Hannah E. Goldstein, Andrew Poliakov, Dennis W. Shaw, Dwight Barry, Kieu Tran, Edward J. Novotny, Russell P. Saneto, Ahmad Marashly, Molly H. Warner, Jason N. Wright, Jason S. Hauptman, Jeffrey G. Ojemann, and Hillary A. Shurtleff
A paucity of effective tasks activate mesial temporal structures, inhibiting memory risk assessment prior to temporal lobe epilepsy surgery. The authors aimed to address this problem. This study presents novel outcome data associated with a pediatric functional (fMRI) memory task: preoperative mesial temporal activation predicted individual postoperative memory outcomes. This pediatric fMRI memory task helps avoid loss, when possible, as well as predict and measure outcomes. The unique imaging overlap technique may influence future imaging measurement approaches, reaching beyond standard masks.
Pratyush Shahi, Junho Song, Sidhant Dalal, Dimitra Melissaridou, Daniel J. Shinn, Kasra Araghi, Eric Mai, Evan Sheha, James Dowdell, Sheeraz A. Qureshi, and Sravisht Iyer
The objective of this study was to assess the outcomes of minimally invasive lumbar decompression in patients 80 years of age or older and compare them with those of younger patients. It was found that although there was less and slower improvement in patients ≥ 80 years of age, they did improve significantly and had low complication and reoperation rates. Advanced age should not be seen as a barrier to surgery but act as a reminder for careful patient selection and the setting of realistic expectations.
Weihua Chu, Xin Chen, Zexian Wen, Xingsen Xue, Guangjian He, Hongyan Zhang, Jingjing Liu, Yang Zhang, Hua Feng, and Jiangkai Lin
Tarlov cysts (TCs) are a common cystic entity in the sacral canal, with a reported prevalence between 1.5% and 13.2%; 10%–20% of patients are symptomatic and need appropriate clinical intervention. However, the choice of treatment remains controversial. The goal of this study was to describe a new microsurgical sealing technique for symptomatic sacral TCs (SSTCs) as well as its long-term outcomes.
Microsurgical sealing was performed using a short incision, leakage coverage with a piece of autologous fat, and cyst sealing with fibrin glue. Postoperative data were collected at three stages: discharge, 1-year follow-up, and a follow-up of 3 years or more. According to the improvement in neurological deficits and degree of pain relief, outcomes were divided into four levels: excellent, good, unchanged, and deteriorated.
A total of 265 patients with SSTCs were treated with microsurgical sealing from January 2003 to December 2020. The mean follow-up was 44.69 months. The percentages of patients who benefited from the operation (excellent and good) at the three stages were 87.55%, 84.89%, and 80.73%, respectively, while those who received no benefit (unchanged and deteriorated) were 12.45%, 15.11%, and 19.27%, respectively. Of the patients with postoperative MRI, the cysts were reduced in size or disappeared in 209 patients (94.14%). CSF leakage from the wound was observed in 15 patients, and 4 patients experienced an infection at the incision. There were no cases of new-onset nerve injury or aseptic meningitis after the operation.
SSTC patients undergoing microsurgical sealing had persistently high rates of symptom relief and few postoperative complications. Microsurgical sealing is an effective, simple, and low-risk method for treating SSTCs.
Ian T. McNeill, Alejandro Carrasquilla, Zerubabbel K. Asfaw, Ernest J. Barthélemy, Alyson Mehr, Kenya D. Townsend, Alexander Joseph, Joshua B. Bederson, Gary C. Butts, and Isabelle M. Germano
In response to the decline of Black and Latinx male medical school matriculants in the US, the authors established the Doctors Reaching Minority Men Exploring Neuroscience (DR. MMEN) program in 2017. Here they report the program's summary and its contributions to the mentorship of minority male students in high school. The authors hope that their work encourages other neurosurgery departments and medical schools to establish similar pipeline programs with early, positive exposure to medicine and its subspecialties.
Rebecca A. Reynolds, Katherine A. Kelly, Ranbir Ahluwalia, Shilin Zhao, E. Haley Vance, Harold N. Lovvorn III, Holly Hanson, Chevis N. Shannon, and Christopher M. Bonfield
Isolated linear skull fractures without intracranial findings rarely require urgent neurosurgical intervention. A multidisciplinary fracture management protocol based on antiemetic usage was implemented at a level 1 pediatric trauma center, and this study evaluated protocol safety and efficacy. The results showed that protocolization of isolated linear skull fracture management is safe and feasible at a high-volume level 1 pediatric trauma center and that neurosurgical consultation may not be warranted in every case.
Jason Yuen, Abhinav Goyal, Timothy J. Kaufmann, Lauren M. Jackson, Kai J. Miller, Bryan T. Klassen, Neha Dhawan, Kendall H. Lee, and Vance T. Lehman
Researchers used conventional statistics and machine learning algorithms to assess the contribution of different skull characteristics in achieving technical success (temperature attained, required energy, and power delivered) in MR-guided focused ultrasound thalamotomy in cases of essential tremor. In addition to the commonly used skull density ratio, other skull parameters were shown to be inputs that could potentially improve outcome prediction. This supports that additional metrics related to eventual sonication parameters should also be explored.
Featuring presentations on selected papers published in this issue by Ms. Audrey Grossen, Dr. Pranay Soni, and Dr. Nicole Frank. Moderated by Dr. Caitlin Hoffman. With Drs. William Couldwell (Editor-in-Chief) and Aaron Cohen-Gadol (Associate Editor).