CNS ORAL PRESENTATIONS
measures included length of operation, estimated blood loss, length more likely to achieve a better outcome and lower rate of recurrence after
of hospitalization, and fusion rates at 1 year. Complications were also
recorded.
RESULTS: Forty patients were enrolled in each group. There was no
crossover between groups. The age was 50.12 +/−11.09 years in the
S TLIF group and 51.3 +/−9.36 years in the MI TLIF group. The
mean operative time and estimated blood loss in the S versus MI TLIF
group were 297 +/−101 versus 323 +/−85 minutes and 417 +/−211
versus 351 +/−198 ml, respectively. There were 4 transfusions in the
S TLIF and 3 transfusions in the MI TLIF group. The patients were
discharged after surgery at 4.12 +/−0.88 days for the S TLIF group and
1.92 +/−0.52 days for the MI TLIF group. The ODI improved from
37 +/−6 to 11 +/−6 in the S TLIF group (ODI difference: 26 +/−7)
and from 38 +/−7 to 11 +/−6 in the MI TLIF group (ODI difference:
26 +/−8). In both groups, the fusion was considered solid (Grade I) in
36 (90%) and partial (Grade II) in 4 (10%) patients at 1 year. There were
no reoperations for pseudarthrosis or any other postoperative compli-
cation. There were 2 superficial wound infections in the standard TLIF
group, which resolved with oral antibiotic treatment alone.
CONCLUSION: The standard and minimally invasive TLIF in
patients with symptomatic spondylolisthesis provided similar clinical and
radiological outcomes at 1 year. The patients undergoing MI TLIF had
a shorter hospital stay. Both surgical techniques yielded good results at
1 year.
304
Microvascular Decompression for Trigeminal Neuralgia:
The Role of Mechanical Allodynia
Chenlong Liao, MD, PhD; Wenchuan Zhang
INTRODUCTION: MVD is ranked as the most effective remedy for
TN. Nevertheless, not all patients can be completely cured by MVD,
and recurrence or delayed relief may occur in a small proportion of
patients. This dilemma reflects the lack of thorough understanding
TN mechanisms, which are now considered a unique form of neuro-
pathic pain and the most common type of neuralgia. This study was
conducted to determine whether mechanical allodynia (MA) acts as
a predictor of outcome after microvascular decompression (MVD) for
trigeminal neuralgia (TN) and discuss the potential pathological mecha-
nisms involved.
METHODS: A series of 246 patients who underwent MVD for TN
were involved in the study. The classifications were based on the charac-
teristic of pain (shock-like or constant), and the presence of MA was
defined from the chart review, retrospectively. The surgical outcome is
defined as excellent, good, and poor. Immediate and long-term outcomes
were compared to provide the information on recurrence and delayed
relief. The relationship among the groups was investigated, and the
strength was determined.
RESULTS: Both presence of MA and type of TN pain are signif-
icant predictors of surgical outcome (P < 0.05). MA was proven to
be an independent predictor of surgical outcome and also a significant
predictor of existence of neurovascular compression (P < 0.05) and lower
rate of recurrence (P < 0.05). No statistically significant predictors of
delayed relief were detected in this study.
CONCLUSION: The presence of MA is a reliable predictor of
immediate and long-term outcome after MVD for TN. Compared to
the patients without MA, the incidence rate of intraoperative neurovas-
cular compression (NVC) was higher in MA-positive patients, who were
264 | VOLUME 64 | NUMBER 1 | SEPTEMBER 2017
Downloaded from https://academic.oup.com/neurosurgery/article-abstract/64/CN_suppl_1/264/4834316
by Serials Section, Dixson Library user
on 17 April 2018
MVD for TN. Application of the information in this study will be helpful
in patient selection of MVD for TN.
305
Speckle-Free and Large Gold Nanorod Enhanced
Optical Coherence Tomography for Brain Tumor
Margin Detection
Derek W. Yecies, MD; Orly Liba; Elliot SoRelle; Rebecca Dutta;
Christy Wilson; Gerald A. Grant, MD; Adam de la Zerda
INTRODUCTION: Optical coherence tomography (OCT) is an
emerging technology with the potential to allow for rapid intraop-
erative detection of brain tumor margins by detecting differences in
structure, intensity, spectral signal, and attenuation. OCT systems are
capable of rapid imaging of large three-dimensional volumes with cellular
level resolution. However, OCT imaging has previously been limited by
speckle artifact and the lack of suitable contrast agents, limitations that
are surmounted in this study.
METHODS: We prepared nude mice with orthotopic U87
glioblastoma xenografts and glass cranial windows. We also created
large gold nanorods (LGNR) with plasmonic peaks tuned to the
spectral range of the OCT scanner. LGNRs were injected intravenously
into tumor-bearing mice and OCT imaging was performed in vivo
utilizing a novel method for the removal of speckle artifact called
Speckle-Free OCT (SFOCT). Fresh ex-vivo patient samples were also
imaged.
RESULTS: OCT and SFOCT readily distinguished tumor from
normal brain with cellular level spatial resolution and to a depth of 1.5
mm. Additionally, SFOCT allowed for the highest resolution ever seen in
vivo of mouse white matter architecture. Cortical layers were also readily
visible in SFOCT in both live mice and in the ex-vivo human samples,
representing a novel ability to interrogate cortical cytoarchitecture across
a large field of view. Systemically administered LGNRs were tumor
specific and provided excellent spectral contrast using OCT. Ex-vivo
hyperspectral and IHC imaging confirmed the localization of LGNRs
within the tumor and found that the LGNRs were largely localized within
tumor associated macrophages.
CONCLUSION: SFOCT and LGNR enhanced OCT imaging are
promising state of the art technologies for intraoperative tumor margin
detection.
306
GCS Does Not Predict Cognitive Outcome 30 Years
After Severe Traumatic Brain Injury
Molly E. Hubbard, MD; Abdullah Bin Zahid, MD; Gabrielle
Meyer, DO; Kathleen Vonderhaar, MD; David Y. Balser; David
Darrow; Anne Kleeberger; Drake Burri; Vikalpa Dammavalam;
Shivani Venkatesh; David Tupper, PhD; Sarah B. Rockswold, MD;
Thomas A. Bergman, MD; Gaylan L. Rockswold, MD, PhD;
Uzma Samadani, MD
INTRODUCTION: Traumatic brain injury (TBI) is a leading cause
of morbidity and mortality in the US. The effects of TBI on quality of life
may not become apparent for years after the injury. There are conflicting
reports in the literature regarding long term outcomes. Physicians are
www.neurosurgery-online.com