Alexander F. C. Hulsbergen, Francesca Siddi, Malia McAvoy, Benjamin T. Lynch, Madeline B. Karsten, Brittany M. Stopa, Joanna Ashby, Jack McNulty, Marike L. D. Broekman, William B. Gormley, Scellig S. D. Stone, Benjamin C. Warf, and Mark R. Proctor
Routine imaging after ventriculoperitoneal shunt revision is relatively common, but it is unclear whether it leads to clinical interventions. Researchers examined a large cohort of patients who underwent shunt revision to determine the utility of postoperative imaging. In only 0.8% of revisions, postoperative imaging led to a change in management that was not otherwise heralded by clinical concerns, indicating a low utility for routine imaging.
William E. Whitehead, Jay Riva-Cambrin, John C. Wellons III, Abhaya V. Kulkarni, David D. Limbrick Jr., Vanessa L. Wall, Curtis J. Rozzelle, Todd C. Hankinson, Patrick J. McDonald, Mark D. Krieger, Ian F. Pollack, Mandeep S. Tamber, Jonathan Pindrik, Jason S. Hauptman, Robert P. Naftel, Chevis N. Shannon, Jason Chu, Eric M. Jackson, Samuel R. Browd, Tamara D. Simon, Richard Holubkov, Ron W. Reeder, Hailey Jensen, Jenna E. Koschnitzky, Paul Gross, James M. Drake, and John R. W. Kestle
Michael J. Strong, Julianne Santarosa, Timothy P. Sullivan, Noojan Kazemi, Jacob R. Joseph, Osama N. Kashlan, Mark E. Oppenlander, Nicholas J. Szerlip, Paul Park, and Clay M. Elswick
Correct-level localization continues to be a problem in spinal surgery, and so the authors sought to formalize this further in a systematic review of the most common localization techniques. This was a qualitative review, and although one technique could not be shown to be superior, the authors found that one or more of the techniques should be used to minimize wrong-level surgery. The value of this study is that it summarizes current localization techniques and their benefits and shortcomings.
Shota Tamagawa, Takatoshi Okuda, Hidetoshi Nojiri, Tatsuya Sato, Rei Momomura, Yukoh Ohara, Takeshi Hara, and Muneaki Ishijima
Researchers set out to investigate the course of the L5 nerve root in the pelvis and to clarify a safe zone for inserting the sacral screw. The L5 nerve roots always coursed outward after exiting the intervertebral foramina and were positioned close to the ala of the sacrum. Surgeons can prevent the S1 pedicle screw from injuring the L5 nerve root.
Ashley L. B. Raghu, Sean C. Martin, Tariq Parker, Tipu Z. Aziz, and Alexander L. Green
The authors assessed the validity of somatosensory thalamus localization using diffusion MRI in the context of deep brain stimulation for pain. The results supported this connectivity-based parcellation technique as a reasonable and safe individualized approach to this region of the thalamus. Analysis of clinical outcomes suggested that this method for targeting may have the potential to improve outcomes over standard atlas-based techniques. This targeting technique now requires further scrutiny, with prospective investigation.
Katherine Leaver, Aaron Viser, Brian H. Kopell, Roberto A. Ortega, Joan Miravite, Michael S. Okun, Sonya Elango, Deborah Raymond, Susan B. Bressman, Rachel Saunders-Pullman, and Marta San Luciano
Researchers assessed response to deep brain stimulation (DBS) in patients with Parkinson disease (PD) with and without the G2019S LRRK2 mutation. Patients with the mutation had favorable motor outcomes with both subthalamic nucleus and internal segment of the globus pallidus DBS. These patients also had longer disease duration and more dyskinesia prior to DBS surgery. With increased availability of genetic testing, mutation status may further guide understanding of clinical response to DBS.