The annual meeting of the American Association of Neurological Surgeons was held from April 9 to 13 in Denver and attracted over 6,100 participants from around the world, including medical attendees, exhibitors, and guests. The conference highlighted recent advances in neurological surgery, with presentations focusing on the prevention, management, and rehabilitation of nervous system disorders, including disorders of the spinal column, spinal cord, brain, and peripheral nerves.
"Scientific papers presented focused on a rich variety of topics, ranging from vaccines that showed promise for the treatment of high-grade malignant brain tumors to updates on the best approaches for the management of stroke to reports on biomechanical issues associated with head injuries sustained in football. Also presented were the largest studies to date on craniotomy (clipping) versus endovascular approaches (coiling) for cerebral aneurysms and arthroplasty versus anterior cervical decompression and spine fusion for cervical disc disease," said Gail Rosseau, M.D., of the Northshore University HealthSystem in Evanston, Ill.
In one study, Alan T. Villavicencio, M.D., of Boulder Neurosurgical Associates in Colorado, and colleagues found that more optimistic patient expectation and mental health were significant factors associated with improved clinical outcomes and higher patient satisfaction scores following cervical spine surgery.
"This prospective clinical study enrolled 79 patients who underwent one- to three-level anterior cervical discectomy and fusion and analyzed clinical outcomes divided in two categories depending whether the patients expected some residual pain or complete resolution of pain postoperatively. The results demonstrated that patient expectations and mental health have a significant impact on clinical outcomes," Villavicencio said.
The investigators found that patients who expected no pain reported lower postoperative neck and arm pain, higher postoperative mental health ratings, and higher satisfaction scores. In addition, higher preoperative mental health ratings significantly predicted lower postoperative neck pain and neck disability scores as well as higher postoperative physical and mental health ratings and patient satisfaction levels.
"While it is very important for a spine surgeon to focus on long-term clinical outcomes related to fusion rates or surgical technique, it is equally important to recognize and address mental health or psychological issues," Villavicencio added.
In another study, Matthew J. McGirt, M.D., of the Vanderbilt University Medical Center in Nashville, Tenn., and colleagues found that transforaminal lumbar interbody fusion is a cost-effective approach for the treatment of spondylolisthesis. The investigators used outcome questionnaires completed either during clinic evaluation or via phone interview to assess pain, disability, and overall health preoperatively and two years postoperatively in patients with magnetic resonance imaging evidence of grade I degenerative lumbar spondylolisthesis. In addition, medical resource utilization was assessed over a two-year period post-surgery.
"The key objective of the study was to evaluate real-world practice environment, value of care, [and] value of lumbar fusion in an effort to define the cost-effectiveness of lumbar fusion," McGirt said. "The results demonstrated that the lumbar fusion is cost-effective in spondylosis treatment. This finding is in contrast to other cost analysis studies applied to randomized trials in artificially constrained research environments."
Jonathan A. Forbes, M.D., of the Vanderbilt University Medical Center, and colleagues evaluated the case of a 17-year-old football player treated at their institution for a subdural hemorrhage suffered secondary to a helmeted collision during football practice. The investigators also reviewed previous published data on the biomechanical threshold of bridging vessel rupture as well as other studies focused on patterns of energy transfer during collisions at various levels of football.
Currently, new and used helmets are certified in a standardized "quality assurance" process that is sanctioned by the National Operating Committee on Standards for Athletic Equipment (NOCSAE), according to Forbes. Under the current protocol, helmets pass certification when they prevent a "severity index" of 1,200 or greater, which only takes into account the effect of translational forces likely to prevent skull fractures, not brain injury or subdural hemorrhage, he said.
"Various studies have looked at the predictive value of each of the individual biomechanical measurements (translational forces, rotational forces, impact duration, impact location). Recent evidence suggests that a combination of these measurements is probably the best way to predict concussions," Forbes explained. "The information we present in the study 'Biomechanics of Subdural Hemorrhage in American Football' strongly links catastrophic subdural hemorrhage to dangerous levels of rotational forces (not translational forces). The findings presented in this study provide substantial evidence that consideration should be given to modify the current NOCSAE standard to include limitation on rotational forces, as well as translational forces."
AANS: Non-Accidental Head Traumas Up in Recession
WEDNESDAY, April 13 (HealthDay News) -- Non-accidental head trauma (NAHT) in infants appears to be more common during periods of recession as compared with non-recession time periods, according to research presented at the annual meeting of the American Association of Neurological Surgeons, held April 9 to 13 in Denver.
AANS: Vaccine Improves Survival in Glioblastoma
MONDAY, April 11 (HealthDay News) -- Tumor lysate-pulsed dendritic cell (DC) vaccine appears to improve overall survival in patients with glioblastoma, according to research presented at the annual meeting of the American Association of Neurological Surgeons, held from April 9 to 13 in Denver.
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