Search

Until recently, there has been no consensus on the optimal operative window for decompressive surgery in acute spinal cord injury (aSCI). However, recent evidence is now supporting a role for early intervention in improving outcomes in this type of patients. The purpose of this letter is to discuss the implications for clinical practice within the European community. Critical appraisal and interpretation of these results for clinical implementation. Leveraging on the evidence that early (

Cervical dystonia is a non-degenerative movement disorder characterized by dysfunction of both motor and sensory cortico-basal ganglia networks. Deep brain stimulation targeted to the internal pallidum is an established treatment, but its specific mechanisms remain elusive, and response to therapy is highly variable. Modulation of key dysfunctional networks via axonal connections is likely important. Fifteen patients underwent preoperative diffusion-MRI acquisitions and then progressed to bilateral deep brain stimulation targeting the posterior internal pallidum. Severity of disease was assessed preoperatively and later at follow-up. Scans were used to generate tractography-derived connectivity estimates between the bilateral regions of stimulation and relevant structures. Connectivity to the putamen correlated with clinical improvement, and a series of cortical connectivity-based putaminal parcellations identified the primary motor putamen as the key node (r = 0.70, P = 0.004). A regression model with this connectivity and electrode coordinates explained 68% of the variance in outcomes (r = 0.83, P = 0.001), with both as significant explanatory variables. We conclude that modulation of the primary motor putamen–posterior internal pallidum limb of the cortico-basal ganglia loop is characteristic of successful deep brain stimulation treatment of cervical dystonia. Preoperative diffusion imaging contains additional information that predicts outcomes, implying utility for patient selection and/or individualized targeting., Raghu et al. report that the majority of variation in outcomes following pallidal DBS for cervical dystonia can be explained by electrode location and structural connectivity. Individual differences in the primary motor cortex–putamen–internal pallidal limb of the direct pathway offer the prospect of a personalized approach.

Objectives: Safe provision of transsphenoidal surgery for pituitary tumors (TSS) has been significantly disrupted by theCOVID-19 pandemic. We assess whether there was any compromise to patient and staff safety from COVID-19 fromundertaking TSS during the COVID-19 pandemic in our institution. Methods: We retrospectively review all the cases performed between the March 1 and September 11, 2020 and comparedour findings to the cases performed between March 1 and September 11, 2019. In doing so, we aim to assess the impact ofthe COVID-19 pandemic on our service. We review individual patient records to identify any COVID-19 relatedcomplications during or after their inpatient stay and evaluate any COVID-19 confirmed cases among staff involved in theseoperations. Results: Twenty-seven patients had TSS since March 2020 versus 39 during the same period in 2019. Of the patientstreated during the COVID-19 pandemic, 10 required urgent TSS for apoplexy or visual compromise, 10 needed expeditedsurgery and seven had elective procedures. Average duration of GA was 43 minutes (vs. 25 minutes in 2019), surgery 78minutes (vs. 79 minutes in 2019). The length of stay postsurgery was 2 days on average ([range: 1-9 days] vs. 3.6 days in2019 [range: 1-27 days]). No COVID-19 related complications were seen, no new infections developed and no staffinvolved contracted COVID-19. Measures taken to minimize risk included patients self-isolating prior to surgery andpreoperative COVID-19 testing with all patients operated on after April 2020 having received a COVID-19 antigen test at 1to 4 days before the date of their surgery. Theater and anesthetic process followed Trust COVID-19 guidance and physicalmeasures to reduce the spread of aerosols generated were used (clear sheet applied over the patient with small openingsfor instruments and endoscope ([ Fig. 1 ]), nasal latex slits ([ Fig. 2 ]), and full PPE (whenever necessary). Conclusion: We did not see any patient or staff COVID-19 complications or have any new COVID-19 cases contracted byundertaking transphenoidal surgery during the COVID-19 pandemic for pituitary tumors (TSS), with appropriate testing andprecautions in place. Anesthetic time did increase for these cases but there again were no compromises to patient safety orrecovery from this.