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American Association of Neurological Surgeons, April 27 - May 1, 2013

The 2013 American Association of Neurological Surgeons 81st Annual Scientific Meeting

The annual meeting of the American Association of Neurological Surgeons was held from April 27 to May 1 in New Orleans 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, Edward Robert Smith, M.D., of Children's Hospital Boston and Harvard Medical School, and colleagues evaluated the use of a noninvasive test, using urine samples, to try to identify whether an individual has brain arteriovenous malformations (AVMs).

"To be clear, the initial goal for this type of biomarker work is not as a tool to screen for AVMs in the general population; it is very unlikely (at least yet) that this type of test will be sensitive and specific enough to be used in this manner. Rather, we hope that some initial translational work might be directed at kids who have been treated for known AVMs, using something like this test to ensure that the cure is permanent and long-lasting," said Smith. "We now have an ongoing national multicenter trial for a urine biomarker test for brain tumors in children and we would hope that a similar type of study might be the next step in this work. Knowing the size of the AVM, or other types of physiologic measures (size, flow, rate of producing chemicals that may relate to AVM growth), may all be useful to measure the effectiveness of treatment, reassuring parents when things are well and helping to predict those cases that might need further treatment before problems occur when the first therapy might not have fully worked. In addition, it may be possible to use some of this information to discover new treatments for AVMs, based on which proteins we detect in the urine."

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In another study, Jessica Wilden, M.D., of the Indiana University School of Medicine in Indianapolis, and colleagues found that a deep brain stimulation (DBS) target, the nucleus accumbens shell, is a structure that helps regulate alcohol intake, and that this structure can be electrically stimulated to affect alcohol drinking.

"The key results of our study include: 1) DBS is effective at reducing chronic alcohol intake in rodents; 2) this effect is current dependent (higher currents, or more electrical power, lead to better results); and 3) this effect can be achieved with unilateral stimulation (surgery on just one side of the head)," said Wilden. "This pilot study's results have been submitted to the National Institutes of Health to hopefully obtain ongoing funding to study this important concept of using neuromodulation to treat refractory addiction."

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Jonathan Riley, M.D., of Emory University in Atlanta, and colleagues found that the spinal cord is capable of tolerating serial unilateral cervical microinjections and bilateral thoracolumbar microinjections without evidence of postoperative neurologic deficit.

"This study has demonstrated the safety of delivering a biologic payload directly to a targeted location within the spinal cord. This was accomplished through the use of a 'risk escalation' paradigm to trial design," said Riley. "In this approach, an effort was made to minimize patient exposure to neurologic morbidity. In light of the fact that this delivery approach was well tolerated by the vulnerable amyotrophic lateral sclerosis (ALS) spinal cord, it may be expected that these results are a conservative estimate of what is tolerable by the spinal cord in non-ALS patients."

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Matthew McGirt, M.D., of the Vanderbilt University Medical Center in Nashville, Tenn., and colleagues found that intra-operative neuromonitoring is associated with significant added cost without any added efficacy or safety benefit in patients undergoing cervical spine surgery for degenerative spondylosis.

"This [study] highlights where you have to look deeper into the details to understand the type of treatment being conducted," said McGirt in a statement. "Different treatments can be of high value in some situations, and lack value in other situations. This is a lesson on how important it is to have clinical expertise and a focused look at value."

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AANS: Brain Machine Interface Can Control Prosthetic Arm

WEDNESDAY, May 1 (HealthDay News) -- A brain-machine interface can be used to control an anthropomorphic prosthetic arm with 10 degrees-of-freedom, according to a study presented at the annual meeting of the American Association of Neurological Surgeons, held from April 27 to May 1 in New Orleans.

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