Neuroendoscopy for spinal disorders: a brief review

Neuroendoscopy has grown rapidly in the last 20 years as a therapeutic modality for treating a variety of spinal disorders. Spinal endoscopy has been widely used to treat patients with cervical, thoracic, and lumbosacral disorders safely and effectively. Although it is most commonly used with minimally invasive lumbar spine surgery, endoscopy has gained widespread acceptance for the treatment of thoracic disc herniations and for anterior release and rod implantation in the correction of thoracic spinal deformity. The authors review the use of endoscopy in spine surgery and in the treatment of spinal disorders as well as in the treatment of intrathoracic nonspinal lesions. Endoscopy has some significant advantages over open or other minimally invasive techniques in that it can allow for better visualization of the lesion, smaller incision sizes with reduced morbidity and mortality, reduced hospital stays, and ultimately lower cost. In addition, spinal endoscopy allows observers and operating room staff to be more involved in each case and fosters education. Spinal endoscopy, like any novel modality, carries with it additional risks and the surgeon must always be prepared to convert to an open procedure. The learning curve for spinal endoscopy is steep and the procedure should not be attempted alone by a novice surgeon. Nevertheless, with training and experience, the spine surgeon can achieve better outcomes, reduced morbidity, and better cosmesis with spinal endoscopy, and the operating times are comparable to open procedures. As technology evolves and more experience is obtained, neuroendoscopy will likely achieve further roles as a mainstay in spine surgery

DRD2/ANKK1 Polymorphism Modulates the Effect of Ventral Striatal Activation on Working Memory Performance

Motivation is important for learning and cognition. Although dopaminergic (D2) transmission in the ventral striatum (VS) is associated with motivation, learning, and cognition are more strongly associated with function of the dorsal striatum, including activation in the caudate nucleus. A recent study found an interaction between intrinsic motivation and the DRD2/ANKK1 polymorphism (rs1800497), suggesting that A-carriers of rs1800497 are significantly more sensitive to motivation in order to improve during working memory (WM) training. Using data from the two large-scale imaging genetic data sets, IMAGEN (n=1080, age 13–15 years) and BrainChild (n∼300, age 6–27), we investigated whether rs1800497 is associated with WM. In the IMAGEN data set, we tested whether VS/caudate activation during reward anticipation was associated with WM performance and whether rs1800497 and VS/caudate activation interact to affect WM performance. We found that rs1800497 was associated with WM performance in IMAGEN and BrainChild. Higher VS and caudate activation during reward processing were significantly associated with higher WM performance (p<0.0001). An interaction was found between the DRD2/ANKK1 polymorphism rs1800497 and VS activation during reward anticipation on WM (p<0.01), such that carriers of the minor allele (A) showed a significant correlation between VS activation and WM, whereas the GG-homozygotes did not, suggesting that the effect of VS BOLD on WM is modified by inter-individual genetic differences related to D2 dopaminergic transmission

Cirurgias endoscópicas para a coluna torácica: avaliação crítica Endoscopic surgery for thoracic spine: critical review

Com o advento da tecnologia vídeo-assistida a endoscopia tem assumido importante papel terapêutico na cavidade torácica. Este artigo é uma avaliação crítica da literatura e tem como objetivo demonstrar o estado atual da cirurgia endoscópica direcionada para a coluna torácica. Hérnias discais, deformidades, infecções, tumores, doenças congênitas e traumatismos estão sendo tratados por técnica endoscópica. Na literatura, as vantagens sobre a toracotomia aberta são visibilidade aumentada e reduções em: tempo de recuperação, perda sanguínea, custos, índice de infecção e morbidade pós-operatória. Algumas desvantagens são: intubação seletiva, significativa curva de aprendizado, dificuldades técnicas na operação de crianças muito pequenas, reparação da dura máter e instrumentação. Embora os benefícios sejam aparentemente claros e haja pronunciado grau de entusiasmo, os autores são cautelosos em afirmar que a toracoscopia já é uma alternativa definitiva à toracotomia convencional. A comparação dos resultados entre as técnicas endoscópica e aberta é dificultada pela escassez de estudos comparativos. Os autores, embora otimistas, recomendam análises de mais estudos prospectivos, multicêntricos e randomizados para uma conclusão definitiva.<br>After the development of video-assisted technology, endoscopic techniques have assumed an important therapeutic role into thoracic cavity. This is a literature review article to show the current state of the endoscopy for thoracic spine. Disc herniations, deformities, infections, tumors, congenital disorders and traumatic events have been treated by endoscopic techniques. On reviewing the literature, the advantages over open approaches are: enhanced visualization, shorter recovery time and decreased blood loss, costs, infection rate and post operative morbidity. Some disadvantages are: one lung anesthesia, significant learning curve, and technical problems in operating on small children, repairing the dura and performing instrumentation. Overall benefits are apparently clear. However, despite the high degree of enthusiasm, authors are cautious to state that endoscopic techniques to the spine already represent a definitive alternative to standard techniques. Comparison between endoscopic and open approaches are still difficult because of the lack of appropriate comparative studies. Authors, although optimistic recommend more prospective, multicentric and randomized studies in order to stand a definitive conclusion