in Journal of Neurosurgery
In Brief
Patients with familial cavernous malformations (FCMs) and their families are concerned about future outlook. Over a 10-year follow-up period, rates of prospective hemorrhage and new seizure after diagnosis were 4.0% and 1.2% per patient-year, respectively. Eighty-three percent of patients were independent (modified Rankin Scale score ≤ 2) at the last follow-up. These findings provide clinically useful information on hemorrhage rate, seizure rate, and functional outcome and are helpful to practicing physicians when counseling patients with FCM and their families.
in Journal of Neurosurgery: Spine
OBJECTIVE
The focus of this modified Delphi study was to investigate and build consensus regarding the medical management of children with moderate and severe acute spinal cord injury (SCI) during their initial inpatient hospitalization. This impetus for the study was based on the AANS/CNS guidelines for pediatric SCI published in 2013, which indicated that there was no consensus provided in the literature describing the medical management of pediatric patients with SCIs.
METHODS
An international, multidisciplinary group of 19 physicians, including pediatric neurosurgeons, orthopedic surgeons, and intensivists, were asked to participate. The authors chose to include both complete and incomplete injuries with traumatic as well as iatrogenic etiologies (e.g., spinal deformity surgery, spinal traction, intradural spinal surgery, etc.) due to the overall low incidence of pediatric SCI, potentially similar pathophysiology, and scarce literature exploring whether different etiologies of SCI should be managed differently. An initial survey of current practices was administered, and based on the responses, a follow-up survey of potential consensus statements was distributed. Consensus was defined as ≥ 80% of participants reaching agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). A final meeting was held virtually to generate final consensus statements.
RESULTS
Following the final Delphi round, 35 statements reached consensus after modification and consolidation of previous statements. Statements were categorized into the following eight sections: inpatient care unit, spinal immobilization, pharmacological management, cardiopulmonary management, venous thromboembolism prophylaxis, genitourinary management, gastrointestinal/nutritional management, and pressure ulcer prophylaxis. All participants stated that they would be willing or somewhat willing to change their practices based on consensus guidelines.
CONCLUSIONS
General management strategies were similar for both iatrogenic (e.g., spinal deformity, traction, etc.) and traumatic SCIs. Steroids were recommended only for injury after intradural surgery, not after acute traumatic or iatrogenic extradural surgery. Consensus was reached that mean arterial pressure ranges are preferred for blood pressure targets following SCI, with goals between 80 and 90 mm Hg for children at least 6 years of age. Further multicenter study of steroid use following acute neuromonitoring changes was recommended.
in Journal of Neurosurgery: Pediatrics
In Brief
Although most patients with spina bifida (SB) survive into adulthood, these patients still have varying degrees of physical disabilities that can impact mental health and cause psychological distress. Researchers leveraged a large-population database that showed a higher prevalence of mental health and substance use disorders in young adults with SB compared with the general population. Multidisciplinary care coordination is needed, particularly during the transition from pediatric to adult care.
in Journal of Neurosurgery: Pediatrics
In Brief
Researchers evaluated pediatric patients who have intractable epilepsy and were treated with a combination of vagus nerve stimulation and brain-responsive neurostimulation. Multiple forms of neuromodulation are used to treat drug-resistant epilepsies, but there are little data showing how these devices interact with each other or if they are safe to use together in adolescents. This study demonstrates that the concomitant use of two neurostimulation devices can be safe and potentially effective for this difficult-to-treat population.
in Journal of Neurosurgery: Spine
In Brief
To better understand postsurgical outcomes for degenerative cervical myelopathy (DCM), the authors identified and predicted outcome trajectories 2 years postsurgery. DCM patients followed distinct recovery trajectories in the first 2 years postoperatively, with most experiencing substantial improvement and a significant minority experiencing little improvement or worsening. The identification of DCM surgery recovery trajectories and their predictors may help clinicians with perioperative counseling and have a positive impact on treatment decision-making, especially for patients with mild DCM.
in Journal of Neurosurgery
E
Delays in the time to treatment from symptom onset are among the greatest barriers in obtaining favorable outcomes after EVT for LVO.
From the Neurosurgical Atlas
Sphenoorbital Meningioma: Techniques for Resection
Visit the Neurosurgical Atlas website >JNSPG Journal Club
February 2023 - Neurosurgical Management of Psychiatric Disease
Featuring presentations on selected articles published in this issue by Dr. Ahmed Raslan, Dr. Kenneth Kishida, and Dr. Michelle Paff. Moderated by Dr. Rees Cosgrove with Drs. William Couldwell (Editor-in-Chief) and Aaron Cohen-Gadol (Associate Editor).
Visit the JNSPG Journal Club page >
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