American Association of Neurological Surgeons, April 30-May 4

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The 84th Annual Scientific Meeting of the American Association of Neurological Surgeons

The annual meeting of the American Association of Neurological Surgeons was held from April 30 to May 4 in Chicago and attracted more than 7,000 participants from around the world, including neurosurgeons, neurosurgical residents, medical students, neuroscience nurses, clinical specialists, physician assistants, allied health professionals, and others interested in neurological surgery. 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.

In one study, Owoicho Adogwa, M.D., of Duke Neurology in Raleigh, N.C., and colleagues found that psychological disorders like depression and anxiety are independently associated with higher all cause 30-day readmission rates after elective spine surgery.

Specifically, the investigators found that patients with a diagnosis of depression were four times more likely to be readmitted within 30 days, independent of their objective improvement from surgery.

"Future interventions to reduce unplanned readmissions should include mental health components," Adogwa said.

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In another study, Asra Al Fauzi, M.D., Ph.D., of the Surabaya Neuroscience Institute in Indonesia, and colleagues found that stem cells can be taken from a patient and transplanted directly into the same patient's brain. The investigators evaluated the role of intraventricular transplantation using bone marrow mesenchymal stem cells in hemorrhagic stroke patients.

"The results showed a significant correlation of neurological status of the patient before and after treatment and no important adverse events derived from the treatment," Fauzi said. "This is a preliminary study with a small sample, so further randomized controlled trials with larger samples are needed. Our study showed a benefit without complications; it is a new hope for the future treatment of permanently disabled patients after stroke."

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Nathan Zwagerman, M.D., of the University of Cincinnati, and colleagues found that lumbar drains help with decreasing cerebral spinal fluid (CSF) leaks after surgery. Specifically, they help with anterior and posterior fossa pathology and this is likely due to large dural defects.

"We thought drains might help but we were not sure of the extent or if there might be situations where it could be avoided. Logically, by reducing CSF pressure, the reconstruction should heal better but we had no idea by how much. The development of the nasoseptal flap has significantly decreased the CSF leak rate overall and we thought this may make the effect less. However, we were surprised at the reduction in the leak rate amongst our patients with anterior or posterior defects," Zwagerman said. "We were equally as surprised at the results with the suprasellar lesions which usually enter high-flow CSF cisterns. Before our study, we routinely used lumbar drains in those patients as well. Now we don't."

According to Zwagerman, lumbar drains are routinely used for occult as well as iatrogenic CSF leaks. However, there has never been a high level of evidence behind this data and certainly no prior randomized controlled trial.

"This study specifically shows where lumbar drains should be used in regards to endoscopic skull base surgery and where it may not be useful," Zwagerman concluded. "Also, it indicates that the infection risks/non-ambulatory risks, while significant, are not statistically associated with lumbar drain usage."

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