEM), originally designed in our laboratory, demonstrated dramatic anti-neoplastic effects against corticotrophic pituitary tumors.
Clinical Presentation: Here we present a case series of four patients with aggressive, ACTH-producing pituitary tumors who had previously depleted all surgical, radiation, and hormonal therapies, and were then treated with CAPTEM. Dramatic clinical improvements in neurological deficits and Cushing’s symptoms were evident in all patients after treatment was initiated. Confirmed by radiographic imaging, two of four patients demonstrated complete regression of disease, one patient had a 75% regression, and the fourth patient has ongoing stable disease for over 4.5 years at the time of this writing. Immunohistochemical analysis of patient’s tumor samples showed low O6-methyguanyl methyltransferase (MGMT) expression and adequate levels of mismatch repair enzymes (MLH-1, MSH-2, MSH-6, and PMS-2), which are important for the in vivo efficacy of CAPTEM.
An interview with Fernando Pinto, PhD., the senior author of November’s Journal Club target article, is available for download. Additional episodes have also been added to the Korean and Japanese Neurosurgery International Podcasts on iTunes. Each podcast episode is the scientific abstract from a published article translated into a foreign language and read by a native speaker. Use iTunes to download new and existing podcasts in your preferred language.
Objective: To demonstrate feasibility of EEA in a variety of age groups and to perform measurements of the corridors and spaces available for surgery as a guide for case selection.
Methods: Only patients <18 years were included. Choice of operative corridor/approach is described in relation to pathological entity and location. Pre-operative/post-operative visual fields and endocrine panels, extent of resection, as well as post-operative long-term complications are described. Prospective MRI-based anatomical measurements of key distances were performed to determine age-dependent surgical indications and limitations.
Background: Lasers have a long history in neurosurgery, yet bulky designs and difficult ergonomics limit their use. With its ease of manipulation and multiple applications, the OmniGuide CO2 laser has reintroduced laser technology to the microsurgical resection of brain and spine lesions. This laser, delivered through a hollow core fiber lined with a unidirectional mirror, minimizes energy loss and allows precise targeting.
Objective: To analyze resections performed by the senior author from April 2009 to March 2013 of 58 cavernous malformations (CMs) in the brain and spine using the OmniGuide CO2 laser, to reflect on lessons learned from laser use in eloquent areas, and to share data on comparisons of laser power calibration and histopathology.
Methods: Data were collected from electronic medical records, radiology reports, operative room records, OmniGuide CO2 laser case logs, and pathology records.