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Stéphanie Puget, Matthew R. Garnett, Delphine Leclercq, Graziella Pinto-Primard, Dinane Samara-Boustani, Christian Sainte-Rose, David Genevieve, Michel Polak, Pascale De Lonlay, Francis Brunelle, Alim Louis Benabid, and Nathalie Boddaert

involving children in whom obesity developed in the absence of any associated hyperphagia. The most frequent causes of childhood obesity were excluded after endocrinological and genetic investigations. In both cases, MR imaging of the brain revealed the presence of a lipoma in the paramedian hypothalamus. Hypothalamic dysfunction can be implicated in obesity. We therefore hypothesized that these lipomas might be the cause of the obesity. These cases highlight the importance of obtaining MR imaging of the brain in children with otherwise unexplained morbid obesity

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Albert E. Telfeian, G. Timothy Reiter, Susan R. Durham, and Paul Marcotte

A high risk of surgery-related perioperative complications in obese patients has been reported in studies performed for other surgical subspecialties. 8, 10, 14 With a growing percentage of the United States population becoming morbidly obese, a need has arisen for elective and emergency treatment plans that address the special considerations involved in the care of these patients. We retrospectively examined the factors involved in caring for morbidly obese patients to assess the results and complications of management that required modification for body

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Krishna Kumar, Rahul K. Nath, C. P. V. Nair, and S. P. Tchang

lipomatosis secondary to simple obesity. It is the 10th case reported in the literature. We establish a set of criteria on which we based the diagnosis and describe the methods undertaken to treat the condition. Case Report This 66-year-old man, a university professor, was referred to the neurosurgical service at our institution after experiencing several years of symptoms consistent with progressive paraparesis. The patient's symptoms began 7 years prior to referral, when he first noted cramping sensations in his left calf, as well as a sensation of coldness and cold

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Casey H. Halpern, John A. Wolf, Tracy L. Bale, Albert J. Stunkard, Shabbar F. Danish, Murray Grossman, Jurg L. Jaggi, M. Sean Grady, and Gordon H. Baltuch

nature. 60 , 73 , 111 The success of DBS in relieving parkinsonism has led to its application in multiple neurological diseases and more recently to treatment-resistant psychiatric conditions. 39 The purpose of this paper is to motivate the neurosurgical community to consider DBS for obesity control. Obesity is a chronic disease with well-substantiated neuropsychiatric underpinnings. Appetite and satiety centers in the brain have been well-documented 93 and thus represent primary areas for investigation. 21 , 97 , 98 Many studies have indicated that the reward

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Sepehr Sani, Kirk Jobe, Adam Smith, Jeffrey H. Kordower, and Roy A. E. Bakay

D eep brain stimulation has become a safe, effective, and commonplace therapy for movement disorders such as Parkinson disease and essential tremor. Recently, treatment with DBS has been attempted for a variety of other clinical indications such as dystonia, obsessive–compulsive disorder, epilepsy, depression, and Huntington disease. Given the success of DBS in these clinical efforts, other indications for which there is currently little effective therapy are being evaluated preclinically, for eventual clinical use. Obesity may be one such indication

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Neha S. Dangayach, Harpreet Singh Grewal, Gian Marco De Marchis, Roberta K. Sefcik, Rachel Bruce, Aarti Chhatlani, E. Sander Connolly, M. Cristina Falo, Sachin Agarwal, Jan Claassen, J. Michael Schmidt, and Stephan A. Mayer

I n spite of advances in neurocritical care, intracerebral hemorrhage (ICH) continues to be associated with high mortality and morbidity. 9 Well-established risk factors for mortality include age > 80 years, a Glasgow Coma Scale (GCS) score < 8, ICH volume > 30 ml, infratentorial location, intraventricular hemorrhage (IVH), and early do-not-resuscitate (DNR) code status. 8 , 9 Much less is known about factors that might confer a protective effect against poor outcome after ICH. Obesity is now considered to be a global epidemic, and relative to normal body

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Trimurti Nadkarni, Harold L. Rekate, and Donna Wallace

S evere obesity leads to increased intraabdominal pressure. 5 In turn, severe venous stasis disease develops as a result of the high intraabdominal pressure. Other causes of intraabdominal venous stasis include congestive heart failure, hypoventilation, systemic hypertension, obesity-related cardiomyopathy, and ventricular dysfunction. 1, 5 A high central venous pressure increases the pressure in the intracranial dural sinuses. The result is poor absorption of CSF and, consequently, increased intracranial pressure, a condition known as pseudotumor cerebri. 3

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Ikemefuna Onyekwelu, Steven D. Glassman, Anthony L. Asher, Christopher I. Shaffrey, Praveen V. Mummaneni, and Leah Y. Carreon

S ociety is facing an obesity epidemic. Since 2003, more than one-third of the US adult population exceeds the World Health Organization's definition of obesity (body mass index [BMI] ≥ 30 kg/m 2 ). 19 Certainly, this will have a large impact on health care as a whole and on musculoskeletal disorders especially, including degenerative conditions of the spine such as stenosis, mechanical disc collapse, and spondylolisthesis. In addition to the growth of the aging population, spine surgeons will now be faced with an increasing number of obese patients who

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Nimesh Patel, Bradley Bagan, Sumeet Vadera, Mitchell Gil Maltenfort, Harel Deutsch, Alexander R. Vaccaro, James Harrop, Ashwini Sharan, and John K. Ratliff

I ncreased body mass or obesity is a major medical concern in the US and other industrialized countries. It is estimated that there are currently 110 million adults in the US who are overweight or obese. Increased loads may put an increased demand on the musculoskeletal system, particularly the lumbar spine. Although this may theoretically result in an increased incidence of low-back pain in this population, this correlation has not been definitively established. 46 A direct correlation of obesity to perioperative adverse events and complications has not

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Alex Soroceanu, Douglas C. Burton, Bassel Georges Diebo, Justin S. Smith, Richard Hostin, Christopher I. Shaffrey, Oheneba Boachie-Adjei, Gregory M. Mundis Jr., Christopher Ames, Thomas J. Errico, Shay Bess, Munish C. Gupta, Robert A. Hart, Frank J. Schwab, Virginie Lafage, and International Spine Study Group

I n 2011, a publication by Finucane et al. 20 reported that the worldwide population had gained 0.4–0.5 kg/m 2 per decade since 1980. The obese (body mass index [BMI] ≥ 30 kg/m 2 ) and overweight (BMI ≥ 25 kg/m 2 ) populations are increasing worldwide, with 4 of 10 adults classified as overweight or obese in 2013, according to the Global Burden of Disease Study. 44 Obesity is particularly prevalent in the US, where 31.7% of adult men and 33.9% of adult women are classified as obese, accounting for a total of 13% of the global obese population; this