Journal of Neurosurgery
Volume 132: Issue 1 (Jan 2020): Pages 1-332
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In Brief

The authors assessed outcomes in stroke patients after removal of nonfunctional tissue of the brain and found that this procedure was associated with improved neurological outcome in some cases, especially young stroke patients with large infarction areas. This important finding indicates that aggressive operative decompression, including resection of nonfunctional brain tissue, leads to better neurological outcomes in selected patients.

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Patients with an aneurysm rupture are at increased risk of stroke. The tool we currently have for stroke detection is a specialized ultrasound of brain vessels that is not always reliable. The authors used a special camera called a pupillometer that can detect pupil variations to identify patients at higher risk for stroke after an aneurysm bleed. They found that pupillometry could potentially identify patients at a higher risk and could predict strokes by 4 to 8 hours.

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The authors sought to demonstrate that upregulation of IGFBP3 is correlated with advanced tumor grades and unfavorable prognoses in glioma patients and that suppression of IGFBP3 induces cell apoptosis, delays in vivo tumor growth, and prolongs survival in a mouse model. The study results indicate that depleting IGFBP3 may be a useful therapy for high-grade gliomas, which have long been considered incurable and have little response to current therapies.

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The authors demonstrated the ability to recognize an important mutation in brain tissue during surgery using a rapid (< 5-minute) chemical test made by mass spectrometry in the operating room. Better patient outcomes are associated with more complete tumor resection.This mutation permits more aggressive resection, but the mutation status must be known at the time of surgery for the surgeon to be able to act on this knowledge and so that outcomes are improved.

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The authors developed a novel simple scoring system to predict the results of microsurgical decompression in patients with trigeminal neuralgia by using preoperative clinical and radiological findings. The resulting assessment tool has a numeric scale ranging from 3 to 0, with higher scores indicating better results, and allows surgeons to predict patient outcomes based on individual patient findings and provide pretreatment counseling to patients based on their own specific predicted outcomes.

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In a preclinical model of neuropathic pain, the authors sought to understand the therapeutic mechanisms of motor cortex stimulation used to treat patients with refractory neuropathic pain syndromes. The results show that the neurotransmitters glycine and GABA released in the periaqueductal gray are the key factors responsible for analgesia induced by cortical stimulation.

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The history of nerve stretching is a fascinating history: as a treatment for various disorders, repair of long nerve gaps, and augmenting regeneration. Yet, the detrimental effects of nerve stretching are well researched. In this paper, the overlap between these opposing positions is explored through the lens of time.

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The authors studied whether or not differences in individual patient anatomy impact the likelihood of procedural success for mechanical thrombectomy in acute ischemic stroke with large-vessel occlusion. Their work is important because an association between anatomical factors and procedural success has not been previously described. The authors’ findings may help in the development of improved thrombectomy devices and techniques.

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The authors present an analysis of 20 patients with recurrent malignant gliomas that were treated with combined 5-aminolevulinic acid (5-ALA) fluorescence-guided resection and photodynamic therapy (PDT) as an innovative and safe method for local tumor control. In the past, PDT using porfimer sodium has been investigated but abandoned due to side effects and lack of survival benefits. The authors believe that their new approach offers possible treatment options for patients with glioblastoma.

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The necessity of preoperative steroid replacement in patients with an intact hypothalamic-pituitary-adrenal (HPA) axis undergoing endoscopic transsphenoidal surgery (ETSS) for nonfunctioning pituitary adenoma (NFPA) was evaluated. Intraoperative serum cortisol levels were significantly higher in patients receiving 100 mg of preoperative hydrocortisone compared with those receiving saline. No patient showed intraoperative hypotension due to adrenal insufficiency. These results suggest that preoperative steroid replacement may be unnecessary in patients with an intact HPA axis undergoing ETSS for NFPA.

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This study was performed to evaluate the effectiveness and safety of a new noncompletely occlusive net-assisted remodeling technique using the Cascade net device for temporary bridging of intracranial aneurysms.

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The authors studied the safety, efficacy, and clinicoradiological outcomes of Gamma Knife radiosurgery (GKRS) on large posterior fossa metastases. There is a paucity of literature that addresses the effect of GKRS in large posterior fossa brain metastases (LPFMs) on peritumoral edema (PTE) and corresponding fourth ventricle volume. In this retrospective review, the authors showed that GKRS resulted in a statistically significant reduction in tumor, PTE, and fourth ventricular volumes. This treatment can be considered for select cases of LPFM, especially in poor surgical candidates.

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Stroke is a leading cause of adult morbidity and mortality. The incremental cost of mechanical thrombectomy is $10,840 compared to medical therapy alone. However, its improvement in functional outcome and avoidance of disability makes it a cost-effective procedure. For mechanical thrombectomy, purchasing devices through a bundled model resulted in a significant hospital cost savings compared to the traditional model of à la carte device purchasing. Adoption of bundled purchasing may improve the risk-sharing balance so that device companies share an increased portion of the cost of acute stroke care.

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Many patients are still suffering from intracerebral hemorrhages despite extensive research. The authors aimed to establish the role of a cell surface marker in CSF to gain further insights after intracerebral hemorrhages. This study showed an impressive increase of these markers compared to healthy adults and also revealed an impact on outcome.

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This article seeks to analyze the decisions Harvey Cushing made with the challenging case of HW, an adolescent boy with a craniopharyngioma involving the third ventricle. HW's case provides valuable lessons for neurosurgeons today, particularly the importance of dedicating all possible time and energy to save a life. Cushing's concepts and perspectives about the importance of scientific knowledge and ethical commitment to the patients are as relevant as ever to guide current generations of neurosurgeons.

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The authors developed a new technique for wrist extension restoration in radial nerve paralysis. They describe their anatomical cadaveric findings and report the results of their nerve transfer technique in 5 patients followed for at least 24 months postoperatively. Although some anatomical studies pertaining to nerve transfer surgery for radial nerve reconstruction have been published, the course and disposition of the pronator teres motor branches and histomorphometric analysis have been lacking until now.

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The authors report their experience in participating in global neurosurgery advocacy at the most recent World Health Assembly. The report captures important elements of current and future areas of advocacy and policy change within global health.

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The surgical treatment for refractory cluster headache is randomly selected and its efficacy is still being proved. In the present study the authors attempted to show how the treatments they use (occipital nerve stimulation and deep brain stimulation) are affecting their patients over time and also tried to determine if there are any predictors of good clinical response to these treatments. The authors believe this is important because it allows one to better select the right technique for the right population.

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The authors explored the use of vessel wall MRI (VWMRI), which has shown potential for use in detecting unstable aneurysms, and hemodynamic characteristics and pathophysiological links to instability, which have not been investigated, to improve risk assessment of incidentally detected unruptured intracranial aneurysms by combining high-resolution computational fluid dynamics with 3D VWMRI to detect and characterize potentially unstable aneurysms. This research is of critical importance because the authors propose hemodynamic predictors that may be more robust than the current standard, which is based on the size and shape of the aneurysm.

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The authors investigated changes in cerebral blood flow (CBF) and the energy metabolic state of the brain during treatment to improve blood flow and avoid ischemic complications in patients after severe aneurysmal subarachnoid hemorrhage. This study contributes to the understanding of the effects of different strategies to augment CBF, which may hopefully be of aid in future clinical decision-making and management of this group of patients.

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The authors focused on the recruitment of homotopic areas in brain lesion–induced functional neuroplasticity in patients with temporal glioma. Their findings provide evidence for a homotopic functional reorganization in glioma patients, which may contribute to memory recovery and predict the extent of specific functional impairment. The findings may have great clinical significance to help neurosurgeons make individualized treatment assessments for patients when considering the iterative resection or extended resection of gliomas in eloquent areas.

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The authors discovered that patient age and artery involvement by the tumor strongly predict tumor recurrence in patients with cranial base chondrosarcoma. Importantly, these two variables are known preoperatively and can guide pre-, intra-, and postoperative surgical management decisions. To this end, the authors propose a simple risk classifier that can inform intraoperative decision-making and guide postoperative management.

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Subdural hematomas and hygromas (SDHs) are common complications in patients with shunted idiopathic normal pressure hydrocephalus (iNPH), and in this registry-based study, such patients were screened nationwide to identify perioperative variables that might increase the risk of SDH.

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The authors found that resection of the hippocampus was associated with associative memory, and that resection of the anterior part of the hippocampus was associated with immediate recall. Resection of the posterior part of the hippocampus was associated with delayed recall. This is the first study to investigate the effect of temporal resection on postoperative memory decline by employing voxel-based analysis, which accounts for individual differences in the extent and locus of resection.

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The aim of this study was to provide an honest and critical assessment of the current state of the art of endoscopic surgery for orbital tumors, involving the personal case series of the authors and a systematic literature review. The recent technological advancement of new intraoperative tools to help the surgeon is extensively considered as well. The endoscopic endonasal and endoscopic transpalprebal approaches have demonstrated to be safe and effective for tumors located in medial and lateral quadrants, respectively, permitting one to approach orbital lesions endoscopically from 360°.

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The authors performed in vitro and in vivo studies of ultrasound transmission through a cranial prosthesis. The prosthesis may serve for several diagnostic and therapeutic ultrasound-based applications, including bedside imaging of the brain and ultrasound-guided focused ultrasound cerebral procedures.

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The authors analyzed clinical specimens and found that the regulatory network of the MEG3/MIR-376B-3P/HMGA2 pathway was involved in the invasiveness of clinical nonfunctional pituitary adenomas (PAs). The authors confirmed their hypothesis through in vivo and in vitro experiments. These results can provide evidence for the treatment of invasive PAs.

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The authors analyzed meningioma brain tumor growth rates among a group of adult patients and determined that tumor size, location, and the amount of tumor left after initial surgery are important factors in predicting if and how quickly the tumor grows back, which helps to personalize treatment decisions such as the imaging follow-up schedule and additional therapies after tumor removal.

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In the largest longitudinal brain analysis cohort of CD patients to date, the authors assessed the reversibility of whole-brain changes in Cushing’s disease (CD) cured by transsphenoidal surgery and the correlations of brain recovery with clinical and hormonal parameters. These findings are important because they provide the first direct demonstration of the rapid reversal of total gray matter loss in remitted CD and suggest that levels of ACTH and serum cortisol are reliable serum biomarkers for clinical use to assess brain recovery after surgical treatment of CD.