John R. W. Kestle , on behalf of the HCRNq Investigators
Iterative quality improvement methodology and standardization of care can close the gap between best clinical practices and common clinical practices. Hydrocephalus Clinical Research Network-Quality (HCRNq) investigators documented potentially important baseline practice variations related to perioperative shunt infection prevention practices, implying that shunt surgery is not standardized and that an opportunity to improve outcomes using knowledge translation interventions exists. Established HCRNq infrastructure will systematically evaluate practice variation and the effects of care standardization on outcomes in pediatric hydrocephalus patients.
Researchers studied whether the Rotterdam model (RM) score to predict postoperative cerebellar mutism syndrome (CMS) will predict the incidence of postoperative mutism in a high-expertise pediatric neurosurgical center. They found poor applicability and generalizability of the RM, as the incidence of postoperative CMS was significantly lower in the cohort of patients who were at high risk for postoperative mutism compared with what was predicted by RM. These findings point to an inadequacy of radiology-based models predicting postoperative CMS, likely because these models do not take into account preoperative symptoms and deficits and surgical experience and expertise.
This research aimed to compare a novel spinal navigation system, using preoperative fan-beam CT, with a traditional counterpart using intraoperative cone-beam CT. The key finding indicates that the novel system achieves comparable accuracy, significantly reduces intraoperative preparation time, reduces radiation exposure, and is expected to be more cost-effective than traditional systems. This study adds value to the broader body of research by confirming that navigated spine surgery, particularly with a preoperative fan-beam CT-based system, not only shortens operative time but also holds promise for improved accessibility in less privileged settings.
Dexamethasone, a long-acting potent glucocorticoid, is one of the most widely used medications in neurosurgery. In this paper, the authors recount the history of dexamethasone’s rise in neurosurgery and discuss its use in brain tumors in the context of emerging neuro-oncological immunotherapies. In 1958, Glen E. Arth synthesized a 16-alpha-methylated analog of cortisone (dexamethasone) for treatment of rheumatoid arthritis. Joseph Galicich, a neurosurgery resident at the time, applied the rheumatological drug to neurosurgery. He gave doses to patients who had undergone craniotomy for tumor removal and saw their paresis improve, midline shift resolve, and mortality rates decrease. He advocated for clinical trials and the drug became a mainstay in neurosurgery. As neuro-oncological treatments evolve to include immunotherapy, the immunosuppressive effects of dexamethasone are becoming an unwanted effect. The question then becomes: how does one treat the patient’s symptoms if the only drug that has been used throughout history may become a detriment to their oncological treatment? Since its discovery, dexamethasone has maintained an impressive staying power in the field, acting as a standard drug for cerebral edema for more than 60 years. However, with the advent of immunotherapy, research is warranted to evaluate ways of treating symptomatic edema in the context of modern neuro-oncological therapies.
Patient-reported outcome measures (PROMs) have become increasingly utilized in clinical research, as they can capture information that is important to patients but has not been captured by traditional measures in past clinical research. The authors reviewed the literature to identify PROMs specific to cerebrovascular disease. The review revealed critical gaps in disease-specific outcome measures and identified opportunities to create new ways of assessing what happens after the onset of these cerebrovascular disorders and following treatment.
This study aimed to investigate the role of supine pelvic tilt (PT) in predicting mechanical failure following surgical correction for lumbar degenerative kyphosis. When postoperative PT aligns with the supine measurement, the risk of mechanical failure significantly decreases. The study offers the concept of personalized target ranges for PT correction, potentially transforming adult spinal deformity management. Also, this study is the first to shed light on PT overcorrection, offering valuable insights for improved surgical outcomes.