Joseph Haynes, Eytan Raz, Omar Tanweer, Maksim Shapiro, Rogelio Esparza, David Zagzag, Howard A. Riina, Christine Henderson, Kaitlyn Lillemoe, Cen Zhang, Sara Rostanski, Shadi Yaghi, Koto Ishida, Jose Torres, Brian Mac Grory, and Erez Nossek
The authors reviewed clinical and surgical characteristics as well as outcomes in patients who underwent carotid endarterectomy (CEA) for symptomatic internal carotid artery web (CW). They found that for patients with symptomatic CW, CEA was a viable treatment option that corrected the defect without permanent procedural complications, achieved definitive pathological diagnosis, avoided any need for long-term antiplatelet medication, and resulted in no recurrence of ischemic symptoms on follow-up. This series substantiates CEA as a primary treatment modality in this subset of patients.
Hamidreza Rajabzadeh-Oghaz, Muhammad Waqas, Sricharan S. Veeturi, Kunal Vakharia, Michael K. Tso, Kenneth V. Snyder, Jason M. Davies, Adnan H. Siddiqui, Elad I. Levy, and Hui Meng
The authors explored real-world application of a data-driven computer model (Rupture Resemblance Score; RRS) developed to objectively gauge the morphological and hemodynamic similarity of incidentally discovered unruptured intracranial aneurysms (UIAs) to ruptured IAs. They explored RRS applicability to cases where the UIA treatment score (UIATS) model recommendation was not definitive. The UIATS recommendation was not definitive for 43% of the UIAs. Using RRS, those could be stratified based on ruptured IA similarity, thus aiding UIA management.
Christian Hoelscher, Ahmad Sweid, Ritam Ghosh, Fadi Al Saiegh, Kavantissa M. Keppetipola, Christopher J. Farrell, Jack Jallo, Pascal Jabbour, Stavropoula Tjoumakaris, M. Reid Gooch, Robert H. Rosenwasser, and Syed O. Shah
Joshua H. Weinberg, Ahmad Sweid, Kalyan Sajja, M. Reid Gooch, Nabeel Herial, Stavropoula Tjoumakaris, Robert H. Rosenwasser, and Pascal Jabbour
The authors demonstrated the feasibility and safety of CorPath GRX robotic-assisted (RA) transradial (TR) carotid artery stenting (CAS) compared to manual TR CAS. Their results suggest that RA TR CAS is feasible, safe, and effective, however additional neurovascular-specific engineering and software modifications are needed prior to complete remote control and widespread adoption. Complete remote control has important implications regarding operative precision and patient access to lifesaving procedures for conditions such as stroke and aneurysm rupture.
Michael Veldeman, Daniel Lepore, Anke Höllig, Hans Clusmann, Christian Stoppe, Gerrit Alexander Schubert, and Walid Albanna
Researchers determined the relevance of procalcitonin in the context of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage. The predictive value of procalcitonin can be shown in identifying patients who are susceptible to DCI and those who develop a worse clinical outcome. In infection-free patients, procalcitonin levels are indicative of DCI-related infarcts and could be used as an available biomarker for surveillance of DCI treatment.
Joshua S. Catapano, Andrew F. Ducruet, Fabio A. Frisoli, Candice L. Nguyen, Christopher E. Louie, Mohamed A. Labib, Jacob F. Baranoski, Tyler S. Cole, Alexander C. Whiting, Felipe C. Albuquerque, and Michael T. Lawton
The authors analyzed all patients with takotsubo cardiomyopathy (TC) and a ruptured intracranial aneurysm and compared outcomes with those in other aneurysmal subarachnoid hemorrhage patients without TC. This article provides the prognostic significance of TC in aneurysmal subarachnoid hemorrhage.
In this study, the authors demonstrate the usefulness of intraoperative fluorescence videoangiography for recipient vessel selection in extracranial to intracranial bypass surgery. This study is important because its findings highlight the significance of a stratified recipient selection based on objective selection criteria to optimize bypass function.
Branden J. Cord, Sreeja Kodali, Sumita Strander, Andrew Silverman, Anson Wang, Fouad Chouairi, Andrew B. Koo, Cindy Khanh Nguyen, Krithika Peshwe, Alexandra Kimmel, Carl M. Porto, Ryan M. Hebert, Guido J. Falcone, Kevin N. Sheth, Lauren H. Sansing, Joseph L. Schindler, Charles C. Matouk, and Nils H. Petersen
In this study, the authors evaluated whether stroke patients with difficult blood vessel anatomy, such as increased tortuosity that precluded a catheter-based approach through the groin, can safely and effectively be treated with direct puncture of the carotid artery. The transcarotid approach was associated with higher rates of blood vessel recanalization, smaller stroke volumes, improvement in stroke severity, and better functional outcome compared with standard of care management after failed transfemoral thrombectomy. This study supports the use of transcarotid puncture for mechanical thrombectomy in patients with challenging vascular anatomy.
Pierina Navarria, Federico Pessina, Elena Clerici, Zefferino Rossini, Davide Franceschini, Giuseppe D’Agostino, Ciro Franzese, Tiziana Comito, Mauro Loi, Matteo Simonelli, Elena Lorenzi, Pasquale Persico, Letterio Salvatore Politi, Marco Grimaldi, Lorenzo Bello, Armando Santoro, Maurizio Fornari, Franco Servadei, and Marta Scorsetti
The authors reviewed data of newly diagnosed anaplastic glioma (AG) classified according to new WHO 2016 CNS classification. The primary aim was to identify prognostic factors, other than IDH status, that impact outcome. Their analysis suggests that other prognostic factors, such as extent of resection and residual tumor volume, have to be considered as well as IDH status, and underline the fundamental role of adjuvant radiotherapy in all AG patients. Few papers have assessed in detail prognostic factors predicting outcome of AG in light of the WHO classification, contributing to clinical decision-making in this heterogeneous subset of primary brain tumors.
Adham M. Khalafallah, Sakibul Huq, Adrian E. Jimenez, Henry Brem, and Debraj Mukherjee
The authors performed, to their knowledge, the first comparative analysis of the effectiveness of the Charlson Comorbidity Index (CCI), the 11-factor modified frailty index (mFI-11), and the 5-factor modified frailty index (mFI-5) in predicting postoperative mortality among brain tumor patients. An important finding was that the mFI-5 predicts postoperative mortality as effectively as the CCI and the mFI-11. Therefore, the simpler mFI-5 can be integrated into clinical workflows to efficiently determine ideal candidates for brain tumor surgery.
Adham M. Khalafallah, Adrian E. Jimenez, Carlos G. Romo, David Olayinka Kamson, Lawrence Kleinberg, Jon Weingart, Henry Brem, Stuart A. Grossman, and Debraj Mukherjee
The authors quantified the efficacy of multidisciplinary tumor boards (MDTBs) by tracking changes in diagnostic interpretations and treatment plans for brain tumor patients after their cases were discussed. The study results demonstrate that MDTB discussions led to a significant number of diagnostic and treatment plan changes, as well as shortened referral times, for patients whose cases were discussed, highlighting the clinical impact of multidisciplinary care within this patient population.
Luigi Maria Cavallo, Diego Mazzatenta, Elena d’Avella, Domenico Catapano, Marco Maria Fontanella, Davide Locatelli, Davide Luglietto, Davide Milani, Domenico Solari, Marco Vindigni, Francesco Zenga, Gianluigi Zona, and Paolo Cappabianca
The authors gathered a large number of cases from different Italian centers in order to analyze the evolution of the specific management of clival chordomas over a 20-year time frame. It is hoped that this contribution will serve as useful information for the surgeon in the management of chordomas.
Chiman Jeon, Sang Duk Hong, Kyung In Woo, Ho Jun Seol, Do-Hyun Nam, Jung-Il Lee, and Doo-Sik Kong
This study aimed to investigate the feasibility of 360° circumferential access to orbital tumors using both an endoscopic transorbital superior eyelid approach (ETOA) and an endoscopic endonasal approach (EEA) according to a "four-zone model" by its epicenter around the optic nerve in the coronal plane. Unlike previous literature reports, the authors found that without transcranial approaches, endoscopic techniques via the transorbital and endonasal corridors allowed for successful removal of orbital tumors by providing minimally invasive 360° circumferential access with acceptable morbidities. The authors' results show that ETOA and EEA should be considered feasible alternative treatment modalities for orbital tumors.
Brett E. Youngerman, Matei A. Banu, Mina M. Gerges, Eseosa Odigie, Abtin Tabaee, Ashutosh Kacker, Vijay K. Anand, and Theodore H. Schwartz
The authors show that the endoscopic endonasal technique is a safe and effective approach to suprasellar meningiomas, with favorable visual outcomes. The combination of postoperative MRI and direct endoscopic inspection can be used in lieu of Simpson grade to predict recurrence. Gross-total resection dramatically reduces long-term recurrence and can be achieved regardless of tumor size, relation to the anterior cerebral artery, or medial optic canal invasion. Risk factors for incomplete resection include prior surgery, tumor lateral to the optic nerve, and complete internal carotid artery encasement. A 3-item score based on these factors is highly predictive of extent of resection.
Neil S. Patel, Matthew L. Carlson, Michael J. Link, Brian A. Neff, Jamie J. Van Gompel, and Colin L. W. Driscoll
In this study, patients with vestibular schwannoma underwent radiosurgery to treat the tumor and cochlear implantation for hearing rehabilitation in the ear affected by tumor. This study is important because it comprehensively reports the largest single-institution experience with these patients and, in doing so, offers evidence to support the use of this strategy in the nuanced management of patients with neurofibromatosis type 2–associated or sporadic vestibular schwannoma.
The authors investigated the fine architecture of the fibrous network and fatty matrix in the jugular foramen. The resulting presentation of these anatomical details may aid neurosurgeons in planning surgical approaches to the region and increase understanding of how tumors in this area grow.
Michael P. Catalino, David M. Meredith, Umberto De Girolami, Sherwin Tavakol, Le Min, and Edward R. Laws Jr.
These researchers compared clinical features, histopathology, and surgical outcomes in patients with Cushing disease who had either a typical adenoma or corticotroph hyperplasia. Patients with hyperplasia had more obscure imaging findings, and they often required additional laboratory testing to confirm the diagnosis of Cushing disease. The surgical approach to hyperplasia was more nuanced, but the biochemical outcomes may be similar. This association between corticotroph hyperplasia and Cushing disease brings some clarity to a disease fraught with ambiguity.
William E. Gordon, William M. Mangham, L. Madison Michael II, and Paul Klimo Jr.
The authors sought to identify the economic value of on-call services provided by neurosurgical residents. Neurosurgery residents at the authors' institution produce enough theoretical economic value exclusively from on-call activities to far exceed the cost of their education. This information could be used to more precisely estimate the true overall cost of neurosurgical training and determine future graduate medical education funding.
Russell R. Lonser, Luke G. F. Smith, Michael Tennekoon, Kavon P. Rezai-Zadeh, Jeffrey G. Ojemann, and Stephen J. Korn
The authors assessed the effectiveness of National Institute of Neurological Disorders and Stroke–initiated programs to increase the number of independent National Institutes of Health–funded neurosurgeon-scientists and grow National Institutes of Health neurosurgery research funding. Targeted research education and career development programs initiated by the National Institute of Neurological Disorders and Stroke led to a rapid and dramatic increase in the number of National Institutes of Health–funded neurosurgeon-scientists and total National Institutes of Health neurosurgery department funding.
Isaac Josh Abecassis, Rajeev D. Sen, Richard G. Ellenbogen, and Laligam N. Sekhar
The authors compiled the steps and funding needed for neurosurgical residents to assemble a “home microsurgery lab” (HML), providing an educational paradigm for microsurgical skill acquisition that can be used to attain critical milestones in the context and style of other core competencies of the Accreditation Council for Graduate Medical Education, particularly in a setting of limited in-person or in-hospital opportunities. To the authors' knowledge, this is the first formal description of an HML for neurosurgeons that enhances educational opportunities for microsurgical trainees, regardless of preexisting abilities or training.
Eric Suero Molina, Michael P. Catalino, and Edward R. Laws
The authors compiled a substantial summary of information regarding the important international neurosurgeons who influenced Harvey Cushing's early career or were influenced by Harvey Cushing as his students in Boston, many of whom became neurosurgery pioneers in their own countries. This historical information is important to our understanding of Cushing's profound influence in establishing not only the profession of neurosurgery but also a movement based on international cooperation that revolutionized modern medicine around the world and remains essential for the continuing success of neurosurgery now and in the future.
Paul M. Brennan, Gordon D. Murray, and Graham M. Teasdale
The Glasgow Coma Scale (GCS) is used to assess consciousness in head-injured patients. The authors devised a simple tool to employ when a patient's injuries prevent a full assessment being made. They demonstrated its utility by applying it to the GCS-Pupils prognostic model, which is used to predict patient outcome. This strategy supports the clinician's estimation of injury severity and patient prognosis, informing decision-making and communication with families.
Ranjan Gupta, Justin P. Chan, Jennifer Uong, Winnie A. Palispis, David J. Wright, Sameer B. Shah, Samuel R. Ward, Thay Q. Lee, and Oswald Steward
The study presents the first-ever description of the temporal profile of human motor endplate (MEP) degeneration following peripheral nerve injury (PNI) with the findings that MEP degeneration differs in time course between humans and mice or rodents and that denervated MEPs may persist in humans for years. The results highlight the importance of species-specific findings and may serve to objectively answer critical questions regarding the optimal timing of both surgical intervention and adjuvant treatments for PNIs.
Andrea Franzini, Luca Attuati, Ismail Zaed, Shayan Moosa, Antonella Stravato, Pierina Navarria, and Piero Picozzi
In this study the authors assessed the safety and efficacy of stereotactic central lateral thalamotomy with Gamma Knife radiosurgery in patients with neuropathic pain. Central lateral thalamotomy for the treatment of neuropathic pain has been performed before with radiofrequency thermal ablation and MR-guided focused ultrasound ablation by a single group, but not with the technique reported here.
Monica Mureb, Danielle Golub, Carolina Benjamin, Jason Gurewitz, Ben A. Strickland, Gabriel Zada, Eric Chang, Dušan Urgošík, Roman Liščák, Ronald E. Warnick, Herwin Speckter, Skyler Eastman, Anthony M. Kaufmann, Samir Patel, Caleb E. Feliciano, Carlos H. Carbini, David Mathieu, William Leduc, DCS, Sean J. Nagel, Yusuke S. Hori, Yi-Chieh Hung, Akiyoshi Ogino, Andrew Faramand, Hideyuki Kano, L. Dade Lunsford, Jason Sheehan, and Douglas Kondziolka
The authors conducted a multicenter retrospective review studying how stereotactic radiosurgery (SRS), when used as the primary surgical intervention in patients with typical trigeminal neuralgia, affects pain outcomes and medication usage based on the time course between diagnosis and radiosurgery. They found that patients managed with SRS within 4 years of diagnosis experienced a shorter interval to pain relief with low risk and that SRS yielded significant decreases in adjunct medication utilization..
Patrick S. Rollo, Matthew J. Rollo, Ping Zhu, Oscar Woolnough, and Nitin Tandon
The authors investigated the relationship between electrode angle of entry and resulting accuracy of electrode placement and subsequent patient outcomes. The study is important because it provides clear evidence of the efficacy and safety of oblique trajectories.
Baotian Zhao, Chao Zhang, Xiu Wang, Yao Wang, Jiajie Mo, Zhong Zheng, Lin Ai, Kai Zhang, Jianguo Zhang, Xiao-qiu Shao, and Wenhan Hu
The authors explored the neuronal networks underlying a series of rare orbitofrontal epilepsy and report the surgical outcome. This study provides solid evidence regarding seizure propagation originating from the orbitofrontal cortex, and the surgical strategies as well as outcomes are also reported, which are important for guiding surgical management of orbitofrontal epilepsy.
Baotian Zhao, Chao Zhang, Xiu Wang, Yao Wang, Chang Liu, Jiajie Mo, Zhong Zheng, Kai Zhang, Xiao-qiu Shao, Wenhan Hu, and Jianguo Zhang
The authors proposed a sulcus-based resection strategy for focal cortical dysplasia, and the efficacy and safety of this method were also assessed. The sulcus-based concept and its related surgical techniques may be more advantageous for focal cortical dysplasia type II management.
Ying Meng, Christopher B. Pople, Suneil K. Kalia, Lorraine V. Kalia, Benjamin Davidson, Luca Bigioni, Daniel Zhengze Li, Suganth Suppiah, Karim Mithani, Nadia Scantlebury, Michael L. Schwartz, Clement Hamani, and Nir Lipsman
MR-guided focused ultrasound (MRgFUS) thalamotomy is a novel surgical treatment for patients with severe tremor-dominant Parkinson's disease. In a health economic comparison, researchers found MRgFUS to be cost-effective for continued medical therapy and deep brain stimulation. This advantage is more robust for the former than the latter. This finding is significant to the integration of MRgFUS technology in the healthcare system.
Travis J. Atchley, Galal A. Elsayed, Blake Sowers, Harrison C. Walker, Gustavo Chagoya, Matthew C. Davis, Joshua D. Bernstock, Nidal B. Omar, Daxa M. Patel, and Barton L. Guthrie
The authors investigated the incidence of seizures occurring after placement of deep brain stimulation electrodes and tried to identify patients and operative variables that may contribute to this complication. This study will help counsel patients on their risk of seizure and may aid in patient selection especially for those at greater risk of postoperative seizures.
Weiyuan Huang, Richard Ogbuji, Liangdong Zhou, Lingfei Guo, Yi Wang, and Brian H. Kopell
The authors sought to determine how iron deposition gradients (measured by quantitative susceptibility mapping [QSM] MRI) within and around the subthalamic nucleus (STN) are correlated with the severity of Parkinson's disease (PD). Loss of the iron deposition gradient within the STN, as well as the loss between adjacent white matter and the STN, correlates with more advanced PD. This parameter is a possible imaging surrogate for disease progression and is a foundation for further study into the efficacy of deep brain stimulation in patients with different STN types.
Benjamin Davidson, Karim Mithani, Yuexi Huang, Ryan M. Jones, Maged Goubran, Ying Meng, John Snell, Kullervo Hynynen, Clement Hamani, and Nir Lipsman
Researchers studied the radiographic features and sonication parameters involved in magnetic resonance imaging–guided focused ultrasound (MRgFUS) capsulotomy for psychiatric disorders. They demonstrated that achieving target heating is more difficult than what has been reported following MRgFUS thalamotomy and may depend on features beyond skull density, such as skull thickness and incidence angle.
Michael B. Keough, Albert M. Isaacs, Geberth Urbaneja, Jarred Dronyk, Andrew P. Lapointe, and Mark G. Hamilton
Acute low-pressure hydrocephalus (ALPH) is a neurological condition that is very difficult to treat because despite patients having clinical manifestations of high pressure and large fluid spaces in the brain, their measured pressures are paradoxically low and not amenable to standard treatments. In this study the authors assessed 195 patients with ALPH and present diagnosis and treatment strategies in managing this debilitating neurological disorder. This study is the largest to date on this topic and the treatment algorithm provided should be a valuable resource for neurosurgeons faced with management of this challenging problem.
Alberto Feletti, Alessandro Fiorindi, Vincenzo Lavecchia, Rafael Boscolo-Berto, Elisabetta Marton, Veronica Macchi, Raffaele De Caro, Pierluigi Longatti, Andrea Porzionato, and Giacomo Pavesi
The authors provide a detailed endoscopic description of the normal anatomy of the posterior third ventricle and its physiological variations, as observed during neuroendoscopic procedures. They also compare the normal anatomy with the alterations due to chronic hydrocephalus. This study is important because the authors provide for the first time a thorough fully endoscopic description of the anatomy of the normal and hydrocephalic third ventricle. This is of the utmost importance for neurosurgeons who want to begin ventricular endoscopy.
The authors describe the birth of neurosurgery in the state of Oklahoma with the arrival of Harry Wilkins and his herculean efforts. He and others were pivotal to the development of what is now the Department of Neurosurgery at the University of Oklahoma, which has led through conflict and national tragedy. The University of Oklahoma, in productive community partnerships, has continued a long tradition of excellence in clinical care and investigation, and its educational program remains its cornerstone.
The exact method of defining the boundary in the optic nerve sheath diameter (ONSD) measurements has not been determined. The authors aimed to compare different methods of obtaining this measurement. They found that, compared with the ONSD excluding the dura mater, the ONSD including the dura mater better estimated the intracranial pressure (ICP). The ONSD/eyeball transverse diameter ratio including the dura mater with a cutoff value of 0.264 best predicted increased ICP. This measurement may be helpful in patients who require invasive ICP monitoring.
Insular gliomas invade surrounding structures not by chance but follow certain extension routes. The authors studied these patterns by analyzing the co-involvement of 12 anatomical structures at presentation in 59 patients with surgically treated gliomas and correlated these patterns with demographic, pathological, genetic, and survival data. The analysis indicated that most insular gliomas were confined to the olfactocentric girdle of the limbic system. Extension into the hippocampocentric girdle but not surrounding opercula was associated with a significantly poorer outcome.
The objective of this study was to establish platform-specific social media guidelines by investigating how stakeholders in the brain tumor community utilize Facebook, Twitter, and YouTube. The authors found that themes differed in popularity across platforms, and conscious incorporation of these themes into content may increase account visibility. The authors propose that medical professionals can increase online accessibility of evidence-based information and better connect with their patient populations on social media by incorporating the latest evidence from the literature and by following guidelines.
The object of this paper was to demonstrate the academic impact of international research fellows in the field of neurosurgery. Despite facing major challenges, international research fellows make substantial academic contributions and reciprocate mentorship in the neurosurgical department. This finding should encourage continued recruitment of global talents to the field of neurosurgery.
This study examined the differences in outcomes and risk factors for persistent symptoms between men and women in a community sample of adult patients with concussion who presented to three Canadian emergency departments. While demographic differences between the sexes were uncommon, women reported more symptoms and experienced a delay in recovery after discharge. These results represented real-world evidence of sex differences in patients with concussion and reinforced the need to consider patient sex in the management and future research.
This study aimed to determine the incidence of brain tumor–related epilepsy (BTE) associated with metastatic brain tumors and retrospectively investigate the risk factors. BTE was recorded in 24.6% of patients during the entire course of treatment. Logistic regression analysis identified young age, male sex, breast cancer, eloquent area, peritumoral edema, dissemination, and maximum tumor volume as significant risk factors. BTE was more common with tumor volumes greater than the cutoff value of 1.92 ml.
The authors asked whether nonrandom distributions of brain metastasis vary according to primary cancer subtype and stereotactic radiosurgery coordinates utilized for treatment of brain metastasis. The authors concluded that nonuniform spatial distributions of metastasis to preferential brain regions vary according to primary cancer subtype. These cancer-specific brain topographic patterns may underlie the ability of tumor cells to adapt to regional neural microenvironments in order to facilitate colonization and establish metastasis.
Researchers investigated the epidemiological characteristics, associated risk factors, and prognostic value of glioma-related epilepsy in patients with diffuse high-grade gliomas diagnosed after implementation of the 2016 updated World Health Organization classification. The occurrence of preoperative and postoperative glioma-related epilepsy was associated with 3 and 4 clinical characteristics, respectively. Postoperative glioma-related epilepsy predicted longer overall survival time. The results provided new insights into the management of glioma-related epilepsy for the benefit of patients with diffuse high-grade gliomas.
In patients with obsessive-compulsive disorder (OCD), the authors evaluated the relation of the neuroanatomical location of cingulotomy treatment to symptomatic improvement to determine whether the lesion placement sites during treatment are related to responder status. Using an anatomical registration matrix, the authors found that cingulotomy lesions that were placed more superiorly and posteriorly within Brodmann area 32 conferred a higher likelihood of response, a finding that is important because the precise underlying neuroanatomical basis for the beneficial effects of this treatment in OCD patients has thus far been poorly understood.
The authors used resection probability maps to quantify and compare glioblastoma surgery decisions from each of 12 neurosurgical teams with those of the other teams. The neurosurgical teams were found to generally agree on which glioblastoma-infiltrated brain regions to biopsy and which to resect, and the few observed differences indicated surgical controversies. The benchmark probability maps of glioblastoma surgery decisions will serve quality-of-care discussions and may steepen the learning curve of neurosurgical education.
In an almost lifelong prospective follow-up study of patients with unruptured intracranial aneurysms and with minimal treatment selection bias, the author compared the population, hypertension, age, size of aneurysm, earlier aneurysm rupture, site of aneurysm (PHASES) score with his own new one for predicting aneurysm rupture risk. Both scores predicted the long-term aneurysm rupture risk moderately well, with the new one, which also included smoking, being easier and slightly better in clinical practice. The findings suggest that decisions about the treatment of unruptured aneurysms in patients of working age can be made with an improved cost-effectiveness.
Researchers aimed to report the outcomes of spinal cord stimulation in patients with central poststroke pain and to explore factors related to outcomes in a multicenter retrospective study. In this multicenter case series with 166 patients, about 60% of patients responded to trial stimulation and about 60% of the patients who underwent implantation showed satisfactory pain relief at last follow-up. Spinal cord stimulation has therapeutic potential for intractable central poststroke pain.
Bypass surgery has evolved into a complex art that incorporates a variety of donors, recipients, interpositional grafts, anastomoses, and suturing techniques. Given these contemporary advancements in bypass techniques, the existing nomenclature that joins abbreviations for donor and recipient arteries with a hyphen is simplistic and uninformative. The authors propose a new nomenclature system based on segmental anatomy and anastomotic details that uses alphanumeric shorthand to code bypasses simply, succinctly, and accurately and clarify technical details, thus encouraging greater descriptive precision.
Researchers applied explainable machine learning techniques to identify factors associated with better outcomes after rescue therapy for postsubarachnoid hemorrhage vasospasm. Younger age and absence of delayed cerebral ischemia/infarction were linked to better rescue outcomes. A machine learning-based, propensity score-matched analysis showed that rescue was associated with higher odds of better 3-month outcome. These findings suggest that trials focusing on preventative or therapeutic interventions in patients with delayed cerebral ischemia/infarction may be most able to demonstrate improvements in outcomes.