Propofol-Based Anesthesia Maintenance and/or Volatile Anesthetics during Intracranial Aneurysm Repair: A Comparative Analysis of Neurological Outcomes.

BACKGROUND: Volatile and intravenous anesthetics have substantial effects on physiological functions, notably influencing neurological function and susceptibility to injury. Despite the importance of the anesthetic approach, data on its relative risks or benefits during surgical clipping or endovascular treatments for unruptured intracranial aneurysms (UIAs) remains scant. We investigated whether using volatile anesthetics alone or in combination with propofol infusion yields superior neurological outcomes following UIA obliteration. METHODS: We retrospectively reviewed 1001 patients who underwent open or endovascular treatment for UIA, of whom 596 had short- and long-term neurological outcome data (modified Rankin Scale) recorded. Multivariable ordinal regression analysis was performed to examine the association between the anesthetic approach and outcomes. RESULTS: Of 1001 patients, 765 received volatile anesthetics alone, while 236 received propofol infusion and volatile anesthetics (combined anesthetic group). Short-term neurological outcome data were available for 619 patients and long-term data for 596. No significant correlation was found between the anesthetic approach and neurologic outcomes, irrespective of the type of procedure (open craniotomy or endovascular treatment). The combined anesthetic group had a higher rate of ICU admission (p < 0.001) and longer ICU and hospital length of stay (LOS, p < 0.001). Similarly, a subgroup analysis revealed longer ICU and hospital LOS (p < 0.0001 and p < 0.001, respectively) in patients who underwent endovascular UIA obliteration under a combined anesthetic approach (n = 678). CONCLUSIONS: The addition of propofol to volatile anesthetics during UIA obliteration does not provide short- or long-term benefits to neurologic outcomes. Compared to volatile anesthetics alone, the combination of propofol and volatile anesthetics may be associated with an increased rate of ICU admission, as well as longer ICU and hospital LOS.

A systematic review of the management of postoperative scars with silicone gel-based products in randomized controlled trials.

Although postoperative scarring may be considered a cosmetic concern, it can greatly impact a patient's quality of life. This extends beyond psychosocial burden influenced by hypertrophic scars and keloids, as patients also experience discomfort and pain. This systematic review evaluates the efficacy of silicone gel (SG)-based products in preventing postoperative abnormal scar formation. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a PubMed search was performed to find randomized, controlled trials investigating the effect of SG-based products on postoperative wound healing. The search yielded 359 publications, but only 30 studies published between 1991-2022 were found to fit the inclusion criteria. Outcomes were extracted from the literature and subsequent quality and risk of bias assessments were performed. Most studies indicated improvement of at least one quality of the scar with the use of SG-based products. The greatest potential variable increasing bias was an inadequate control group. Studies also suffered from small sample sizes, use of unvalidated scar assessment scales, lack of double-blinding, and short follow-up periods. Overall, SG-based products demonstrated potential in preventing abnormal scar formation during postoperative healing, but further studies are required to validate the results of current literature.

Clinical Features and Neurosurgical Management of Metastatic Intradural Extramedullary Renal Cell Carcinoma.

Intradural extramedullary metastasis of renal cell carcinoma is exceedingly uncommon, and only 19 cases have been reported in the literature. It is thought to metastasize from the kidneys through venous networks or along nerves and may also spread from brain metastases through cerebrospinal fluid. We present a 52-year-old female, two years after a nephrectomy with myelopathic symptoms, who was found to have thoracic intradural extramedullary metastasis from renal cell carcinoma. The thoracic tumor was resected without any added deficit, but an additional brain mass was found on postoperative imaging. The present case and a literature review were discussed to explore considerations for neurosurgical intervention in similar patients, evaluate surgical outcomes, and highlight current theories on routes of metastasis. Given the risk of neurological decline in patients with metastatic intradural renal cell carcinoma, surgical resection should be considered upon its discovery, and postoperative surveillance imaging is encouraged.

Mortality risk factors in febrile ulceronecrotic Mucha- Habermann disease: A systematic review of therapeutic outcomes and complications.

Febrile Ulceronecrotic Mucha- Habermann Disease (FUMHD) is a variant of Pityriasis Lichenoides Et Varioliformis Acuta (PLEVA). Although rare, the condition may progress to involve serious complications and even lead to fatal outcomes if diagnosis and appropriate treatment is delayed. A PubMed search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMSA) guidelines was performed to find cases of FUMHD from the earliest records to October 2021. Treatments, complications, and patient outcomes were extracted from the literature and summarized, while a review of quality was also performed. A total of 63 publications with 68 patients were found. Successful treatment modalities for FUMHD included antibiotics, antivirals, systemic steroids, Methotrexate (MTX), cyclophosphamide, Cyclosporine (CYA), Intravenous Immunoglobulins (IVIG), pentoxifylline, and ultraviolet B phototherapy. Out of 68 patients, 55 patients had their condition fully resolved and 13 cases were fatal. Increased age, systemic involvement, and monoclonal T-cell receptor rearrangement were associated with worst prognosis, but mucosal involvement did not affect mortality risk. Overall, the publications had low risk of bias, but most lacked adequate follow-up periods. FUMHD is a diagnostic and therapeutic challenge due to the lack of clearly defined diagnostic criteria and optimum treatment. Further studies with larger patient populations and longer follow-up periods may lead to refinement of diagnostic criteria, establish an optimum treatment regimen, and better estimate the likelihood of recurrence.

Efficacy of topical treatments for molluscum contagiosum in randomized controlled trials.

Although molluscum contagiosum (MC) is a common infectious dermatosis that is self-resolving, treatment can diminish discomfort and decrease the risk of autoinoculation and infection to others, because it is transmitted through direct skin contact. This systematic review evaluates the efficacy of topical treatments for MC. A PubMed search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to find randomized, controlled trials of MC treatment. The search yielded 129 publications, but only 15 studies published between 1994 and 2020 were found to fit the inclusion criteria. Treatment modalities included podophyllotoxin, imiquimod, sodium nitrite, myrtle leaf extract, phenol, Salatac Gel (salicylic acid with lactic acid), potassium hydroxide, cantharidin, SB206, and VP-102. Outcomes were extracted from the literature, and subsequent quality and risk of bias assessments were performed. All treatments were more efficacious than the control except cantharidin, potassium hydroxide, and imiquimod, which had varying degrees of efficacy throughout studies. Overall, studies were of sufficient quality and had low risk of bias, but they had small sample sizes and lacked adequate explanation of statistical analysis. Current first-line treatment entails mechanical methods such as cryotherapy and curettage, which may be frightening to children with MC, so the development and assessment of topical treatments allows for alternative efficacious techniques.

Kyphoplasty Solves Stabilization and Pain Control Inadequately Treated via Prior Hartshill Rectangle for Thoracolumbar Burst Fracture.

Surgical management of spinal burst fractures has progressed to include minimally invasive techniques as preferred modalities of treatment. Burst fractures with indications for surgical treatment either through instability or intractable pain classically have required pedicle screw fixation, which requires extensive dissection resulting in postoperative pain and significant recovery time, and also requires longer operative times with more potential blood loss. Balloon kyphoplasty is an established percutaneous technique that can provide quick pain relief for patients with intractable pain following compression and burst fractures, and vertebral body height can also be restored. In the present case, a female patient was seen in the emergency room with intractable pain and a dehiscent thoracolumbar incision after recently undergoing surgery with placement of a Hartshill rectangle and sublaminar wires at another institution for a T12 burst fracture (AO classification [AO] A4 and thoracolumbar injury classification and severity score [TLICS] 4) caused by a motor vehicle accident. Imaging identified an acute unhealed fracture at T12 and other vertebrae with questionable lesions. She underwent surgery to remove the Hartshill construct, stabilize the fracture, biopsy lesions (T7, T10, L2, and L4), and debride and close the wound. Following hardware removal, kyphoplasty was then performed through the open exposure at T12, which could have otherwise been done percutaneously. The patient experienced immediate and complete resolution of her pain associated with the fracture and had no neurological deficits. Modern minimally invasive techniques including kyphoplasty should be favored when indicated as alternative treatment options over more invasive treatment modalities, as they lead to quicker resolution of pain and recovery when compared to techniques requiring a large exposure.

Pediatric Temporal Lobe Meningioma With Meningioangiomatosis Mimicking Invasive Meningioma.

Meningiomas combined with meningioangiomatosis (MA-M) present similarly to more invasive lesions because of their appearance on neuroimaging. These lesions are especially rare in pediatric patients and suggestive imaging can help identify them for differential diagnosis. An 11-year-old male child who presented with diplopia and a headache was found to have an edematous invasive appearing temporal lobe mass on magnetic resonance imaging. Despite the lesion's appearance, it was completely resected and found to be a benign MA-M upon histopathologic examination. The present case demonstrated a rare meningioma with meningioangiomatosis that appeared to be a higher grade or invasive lesion upon initial imaging in a pediatric patient. A review of the literature was performed on patients who presented similarly. Despite the rarity of this condition in children, neuroimaging should be carefully examined prior to surgical resection of similar masses in preparation for highly vascular tissue, and post-operative course can be better anticipated when MA-M is considered during differential diagnosis.

Minimally invasive robotic cervicothoracic fusion: a case report and review of literature.

Minimally invasive surgery (MIS) of the posterior cervical spine with robotic assistance has recently emerged to treat degenerative disc disease. Robotic arms and 3D neuronavigation with preoperatively planned placement are used to achieve real-time intraoperative guidance, reducing screw malposition through increased accuracy and stability. This results in decreased blood loss, postoperative pain, and quicker recovery time compared to other techniques. We aim to demonstrate a novel technical approach to posterior cervical spine fusion using robotic assistance and discuss its advantages. In a patient with right hand weakness and a right paracentral disc herniation of the cervicothoracic spine, we performed a MIS percutaneous and robotically assisted posterior spinal fusion at C7-T2, with complete C7-T1 and T1-2 right-sided facetectomies and also a T1-T2 discectomy. Preoperative software planning and a robotic platform attachment configuration was used. There was immediate postoperative improvement in upper extremity strength and the patient was discharged without complications. Postoperative imaging confirmed accurate hardware placement, and follow-up at both 3- and 4-month confirmed improved upper extremity strength with sensation intact throughout. MIS robotic posterior cervicothoracic fusion can effectively be used to improve patient outcomes. Further implementation of robotic assistance during cervical fusion in larger studies is needed to further evaluate its effectiveness.

The utility of deep brain stimulation surgery for treating eating disorders: A systematic review.

BACKGROUND: Deep brain stimulation (DBS) has demonstrated preliminary success as a treatment for neuropsychological disorders including obsessive-compulsive disorder and substance use disorder. This systematic review aims to assess the use of DBS in treating eating disorders (EDs) to determine its utility and the extent of adverse effects. METHODS: A PubMed search following PRISMA guidelines was executed to find studies encompassing DBS as a treatment of ED. Outcomes were extracted from the literature and summarized while a review of quality was also performed. RESULTS: From a search yielding 299 publications, 11 studies published between 2010 and 2020 were found to fit the inclusion criteria. Out of 53 patients who began with an abnormal BMI before treatment, 22 patients (41.5%) achieved normal BMI on follow-up. Significant neuropsychological improvement was seen in most patients as measured by neuropsychiatric testing and questionnaires. CONCLUSION: DBS as a treatment for ED may result in significant objective and psychological benefits. Further studies should aim to increase the sample size, standardize follow-up protocol, and standardize the neuropsychiatric tests used to determine psychological and physiological benefits.

Outcomes of deep brain stimulation surgery for substance use disorder: a systematic review.

Long has the standard of care for substance use disorder (SUD) been pharmacotherapy, psychotherapy, or rehabilitation with varying success. Deep brain stimulation (DBS) may have a beneficial reduction in the addiction-reward pathway. Recent studies have found reduced relapse and improvements in quality of life following DBS stimulation of the nucleus accumbens. We aim to identify positive outcomes and adverse effects to assess the viability of DBS as a treatment of addiction. A PubMed search following PRISMA guidelines was conducted to identify the entirety of reports reporting DBS as a treatment for SUD. Outcomes were extracted from the literature to be summarized, and a review of the quality of publications was also performed. From 2305 publications, 14 studies were found to fit the inclusion criteria published between 2007 and 2019. All studies targeted the nucleus accumbens (NAc) and remission rates at 6 months, 1 year, 2 years, and more than 6 years were 61% (20/33), 53% (17/32), 43% (14/30), and 50% (3/6), respectively. Not all studies detailed the stimulation settings or coordinates. The most common adverse effect across studies was a weight change of at least 2 kg. DBS shows potential as a long-term treatment of SUD in refractory patients. Further studies with controlled double-blind paradigms are needed for evaluation of the efficacy and safety of this treatment. Future studies should also investigate other brain regions for stimulation and optimal device stimulation parameters.

Acute serotonin 2A receptor activation impairs behavioral flexibility in mice.

Serotonin 2A (5-HT2A) receptors are the primary site of action of hallucinogenic drugs and the target of atypical antipsychotics. 5-HT2A receptors are also implicated in executive function, including behavioral flexibility. Previous studies showed that 5-HT2A receptor blockade improved behavioral flexibility in rodent models related to autism spectrum disorder and schizophrenia. The current study instead was conducted to examine the impact of acute 5-HT2A receptor activation on behavior flexibility in the control C57BL/6 J strain. Because of the therapeutic potential of serotonergic hallucinogens and the unknown impact of many of these compounds on cognition, the present study examined how the 5-HT2A/2C agonist 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI) and the more selective 5-HT2A agonist 25CN-NBOH impacted behavioral flexibility in C57BL/6 J mice. Male mice were tested on a probabilistic spatial discrimination and reversal learning task after an intraperitoneal injection of vehicle, 2.5 mg/kg DOI, 1.0 mg/kg 25CN-NBOH, 1.0 mg/kg of the 5-HT2C receptor antagonist SER-082 or combined treatment with SER-082 (1.0 mg/kg) and 2.5 mg/kg DOI before testing of probabilistic reversal learning. All groups demonstrated comparable performance on the initial spatial discrimination, i.e. similar trials to criterion. DOI alone did not impair reversal learning, whereas 25CN-NBOH increased the number of trials to criterion during reversal learning. Because 5-HT2A and 5-HT2C receptors have been shown to functionally antagonize each other in several behavioral paradigms, we also tested whether blockade of 5-HT2C receptors would unmask 5-HT2A receptor activation by DOI and impair reversal learning. Mice treated with SER-082 in combination with DOI required significantly more trials to reach criterion. In an additional experiment, a dose response experiment with 25CN-NBOH revealed that the 1.0 mg/kg dose tested in reversal learning did not affect locomotor activity. Together, these findings indicate that activation of 5-HT2A receptors impairs probabilistic reversal learning and that 5-HT2A and 5-HT2C receptors exert opposing effects on behavioral flexibility in male mice.

Engorged venous plexus mimicking adjacent segment disease: Case report and review of the literature.

BACKGROUND: An engorged venous plexus may mimic nerve compression from a herniated disk on the magnetic resonance (MR) studies as they both have similar signal intensities. During a laminectomy, if an engorged venous plexus is encountered instead of a disk herniation, there may be marked unanticipated bleeding. CASE DESCRIPTION: A 58-year-old female who had a prior anterior lumbar interbody fusion later returned with recurrent radiculopathy. Adjacent segment disease from a spinal disk herniation was suspected based on the surgical history, physical examination, and imaging (MRI) findings. Rather than a disk, an engorged venous plexuses (EVP) was encountered intraoperatively. CONCLUSION: Here, we discussed our findings regarding a lumbar EVP rather than a herniated disk and reviewed the current literature. Although rare, a higher index of suspicion for these vascular malformations based on combined historical information and MRI studies should allow one to better detect and/or anticipate an EVP rather than a routine disk.

Maternal immune activation impairs cognitive flexibility and alters transcription in frontal cortex.

BACKGROUND: Epidemiological studies suggest that the risk of neurodevelopmental disorders such as autism spectrum disorder (ASD) and schizophrenia is increased by prenatal exposure to viral or bacterial infection during pregnancy. It is still unclear how activation of the maternal immune response interacts with underlying genetic factors to influence observed ASD phenotypes. METHODS: The current study investigated how maternal immune activation (MIA) in mice impacts gene expression in the frontal cortex in adulthood, and how these molecular changes relate to deficits in cognitive flexibility and social behavior, and increases in repetitive behavior that are prevalent in ASD. Poly(I:C) (20 mg/kg) was administered to dams on E12.5 and offspring were tested for social approach behavior, repetitive grooming, and probabilistic reversal learning in adulthood (n = 8 vehicle; n = 9 Poly(I:C)). We employed next-generation high-throughput mRNA sequencing (RNA-seq) to comprehensively investigate the transcriptome profile in frontal cortex of adult offspring of Poly(I:C)-exposed dams. RESULTS: Exposure to poly(I:C) during gestation impaired probabilistic reversal learning and decreased social approach in MIA offspring compared to controls. We found long-term effects of MIA on expression of 24 genes, including genes involved in glutamatergic neurotransmission, mTOR signaling and potassium ion channel activity. Correlations between gene expression and specific behavioral measures provided insight into genes that may be responsible for ASD-like behavioral alterations. CONCLUSIONS: These findings suggest that MIA can lead to impairments in cognitive flexibility in mice similar to those exhibited in ASD individuals, and that these impairments are associated with altered gene expression in frontal cortex.