Journal of Neurosurgery
Volume 131: Issue 5 (Nov 2019): Pages 1347-1682
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In Brief

The authors compared clinical results in patients with newly diagnosed glioblastoma who were treated with or without photodynamic therapy (PDT) using talaporfin sodium and semiconductor laser. The PDT group showed statistically better overall survival (27.4 months) than the control group (22.1 months). Progression-free survival was also longer in the PDT group (19.6 months) than the control group (9.0 months). A randomized clinical trial is warranted, and PDT may become the standard treatment for glioblastoma in the future.

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Malignant peripheral nerve sheath tumors are devastating malignancies with an immense opportunity for advancement in therapeutic options. The work described in this paper was performed in an effort to help people suffering from these tumors and represents a first step toward utilizing targeted intratumoral therapy as a novel treatment strategy.

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Endovascular thrombectomy has been a standard treatment for acute large vessel occlusion strokes since multiple randomized controlled trials confirmed its efficacy. Together with a faster and higher grade of recanalization, complete recanalization with a first-pass stent retriever thrombectomy (first-pass recanalization [FPR]) has been suggested as an independent predictor of a good outcome. Here, the authors hypothesized that FPR was also associated with good outcomes in contact aspiration thrombectomy and performed an analysis to test that hypothesis.

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In this paper the authors investigated the surgical anatomy of the foramen lacerum, a gap at the base of the skull formed by the incomplete confluence of the sphenoid, petrous, and clival bones. It has an intimate relation with the internal carotid artery and sits at the crossroad of endoscopic endonasal approaches to the middle and posterior cranial fossa. The authors describe key anatomical concepts that make surgery in this region more accurate and effective.

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Bone flap resorption (BFR) is a frequent complication of autologous cranioplasty (AC), resulting in disfiguring defects and loss of bony coverage of the brain, but the pathophysiology of BFR remains unclear, and no preventive measures have been identified to date. This study investigates risk factors for BFR after AC. The results of the analysis show that hypertensive patients treated with ACE inhibitors demonstrate a lower rate of BFR than patients treated with other hypertensive medications and nonhypertensive patients.

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In this study, the authors implemented two significant changes to the insertion of external ventricular drains (EVDs), one of the most common emergency neurosurgical procedures: 1) a standardized perioperative care bundle, and 2) simulation workshops to improve surgical technique. These changes showed significant improvements in accuracy of EVD placement, reduced infections by almost half, and decreased rates of displacement, all major sources of morbidity and mortality, thereby significantly improving outcomes in a lasting and reproducible fashion.

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This study was performed to correlate the oxidative stress imbalance and inflammatory changes in patients with traumatic brain injury and to relate these to the clinical outcomes. This may help identify the independent biomarker predictors of recovery in patients with moderate to severe traumatic brain injury. From this study clinicians may gain an understanding of the ways in which diagnosis, prevention, modulation, and intervention in traumatic brain injury will minimize or avert the effects of oxidative stress and the inflammatory response and may lead to improved clinical outcomes.

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The motor root of the trigeminal nerve runs close to the sensory root and receives considerable radiation during Gamma Knife radiosurgery (GKRS) for trigeminal neuralgia (TN). The study objective was to evaluate the changes in the muscles of mastication before and after upfront GKRS in patients with idiopathic TN by using MRI. A subset of patients with TN with significant pain on chewing have pre-GKRS disuse atrophy of the muscles of mastication. A reversal of the atrophy occurs in a majority of the patients following GKRS. New-onset motor neuropathy post-GKRS was rare. The study reveals some interesting changes that occur in the muscles of mastication in trigeminal neuralgia.

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In this work the authors present Frazier's contributions to the treatment of craniopharyngiomas (a true accomplishment), and a comprehensive review of Frazier's complete craniopharyngioma series, which he never published.

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The authors reviewed the early postmarket results, including outcomes, technical nuances, and challenges, of the PulseRider device for treatment of wide-necked intracranial aneurysms. This study furthers the knowledge and collective experience with the new PulseRider as it takes its place in the armamentarium of treatments for wide-necked bifurcation aneurysms.

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The authors report for the first time a single-institution validation of the Brain Injury Guidelines. Implementation of care protocol improvements in neurotrauma offers the possibility of both improved care and resource savings in trauma systems.

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The authors compared academic rank achievement in men versus women neurosurgeons after controlling for their institution, number of years in practice, and number of publications. It was found that men were twice as likely as women to achieve the highest academic rank, full professor, after controlling for years in practice and institution. This trend was near significant when controlling for years in practice, institution, and number of publications.

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The authors analyzed data from 114 patients with a posterior fossa arteriovenous malformation and identified a predictor of bad outcome after endovascular treatment that has never been described before.

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This study compares two different approaches to the upper third of the retroclival area: the open pretemporal transcavernous approach and the endoscopic endonasal transcavernous approach. This is the first study to directly compare these approaches and objectively outline the anatomical boundaries of each approach using actual data obtained from human cadaveric specimens.

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This study used MRA to evaluate the quantitative changes in the calibers of donor arteries associated with combined direct and indirect bypass procedures in adults and children with moyamoya disease. The study is important because caliber changes in the donor arteries can be easily measured by MRA and could be used as indicators of direct and indirect bypass development.

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The authors advocate a novel operative method for Rathke’s cleft cyst to prevent recurrences, and they evaluate the outcomes with comparison between this new method and a conventional method. This method is a safe, simple, and effective way to reduce recurrences, therefore it should be widely recognized for readers.

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The infratemporal fossa (ITF) and parapharyngeal space are anatomical regions that can be challenging to access without the use of complex, cosmetically disfiguring approaches. With advances in endoscopic techniques, a new group of surgical approaches to access the intracranial space through the orbit has been recently referred to as transorbital neuroendoscopic surgery. The objective of this study was to establish a transorbital endoscopic approach utilizing the inferior orbital fissure to gain access to the ITF and parapharyngeal space and provide a detailed endoscopic anatomical description of this approach.

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Researchers analyzed clinical outcomes of 142 patients undergoing treatment of unruptured brain arteriovenous malformations. Contrary to the only randomized clinical trial (ARUBA), they found that treatment at a center with a high level of expertise yields good clinical outcomes, with key safety endpoints (stroke, death, and disability) better than ARUBA. Compared to natural history studies, results were favorable at follow-up times of 5–10 years. These findings support current arteriovenous malformation registry studies and future randomized controlled trials.

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This study is the first to report the difference in plasma soluble receptor for advanced glycation end products (sRAGE) levels in a subset of patients with subarachnoid hemorrhage (SAH). The results show that the plasma sRAGE levels could be used as a potential biomarker for the prediction of symptomatic vasospasm after SAH.

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This historical vignette recounts the first 100 years of the Department of Neurosurgery at Virginia Commonwealth University, which is important because it was the first Neurosurgery Department in the Southeast and home to one of the first four residency programs; prominent graduates include Frank Mayfield and Gayle Crutchfield.

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This study is the first to report the difference in plasma soluble receptor for advanced glycation end products (sRAGE) levels in a subset of patients with subarachnoid hemorrhage (SAH). The results show that the plasma sRAGE levels could be used as a potential biomarker for the prediction of symptomatic vasospasm after SAH.

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To date, no human studies have correlated the effect of aspirin on intracranial aneurysm (IA) growth. This paper describes a 10-year retrospective analysis of patients who harbored multiple IAs, had the primary aneurysm treated by surgical or endovascular means, and had remaining aneurysms observed over a follow-up period of at least 5 years after the initial treatment. The authors’ results suggest that, in patients with multiple IAs ≤ 5 mm, aspirin use significantly decreases the risk of aneurysm growth.

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In this study, the authors aimed to evaluate the role of extent of surgical resection in diffuse low-grade gliomas (LGGs), in light of the latest WHO molecular classification. The study results highlight differences in the effects of surgery across the 3 prognostically diverse LGG subgroups, oligodendrogliomas, IDH-mutant astrocytomas, and IDH-wildtype astrocytomas, and can thus help guide surgical decision making.

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This study investigates the correlations between molecular subgroup and clinical features in a large cohort of meningiomas. The authors identify previously undescribed relationships with age, histology, sex, precise location, volume, and Ki-67 index, and confirm earlier associations with location, histology, grade, and volume. These findings suggest that noninvasive patient features carry predictive value for the underlying driver event.

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The authors evaluated the extent of resection and postsurgical outcomes in epilepsy patients with ulegyria who underwent intracranial electroencephalography (iEEG) monitoring prior to resection to clarify the efficacy of iEEG-guided partial resection of ulegyria.

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The authors conducted a nationwide survey of neurosurgical residency program directors, with 93% completion rate, in order to establish the current role of evidence-based medicine curricula in neurosurgical residency training and education. These data can help program directors improve evidence-based medicine curricula at their institutions.