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The primary objective of this editorial is to introduce what we believe to be the next wave of technology poised to revolutionize neurosurgical care and knowledge (all subspecialties of neurosurgery) as we currently understand it—the development of extended specialty-focused large language models (LLMs) in medicine. We describe AtlasGPT, an LLM based on reliable peer-reviewed neurosurgery-specific data sources.

Over the past 5 years, artificial intelligence (AI), accelerated dramatically by the advent of ChatGPT and GPT-4, has emerged as a mainstream force at the forefront of innovation, with applications relevant across industries. 1–12 Although the prowess of

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In Brief

Olfactory groove meningioma is a slow-growing pathology that often presents late with a large-volume tumor that is intricately involved with surrounding neurovascular structures. Its management is complex, with both open and endonasal options. The authors describe their algorithm to assist surgeons in selecting what they believe to be the best approach for safe resection dependent on olfaction and anatomical relationships to the midline of the orbit. They found that their algorithm offers both safe and consistent oncological outcomes in these patients.

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OBJECTIVE

The literature on non–small cell lung cancer (NSCLC) brain metastases (BMs) managed using stereotactic radiosurgery (SRS) relies mainly on single-institution studies or randomized controlled trials (RCTs). There is a literature gap on clinical and radiological outcomes of SRS for NSCLC metastases in real-world practice. The objective of this study was to benchmark mortality and progression outcomes in patients undergoing SRS for NSCLC BMs and identify risk factors for these outcomes using a national quality registry.

METHODS

The SRS Registry of the NeuroPoint Alliance was used for this study. This registry included patients from 16 enrolling sites who underwent SRS from 2017 to 2022. Data are prospectively collected without a prespecified research purpose. The main outcomes of this analysis were overall survival (OS), out-of-field recurrence, local progression, and intracranial progression. All time-to-event investigations included Kaplan-Meier analyses and multivariable Cox regressions.

RESULTS

Two hundred sixty-four patients were identified, with a mean age of 66.7 years and a female proportion of 48.5%. Most patients (84.5%) had a Karnofsky Performance Status (KPS) score of 80–100, and the mean baseline EQ-5D score was 0.539 quality-adjusted life years. A single lesion was present in 53.4% of the patients, and 29.1% of patients had 3 or more lesions. The median OS was 28.1 months, and independent predictors of mortality included no control of primary tumor (hazard ratio [HR] 2.1), KPS of 80 (HR 2.4) or lower (HR 2.4), coronary artery disease (HR 2.8), and 5 or more lesions present at the time of SRS treatment (HR 2.3). The median out-of-field progression-free survival (PFS) was 24.8 months, and the median local PFS was unreached. Intralesional hemorrhage was an independent risk factor of local progression, with an HR of 6.0. The median intracranial PFS was 14.0 months and was predicted by the number of lesions at the time of SRS (3–4 lesions, HR 2.2; 5–14 lesions, HR 2.5).

CONCLUSIONS

In this real-world prospective study, the authors used a national quality registry and found favorable OS in patients with NSCLC BMs undergoing SRS compared with results from previously published RCTs. The intracranial PFS was mainly driven by the emergence of new lesions rather than local progression. A greater number of lesions at baseline was associated with out-of-field progression, while intralesional hemorrhage at baseline was associated with local progression.

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In Brief

The goal of this study was to evaluate the efficacy and safety of stereotactic radiosurgery (SRS) in controlling colorectal brain metastases by analyzing data from 10 international institutions. SRS was highly effective in local tumor control, with a 3-year local control rate of 72%. Overall survival was 20% at 3 years. Age and tumor volume significantly affected outcomes. The study provides crucial insights into the safety and efficacy of SRS for colorectal brain metastases, highlighting factors like age, tumor volume, and performance status that can guide treatment decisions and risk assessment.

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In Brief

The authors investigated the survival outcomes of intracranial extraventricular neurocytomas. These rare tumors portend a poorer prognosis than central neurocytomas, despite both being WHO grade 2 tumors. This study found that complete surgical extirpation is the cornerstone of management. There is no clearly established role for postoperative adjuvant therapy. Additional large multicenter trials are required to further understand the characteristics and surgical outcomes of this uncommon lesion.

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In Brief

The optimal treatment strategy for jugular foramen schwannomas (JFSs) remains controversial. Researchers retrospectively analyzed the clinical and radiographic outcomes of 74 patients with JFS treated by CyberKnife-based hypofractionated stereotactic radiotherapy. The results proved that hypofractionated stereotactic radiotherapy was a safe and effective primary or adjuvant treatment strategy for JFSs.

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In Brief

Imaging-negative Cushing's disease is thought to occur because of the insufficient image resolution of clinical magnetic resonance imaging (MRI) utilizing an external head receiver coil. The authors developed a custom flexible receiver coil designed to be positioned directly on the sella turcica as part of an intraoperative MRI study. Here, they evaluated its performance using simulation, a phantom, and cadaveric models. The ultra-;high-resolution images show the potential of this technological advancement and approach.

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In Brief

Postoperative visual outcome is a major concern of neurosurgeons for patients with craniopharyngiomas. By retrospectively reviewing the data of patients with craniopharyngiomas, the researchers of this study investigate the application value of visual evoked potential (VEP) amplitude reduction (N75-P100 and P100-N145) for predicting postoperative visual dysfunction and refine current warning criteria for VEP monitoring.

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The authors assessed the utility of copeptin measurement after extubation and 1 day following pituitary surgery to predict arginine vasopressin deficiency (AVD). Both time points predicted postoperative AVD, but measuring copeptin early allowed for timely allocation of resources. An optimal cut point of < 8.5 pmol/L predicted AVD (sensitivity 70%, specificity 80%), whereas a concentration > 22.9 pmol/L made AVD unlikely, demonstrating the value of copeptin in predicting AVD after surgery. However, interpretation could be impacted by perioperative glucocorticoids.

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In Brief

Neurosurgeons maintain a primary role in the multidisciplinary treatment of acromegaly. The authors of this review discuss relevant diagnostic criteria, anatomy, and surgical management strategies, as well as next steps in persistent cases for which surgery is not curative.

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In Brief

The objective of this paper was to develop a novel scoring system to predict visual outcomes based on preoperative risk factors in patients undergoing surgery for anterior clinoid meningiomas. Abnormal optical coherence tomography, radiographic evidence of optic nerve encasement by the tumor, and severe preoperative visual deficits accurately predicted visual outcome. This practical and novel scoring system can guide preoperative discussions with patients and timely surgical intervention to yield optimal visual function outcomes.

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In Brief

The authors investigated the effect of rigid orbital reconstruction after spheno-orbital meningioma resection on proptosis outcomes as measured by the exophthalmos index (EI). They found that patients with rigid orbital reconstruction had a greater reduction in proptosis and a 9 times higher odds of achieving a normal EI. This was unrelated to the degree of orbital resection. Rigid reconstruction may prevent frontal lobe descent from limiting orbital reexpansion and therefore maximize proptosis correction.

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The proposed taxonomy for basal ganglia cavernomas aims to guide surgical approach selection based on clinical syndrome and anatomical location. Three subtypes of cavernomas were defined in 54 patients: caudate (31, 57%), putaminal (16, 30%), and pallidal (7, 13%). The preferred surgical approach for each subtype was a single approach in ≥ 81% of cases. The proposed taxonomy can increase diagnostic acumen at the patient bedside, help identify optimal surgical approaches, and improve patient outcomes.

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In Brief

The aim was to compare the overall costs of diagnostic cerebral angiography for both transradial (TR) and transferal routes and to shed light on the individual equipment costs for each route. TR access may be a less expensive option, especially for patients undergoing diagnostic or follow-up cerebral angiography. The main problem faced when using the TR route is the high rate of crossover, which may be resolved with the adoption of new radial artery–specific devices. Future studies are encouraged to assess the effect of radial artery–specific devices on overall cost.

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In Brief

The authors summarized recent advances in transcriptomic techniques, the current understanding of flow diversion biology in intracranial aneurysm treatment, and avenues for further research. They found that, despite increasing use of flow diversion in aneurysm treatment, knowledge of its underlying mechanisms is lacking. Transcriptomic studies of flow diversion alongside liquid and endovascular biopsies can provide further understanding. The authors introduce the flow diversion microenvironment, which provides a background for future transcriptomic and biological studies into the development of targeted aneurysm treatment.

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The trans-middle cerebellar peduncle (MCP) approach for lateral pontine cavernous malformation (CM) resection was the most common approach in our experience. A review of lesional neuroanatomy, operative trajectory, and clinical outcomes revealed an "invisible triangle" bounded by the corticospinal tract, superior cerebellar peduncle, and pontine tegmentum, providing the safest surgical corridor. The trans-MCP approach and invisible triangle empower safe resection of many brainstem CMs, including large lesions and those extending into the midbrain or medulla.

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In Brief

Patient-reported outcome measures (PROMs) have become increasingly utilized in clinical research, as they can capture information that is important to patients but has not been captured by traditional measures in past clinical research. The authors reviewed the literature to identify PROMs specific to cerebrovascular disease. The review revealed critical gaps in disease-specific outcome measures and identified opportunities to create new ways of assessing what happens after the onset of these cerebrovascular disorders and following treatment.

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OBJECTIVE

Carotid artery stenosis (CAS) is associated with an annual stroke risk of 2%–5%, and revascularization with carotid endarterectomy (CEA) can reduce this risk. While studies have demonstrated that hospital CEA volume is associated with mortality and myocardial infarction, CEA volume cutoffs in studies are relatively arbitrary, and no specific analyses on broad complications and discharge disposition have been performed. In this study, the authors systematically set out to identify a cutoff at which CEA procedural volume was significantly associated with major complications and nonroutine discharge.

METHODS

Asymptomatic and symptomatic CAS patients undergoing CEA were retrospectively identified in the Nationwide Readmissions Database (2010–2018). The association of CEA volume with outcomes was explored as a continuous variable using locally estimated scatterplot smoothing. The identified volume cutoff was used to generate dichotomous volume cohorts, and multivariate analyses of patient and hospital characteristics were conducted to evaluate the association of CEA volume with major complications and discharge disposition.

RESULTS

Between 2010 and 2018, 308,933 asymptomatic and 32,877 symptomatic patients underwent CEA. Analysis of CEA volume with outcomes as a continuous variable demonstrated that an increase in volume was associated with a lower risk until a volume of approximately 7 cases per year (20th percentile). A total of 6702 (2.2%) asymptomatic and 1040 (3.2%) symptomatic patients were treated at the bottom 20% of hospital procedure volume. Increased rates of complications were seen at low-volume centers among asymptomatic (3.66% vs 2.77%) and symptomatic (7.4% vs 6.87%) patients. Asymptomatic patients treated at low-volume centers had an increased likelihood of major complications (OR 1.26, 95% CI 1.07–1.49; p = 0.007) and nonroutine discharge (OR 1.36, 95% CI 1.24–1.50; p < 0.0001). Symptomatic patients treated at low-volume centers were also more likely to experience major complications (OR 1.47, 95% CI 1.07–2.02; p = 0.02) and nonroutine discharge (OR 1.26, 95% CI 1.07–1.47; p = 0.005). Mortality rates were similar between low- and high-volume hospitals among asymptomatic (0.36% and 0.32%, respectively) and symptomatic (1.06% and 1.49%, respectively) patients, while volume was not significantly associated with mortality among asymptomatic (OR 1.06, 95% CI 0.67–1.65; p = 0.81) and symptomatic (OR 0.81, 95% CI 0.43–1.54; p = 0.52) patients in multivariate analysis.

CONCLUSIONS

CEA patients, asymptomatic or symptomatic, are at a higher risk of major complications and nonroutine discharge at low-volume centers. Analysis of CEA as a continuous variable demonstrated a cutoff at 7 cases per year, and further study may identify factors associated with improved outcome at the lowest-volume centers.

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In Brief

Researchers evaluated serial screening neurovascular imaging studies of a large cohort of patients with Loeys-Dietz syndrome (LDS) to better understand the natural history of intracranial aneurysms (ICAs) in these patients. There was a high prevalence of ICAs (23%) and a high de novo ICA formation rate (3.1% per patient year) in LDS patients, but the growth rate of ICAs was similar to that of the non-LDS patients (0.3 mm/year).

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In Brief

Researchers retrospectively evaluated the treatment outcomes of stereotactic radiosurgery for noncavernous sinus dural arteriovenous fistulas and predictors of their obliteration. At a median follow-up of 17 months, the overall complete obliteration rate was 63.1%. The effects of stereotactic radiosurgery on noncavernous sinus dural arteriovenous fistulas vary according to location. High-flow shunt and venous ectasia were associated with incomplete obliteration.

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In Brief

Conference abstract publication rates represent a way to gauge the quality of a discipline's research to ensure that the highest standards are maintained for the advancement of clinical practice within a given area of medicine, such as vascular neurosurgery. In this study, the authors assessed the publication rate of abstracts presented at the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Cerebrovascular Section Meeting from 2014 to 2018. Ultimately, the results showed that the society is maintaining high standards for scientific research and progress as indicated by several findings, including a robust abstract publication rate of nearly 50%.

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In Brief

The assessment of general postoperative complaints after lateral neurosurgical approaches in patients with benign intracranial conditions showed a significant increase in complaints such as pseudoankylosis, temporal pain, cosmetic asymmetry, sensory disturbances, and weather sensitivity at 3 months postoperatively. The extent of temporal muscle (TM) mobilization significantly influenced postoperative pain, thus suggesting that temporal mobilization should be kept as minimal as possible. The findings aggregate and confirm sparse reports of postoperative impairment associated with TM mobilization.

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In Brief

This study compares preoperative characteristics and postoperative outcomes between patients who underwent bilateral carpal tunnel release (CTR) at the same time (simultaneously) or in two staged procedures (staged) via both endoscopic and open approaches. Patients who had undergone staged CTR had significantly higher rates of medical comorbidities. Before and after propensity score matching on comorbidites, staged CTR was associated with more postoperative complications, indicating that these comorbidities likely do not impact postoperative outcomes. Patient selection for bilateral CTR is likely multifactorial and requires shared decision-making between surgeons and patients to select the most optimal approach.

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In Brief

In patients with severe traumatic brain injury, different paradigms of care were assessed by comparing high-frequency intracranial pressure, brain oxygen, and brain blood flow measurements to optimal cerebral perfusion pressure (CPPopt) and deviations from it. Contrary to the hypothesis, CPPopt is physiologically meaningful and associated with optimized brain oxygenation and blood flow values. These findings support targeting CPPopt as an initial step in the care of patients with severe traumatic brain injury.

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In Brief

The GET-UP Trial is a randomized clinical trial investigating the clinical impact of an early mobilization protocol after surgery for chronic subdural hematoma. Primary findings showed that early mobilization is associated with fewer medical complications and no significant change in surgical recurrence. Herein, the authors report the 1-year follow-up results, indicating that early mobilization leads to improved functional outcomes. These findings support the use of an early mobilization protocol over mandatory bed rest for these patients.

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OBJECTIVE

Functional stereotactic neurosurgery including deep brain stimulation (DBS) and radiofrequency lesioning is well established and widely used for treatment of movement disorders and various other neurological and psychiatric diseases. Although functional stereotactic neurosurgery procedures are considered relatively safe, intracranial hemorrhage resulting in permanent neurological deficits may occur in 1%–3% of patients. Microelectrode recording (MER) has been recognized as a valuable tool for refining the final target in functional stereotactic neurosurgery. Moreover, MER provides insight into the underlying neurophysiological pathomechanisms of movement disorders and other diseases. Nevertheless, there is an ongoing controversy on whether MER increases the risk for hemorrhage. The authors aimed to compare the risk of hemorrhage in functional stereotactic neurosurgical procedures with regard to the use of MER.

METHODS

The authors performed a comparative analysis on a consecutive series of 645 functional neurosurgery procedures, including 624 DBS surgeries and 21 radiofrequency lesionings, to evaluate whether the use of MER would increase the risk for hemorrhage. MER was performed in 396 procedures, while no MER was used in 249 cases. The MER technique involved the use of a guiding cannula and a single trajectory when feasible. Postoperative CT scans were obtained within 24 hours after surgery in all patients and screened for the presence of hemorrhage.

RESULTS

Twenty-one intracranial hemorrhages were detected on the postoperative CT scans (3.2%). Of the 21 intracranial hemorrhages, 14 were asymptomatic and 7 were symptomatic. Symptoms were transient except in 1 case. There was no statistically significant correlation between hemorrhage and the use of MER at any site (subdural, ventricle, trajectory, target, whether asymptomatic or symptomatic). There were 4 cases of symptomatic hemorrhage in the MER group (1%) and 3 cases in those without MER (1.2%).

CONCLUSIONS

Intraoperative MER did not increase the overall risk of hemorrhage in the authors’ experience using primarily a single MER trajectory and a guiding cannula.

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In Brief

Researchers retrospectively compared efficacy and safety outcomes at 6 months after MR-guided focused ultrasound thalamotomy in 52 tremor patients using two different lesion coordinates, which differed in target depth. Challenging previous assumptions, they found that a more ventral target induced fewer side effects while tremor reduction was equivalent. Moreover, patient satisfaction mainly depended on tremor reduction as most side effects, even when impacting quality of life, were well tolerated if tremor control was satisfactory.

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In Brief

The objective of this study was to evaluate how modifying deep brain stimulation (DBS) lead trajectories affects radiofrequency (RF) heating during 3T MRI scans. The authors discovered that introducing small concentric loops near the surgical burr hole significantly reduced RF heating by nearly fourfold. Their findings provide a practical approach for surgeons to adjust DBS lead configurations, thereby enhancing MRI safety and expanding postoperative care options.

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In Brief

Researchers assessed the effectiveness of high-precision fiber tractography using the generalized q-sampling imaging (GQI) algorithm as a planning image in transcranial MR-guided focused ultrasound (TcMRgFUS) to achieve more favorable clinical outcomes. The use of the high-precision GQI algorithm enables superior visualization of fiber tractography compared with the diffusion tensor imaging algorithm. These results suggest that using the GQI algorithm has the potential to enhance targeting precision for TcMRgFUS.

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OBJECTIVE

The pathophysiology of posthemorrhagic hydrocephalus (PHH) is not well understood, but recent data suggest blood components play a significant role. This study aimed to understand the timing of membrane attack complex (MAC) activation after intraventricular hemorrhage (IVH) and the effect of MAC inhibition on PHH development.

METHODS

This study was composed of four parts. First, 24 young adult male rats underwent stereotactic intraventricular injection of autologous blood or saline and MRI on day 1, 3, or 7 after hemorrhage. Second, 18 rats underwent intraventricular injection of saline, autologous blood with aurin tricarboxylic acid (ATA) in vehicle, or autologous blood with vehicle and underwent serial MRI studies on days 1 and 3 after hemorrhage. Third, 12 rats underwent intraventricular injections as above and MRI 2 hours after hemorrhage. Finally, 24 rats underwent the intraventricular injections as above, as well as serial MRI studies on days 1, 7, 14, and 28 after hemorrhage. The MR images were used to calculate ventricular volume and iron deposition. Open field testing was performed to assess functional outcomes. Outcomes on day 28 were reported as a ratio to the animal’s baseline values and normalized via log-transformation. Statistical analysis included the Shapiro-Wilk tests for normality and t-tests and 1-way analysis of variance for 2 and 3 groups of continuous variables, respectively.

RESULTS

MAC was found within the hematoma 1 day after hemorrhage and persisted until day 7. Administration of ATA resulted in similar intraventricular hematoma volumes compared to vehicle 2 hours after hemorrhage. At 1 and 3 days after hemorrhage, ATA administration resulted in significantly smaller ventricular volumes and less hemolysis within the hematoma than in the vehicle animals. Administration of ATA also resulted in significantly smaller ventriculomegaly and less iron deposition in the periventricular area than in the vehicle rats 28 days after hemorrhage. Functionally, ATA rats were significantly faster, traveled longer distances, and spent less time resting than vehicle rats at 28 days.

CONCLUSIONS

MAC was activated early and persisted within the hematoma until day 7 after IVH. MAC inhibition attenuated hemolysis in the clot and ventriculomegaly acutely after IVH. One month after hemorrhage, MAC inhibition attenuated ventriculomegaly and iron accumulation and improved functional outcomes.

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In Brief

The objective of this study was to investigate the change in ventricular volume (VV) following adjustment of shunt opening pressure in idiopathic normal pressure hydrocephalus. The key finding was a stepwise reduction in VV with a stepwise reduction of opening pressure. These results show a possible future role for the use of VV in the setting of suspected shunt malfunction.

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In Brief

Researchers designed a low-profile device for reliable ventricular access, the Device for Intraventricular Entry (DIVE) guide, and prospectively studied its safety, efficacy, and accuracy at a large academic center. The DIVE guide facilitated successful ventricular cannulation in 100% of cases, with 92% achieving Kakarla grade 1 placement in an average of 1.06 passes, without any clinical complications. This single-center prospective study demonstrates the safety and effectiveness of the DIVE-assisted ventricular access, providing valuable insights for improving ventricular catheter placement techniques in neurosurgery.

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When the Women in Neurosurgery (WINS) group published their seminal Journal of Neurosurgery paper in 2008, it set the goal of increasing women representation in neurosurgery to 20% of residents by 2012 and 20% of faculty by 2020. 1 This group emphasized the need to increase recruitment of women medical students, establish a mentorship model for younger women trainees, and advocate for the promotion of women into leadership positions in organized neurosurgery. Since that time, there has been an increase in women in neurosurgery, with more women medical students matriculating into neurosurgical residencies, 2

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TO THE EDITOR: As a neurosurgeon, I read with interest the article by Liu et al. 1 (Liu Z, Mela A, Argenziano MG, et al. Single-cell analysis of 5-aminolevulinic acid intraoperative labeling specificity for glioblastoma. J Neurosurg. Published online September 22, 2023. doi: 10.3171/2023.7.JNS23122). The authors used paired single-cell imaging and RNA sequencing of glioblastoma (GBM) surgical specimens from patients who had received 5-aminolevulinic acid (5-ALA) prior to surgery to demonstrate that 5-ALA treatment resulted in labeling that was not specific to neoplastic glioma cells. Their concluding paragraph states that 5-ALA "could spuriously label nonneoplastic

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TO THE EDITOR: We are writing to express our appreciation for the study by Liu et al. 1 (Liu Z, Mela A, Argenziano MG, et al. Single-cell analysis of 5-aminolevulinic acid intraoperative labeling specificity for glioblastoma. Published online September 22, 2023. J Neurosurg. doi:10.3171/2023.7.JNS23122). This research investigates the fluorescence specificity of 5-aminolevulinic acid (5-ALA) in neoplastic glioma cells, utilizing single-cell analysis techniques.

The study addresses the critical question of whether the fluorescence induced by 5-ALA is specific to neoplastic glioma cells at the single-cell level. By using SCOPE-seq2 (single-cell optical phenotyping and expression sequencing–version 2)

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TO THE EDITOR: We read with interest the study by Donegan et al., 1 in which the authors identified the optimal cut-point concentration of copeptin to predict arginine vasopressin (AVP) deficiency after surgery for pituitary disorders (Donegan D, Bornhorst J, Van Gompel J, et al. Postsurgical utility of copeptin for the prediction of postoperative arginine vasopressin deficiency. J Neurosurg. Published online November 10, 2023. doi:10.3171/2023.8.JNS23418). We congratulate the authors on their excellent results and thank them for their valuable contribution to postoperative pituitary management. However, we are writing to present a new perspective on AVP

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TO THE EDITOR: We read with keen interest the article by Cohen-Cohen et al. 1 (Cohen-Cohen S, Graffeo CS, Botello-Hernandez E, et al. Anterior clinoid meningiomas: surgical results and proposed scoring system to predict visual outcomes. J Neurosurg. Published online November 3, 2023. doi:10.3171/2023.8.JNS23894). The study offers important insights into surgical trends and outcomes for these complex tumors. However, we wish to highlight the significance of stereotactic radiosurgery (SRS) as a viable alternative treatment approach.

The authors advocate for microsurgical resection in treating anterior clinoid meningiomas (ACMs), aiming to decompress the optic apparatus, preserve or

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TO THE EDITOR: We would like to congratulate Asano et al. 1 for their study (Asano K, Hasegawa S, Matsuzaka M, et al. Brain tumor–related epilepsy and risk factors for metastatic brain tumors: analysis of 601 consecutive cases providing real-world data. J Neurosurg. 2022;136[1]:76-87). The authors of this paper aimed to explore the incidence of brain tumor–related epilepsy (BTE) associated with brain metastasis. BTE is an expected finding in patients with brain tumors. Although brain metastasis is less likely than primary brain tumors to cause seizures, because metastatic brain tumors are more prevalent than primary

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In Brief

The authors reported a study using cortico-cortical evoked potentials and diffusion tensor imaging to clarify the connectivity between the paracentral lobule and the primary motor cortex (M1). The paper reported a novel finding that fibers connecting the subcentral lobule to M1 can be identified using two methods. They reported that this result could be helpful in predicting the recovery of motor function during surgery for patients with brain tumors

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In Brief

This study aimed to determine the prospective risk and risk factors for symptomatic hemorrhage from a cavernous malformation. Prior symptomatic hemorrhage and a persistent or new bright T1 signal on surveillance brain MRI follow-up were found to predict future hemorrhage. This study confirms hemorrhage rates from prior studies but demonstrates the additional value of surveillance MRI studies 3 months to 1 year after diagnosis and provides a potential marker of disease activity to follow.

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In Brief

This study analyzed changes in National Institutes of Health (NIH) and foundational research funding trends for cerebrovascular (CV) surgeons over time. The analysis revealed that although there was an increase in the number of NIH-funded CV surgeons and NIH grants awarded per CV surgeon, there was also a significant decrease over time in CV surgeons with career development awards. The latter findings suggest that the pipeline for future NIH-funded CV surgeons may be in decline.

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In Brief

The authors describe a computational approach to identify interictal epileptiform discharges (IEDs) from stereoelectroencephalography electrode recordings of patients with epilepsy and leverage the directionality of IED traveling waves to localize the seizure onset zone (SOZ). IEDs heterogeneously localized to the SOZ, but patients with a higher proportion of IED traveling waves had a significantly greater degree of IED colocalization to the SOZ by multivariate regression, making this attribute a potentially useful biomarker for SOZ localization.

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In Brief

Researchers present a novel paradigm of insular glioma treatment with laser interstitial thermal therapy (LITT). Isolated insular tumors were treated with LITT; insular tumors with frontotemporal involvement were treated with LITT and resection of extra-insular disease. Insular LITT is feasible, allows for improved cytoreduction, and may ameliorate the risks of conventional insular glioma surgery. Incorporating LITT into the broader framework of insular glioma treatment may improve outcomes and democratize the ability of neurosurgeons to treat these technically demanding tumors.

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OBJECTIVE

Shunt-dependent hydrocephalus is a major complication of aneurysmal subarachnoid hemorrhage (SAH). Despite this, the factors influencing shunt dependency and shunt failure remain unclear. Therefore, the aim of this study was to estimate shunt dependency and failure rates and determine the contributing factors in patients with aneurysmal SAH using the Korean National Health Insurance database over a 13-year period.

METHODS

Patients with aneurysmal SAH aged > 18 years who underwent surgical procedures were included. Using the shunt surgery prescription data, the shunt-dependent hydrocephalus rate was evaluated according to sex, age, aneurysm location, and year of admission. Among patients who underwent shunt surgery, the shunt failure rate was estimated using surgical prescription data.

RESULTS

A total of 57,030 patients with SAH who underwent aneurysm surgery were included. The overall raw rate of shunt-dependent hydrocephalus was 15.0% (8530/57,030). Age (HR 1.04, 95% CI 1.04–1.04; p < 0.001) and endovascular coiling (vs surgical clipping, HR 0.71, 95% CI 0.67–0.74; p < 0.001) were related to shunt-dependent hydrocephalus in the multivariate logistic regression analysis. Posterior circulation and anterior communicating aneurysms showed a high risk of shunt dependency. Among 8530 patients who underwent shunt surgery, the shunt failure rate was 11.3% (961/8530). Female sex (HR 1.18, 95% CI 1.01–1.39; p = 0.0324), age (HR 0.99, 95% CI 0.98–0.99; p < 0.001), early shunt placement (HR 1.25, 95% CI 1.08–1.47; p = 0.004) and lumboperitoneal shunt placement (HR 2.19, 95% CI 1.65–2.91; p < 0.001) were the risk factors for shunt failure in the multivariate logistic regression analysis.

CONCLUSIONS

The rate of shunt-dependent hydrocephalus after aneurysmal SAH was 15.0% in this study using a medical claims database in Korea. The shunt surgery rate was highest in patients in their 60s and 70s. Shunt failure occurred in 11.3% of the patients, and a lumboperitoneal shunt was most related to the need for revision surgery.

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In Brief

This study aimed to evaluate the efficacy of deep brain stimulation (DBS) targeting superior cerebellar peduncles (SCPs) in adults with spastic cerebral palsy. The authors found significant improvements in dystonic and spastic symptoms and quality of life, along with evidence of engaged contacts within the dentato-rubro-thalamic tract, suggesting a mechanistic insight into SCP DBS. These findings add value by highlighting SCP DBS as a promising, well-tolerated treatment for alleviating symptoms in spastic cerebral palsy.

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In Brief

This study assessed barriers to neurosurgery among medical students, with a focus on the interaction between gender and race. Upon stratification of students by gender and underrepresented in medicine (URM) status, female URM students were found to be most hesitant toward neurosurgery due to opportunities for health equity work and the presence of individuals who share their identities within the field. These findings offer insights into the challenges faced by female and URM students considering neurosurgery, exposing persistent barriers in the field.

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In Brief

The authors aimed to develop a nomogram to predict good neoangiogenesis in patients with moyamoya disease (MMD) and type 2 diabetes mellitus (T2DM) to aid neurosurgeons in the identification of suitable candidates for EDAS. Four predictors (FGD5 rs11128722, VEGFA rs9472135, Suzuki stage, and internal carotid artery moyamoya vessels) were used for nomogram development. The nomogram developed in this study accurately predicted neoangiogenesis in patients with MMD and T2DM after EDAS and may assist neurosurgeons in identifying suitable candidates for indirect revascularization surgery.

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In Brief

The goal of this study was to evaluate the feasibility of a minimally invasive approach to the middle cranial fossa using a novel endaural subtemporal (EAST) keyhole. Representative imaging from cadaveric dissection is provided with a stepwise discussion of the procedure, and descriptions of 6 patients who underwent craniotomy via the approach are presented. Further research is needed to establish the limitations and potential complications of this novel approach.

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In Brief

This study aimed to identify the histopathological changes within the aneurysm sac following flow diverter treatment. Healed aneurysms exhibited myofibroblasts, collagen, and a well-organized fibrin network in the aneurysm neck. In contrast, unhealed aneurysms displayed a poorly organized fibrin network with scattered myofibroblasts. This study suggests that the degree of fibrin accumulation within the aneurysm sac and organization of the fibrin network can affect the outcomes of flow diversion.

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TO THE EDITOR: We commend Burkhardt et al. 1 for examining the important topic of neurosurgery resident case volumes (Burkhardt E, Adeeb N, Terrell D, et al. Factors impacting neurosurgery residents’ operative case volume: a nationwide survey. J Neurosurg. 2024;140[2]:570-575). Undoubtedly, case volume significantly influences resident training when all factors are held equal. However, this study contained several confounders worthy of further discussion. First, the reliance on self-reported, survey-based estimates of faculty case volume induced subjectivity. Similarly, this survey restricted necessary nuance by reducing complex variables to binary responses. For example, in many programs, resident

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TO THE EDITOR: We commend Hopkins et al. 1 for their tremendous contribution to our field with AtlasGPT (Hopkins BS, Carter B, Lord J, et al. Editorial. AtlasGPT: dawn of a new era in neurosurgery for intelligent care augmentation, operative planning, and performance. J Neurosurg. 2024;140[5]:1211-1214). This work highlights the pioneering technological spirit driving our discipline, pursuing excellence in neurosurgical practice, education, and research. With its retrieval-augmented generation (RAG) architecture leveraging a rich collection of neurosurgical articles, AtlasGPT exemplifies the ongoing strides and the forthcoming challenges of biomedical large language model (LLM)–driven applications.

RAG is

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In Brief

Health-related quality of life (HRQOL) is an increasingly important metric in brain tumor care. The authors reviewed interventions aimed at the most important determinants of HRQOL in glioma, with a particular emphasis on fatigue, sleep disturbance, anxiety, depression, neurocognitive dysfunction, caregiver distress, and end-of-life concerns. Implementation of evidence-based interventions to address these determinants of HRQOL in a coordinated program has the potential to be transformative for the care of patients with brain tumors.

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Researchers aimed to compare the safety and effectiveness of the Woven EndoBridge (WEB) device for intracranial aneurysms with the traditional approaches of primary and stent-assisted coiling. This meta-analysis of 16 studies showed comparable complete and adequate aneurysm occlusion rates on the follow-up evaluation between the study groups with a significantly lower rate of complications in the WEB device group. The study provides high-quality evidence on the safety and effectiveness of WEB device for intracranial aneurysms.

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This study aimed to develop and validate a predictive nomogram model for long-term rebleeding events in patients with hemorrhagic moyamoya disease (HMMD). Four predictors (age at onset, number of episodes of bleeding, posterior circulation involvement, and encephaloduroarteriosynangiosis [EDAS] surgery) were selected for development of the nomogram, which accurately predicted rebleeding events and assisted clinicians in identifying high-risk patients and devising individual treatments. Comprehensive and ongoing monitoring should be implemented in specific patients with HMMD throughout their entire lifespan.

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The researchers' objective was to develop and test a device for improving the accuracy of bedside ventriculostomy placement. The device allows the neurosurgeon to set an angle of entry, based on CT scans, that would lead to accurate ventriculostomy insertion. Device use was tested on phantom skulls and showed increased success over the Ghajar guide. This study reports a device and methodology that seek to improve the accuracy of bedside ventriculostomy placement.

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Researchers reviewed records from the Waring Historical Library at the Medical University of South Carolina and described a case of peripheral nerve repair occurring in 1880. This case stands as one of the earliest descriptions in the United States of peripheral nerve repair with the restoration of function. This paper provides an interesting historical anecdote that demonstrates the principles of peripheral nerve injury management still employed today.