Two-year outcome of vagus nerve stimulation in treatment-resistant depression.

One of the major goals of antidepressant treatment is a sustained response and remission of depressive symptoms. Some of the previous studies of vagus nerve stimulation (VNS) have suggested antidepressant effects. Our naturalistic study assessed the efficacy and the safety of VNS in 74 European patients with therapy-resistant major depressive disorder. Psychometric measures were obtained after 3, 12, and 24 months of VNS. Mixed-model repeated-measures analysis of variance revealed a significant reduction (P < or = 0.05) at all the 3 time points in the 28-item Hamilton Rating Scale for Depression (HRSD28) score, the primary outcome measure. After 2 years, 53.1% (26/49) of the patients fulfilled the response criteria (> or =50% reduction in the HRSD28 scores from baseline) and 38.9% (19/49) fulfilled the remission criteria (HRSD28 scores < or = 10). The proportion of patients who fulfilled the remission criteria remained constant as the duration of VNS treatment increased. Voice alteration, cough, and pain were the most frequently reported adverse effects. Two patients committed suicide during the study; no other deaths were reported. No statistically significant differences were seen in the number of concomitant antidepressant medications. The results of this 2-year open-label trial suggest a clinical response and a comparatively benign adverse effect profile among patients with treatment-resistant depression.

Experience with 102 Frameless Stereotactic Biopsies Using the neuromate Robotic Device.

OBJECTIVE: Stereotactic biopsy is a standard procedure in neurosurgery. In addition to or even replacing frame-based stereotaxy, some centers also use frameless imaging-based techniques and more recently robotic systems. Here we report a retrospective analysis of our experience with 102 consecutive biopsies performed in our institution using the neuromate robotic device. METHODS: Between March 2013 and April 2018, 102 robot-assisted frameless biopsies were performed in 100 consecutive patients (median age/range: 66/7-86 years, male: 64). Target lesions were deep-seated (insula, basal ganglia, thalamus, midbrain, cerebellar peduncle) in 29 (28.4%) and/or small (<15 mm) in 24 (23.5%) cases. We retrospectively analyzed the histopathologic results as well as complications and the duration of the procedures. RESULTS: A definite histologic diagnosis could be established in 94 of 102 procedures (92.2%; 94/100 patients = 94.0%), including 67 glial and glioneuronal tumors, 16 central nervous system lymphomas, 7 metastases, 1 primitive neuroectodermal tumor, and 5 cases with inflammatory or infectious disorders. There were no infectious complications. A total of 13 cases (12.7%) suffered from biopsy-related hemorrhages >10 mm; however, persistent surgery-related neurologic worsening was seen in only 3 (2.9%). The average operating time was 10 minutes for placement of the localizing device under local anesthesia and 30 minutes for the actual biopsy procedure. CONCLUSIONS: Robot-assisted fameless stereotactic biopsies using the neuromate robot are an alternative to frame-based stereotaxy with a similar diagnostic yield and comparable complication rates.

Functional recovery not correlated with axon regeneration through olfactory ensheathing cell-seeded scaffolds in a model of acute spinal cord injury.

The implantation of bioengineered scaffolds into lesion-induced gaps of the spinal cord is a promising strategy for promoting functional tissue repair because it can be combined with other intervention strategies. Our previous investigations showed that functional improvement following the implantation of a longitudinally microstructured collagen scaffold into unilateral mid-cervical spinal cord resection injuries of adult Lewis rats was associated with only poor axon regeneration within the scaffold. In an attempt to improve graft-host integration as well as functional recovery, scaffolds were seeded with highly enriched populations of syngeneic, olfactory bulb-derived ensheathing cells (OECs) prior to implantation into the same lesion model. Regenerating neurofilament-positive axons closely followed the trajectory of the donor OECs, as well as that of the migrating host cells within the scaffold. However, there was only a trend for increased numbers of regenerating axons above that supported by non-seeded scaffolds or in the untreated lesions. Nonetheless, significant functional recovery in skilled forelimb motor function was observed following the implantation of both seeded and non-seeded scaffolds which could not be correlated to the extent of axon regeneration within the scaffold. Mechanisms other than simple bridging of axon regeneration across the lesion must be responsible for the improved motor function.