Editor's Choice

Editor's Choice image

The following articles were identified by Dr. James Rutka, Editor-in-Chief of the Journal of Neurosurgery Publishing Group, as being of particular importance or interest to our readership.

May 2023

Development of a clinical model to predict vagus nerve stimulation response in pediatric patients with drug-resistant epilepsy
Nallammai Muthiah, Arka N. Mallela, Lena Vodovotz, Nikhil Sharma, Emefa Akwayena, Evelyn Pan, William Welch, George M. Ibrahim, and Taylor J. Abel

The objective of this study was to create a clinical vagus nerve stimulation (VNS) prediction tool for use in an outpatient setting. Despite large sample size and rigorous model optimization, clinical variables alone were not able to accurately predict VNS response among pediatric patients with drug-resistant epilepsy. This score may be useful after further validation, although its predictive ability underscores the need for more robust biomarkers to predict treatment response.


Flexible neuroendoscopy for endoscopic third ventriculostomy and fourth ventricular arachnoid cyst fenestration in an infant
Luis Fernandez, Melissa A. LoPresti, Jae Eun Lee, Michael DeCuypere, and Sandi K. Lam

Flexible neuroendoscopy is shown for navigation through a dilated cerebral aqueduct to fenestrate a fourth ventricular arachnoid cyst and perform endoscopic third ventriculostomy for management of hydrocephalus through a single frontal entry burr hole. Treatment of fourth ventricular arachnoid cysts has not been widely discussed in the literature, and this is the first description of the use of flexible neuroendoscopy to treat a child with this pathology. The authors discuss key surgical considerations, anatomy, and operative technique.


Clinical outcome in decompression alone versus decompression and instrumented fusion in patients with isthmic spondylolisthesis: a prospective cohort study
Kayoumars Azizpour, Pieter J. Schutte, Mark P. Arts, Willem Pondaag, Gerrit J. Bouma, Maarten Coppes, Ewout W. Steyerberg, Wilco C. Peul, and Carmen L. A. Vleggeert-Lankamp

Decompression and instrumented fusion are commonly performed as the surgical treatment in patients with symptomatic isthmic spondylolisthesis. However, evidence is lacking as to whether fusion is indeed superior to decompression alone for these patients. In this study, the authors demonstrated that adding fusion to decompression is a superior treatment in terms of functional outcome and perceived recovery. The findings of this study support the scientific basis for the widespread practice of fusion in isthmic spondylolisthesis.


Methylprednisolone in acute traumatic spinal cord injury: case-matched outcomes from the NASCIS2 and Sygen historical spinal cord injury studies with contemporary statistical analysis
Fred H. Geisler, Ali Moghaddamjou, Jamie R. F. Wilson, and Michael G. Fehlings

Methylprednisolone (MP) in acute traumatic spinal cord injury (ATSCI) remains controversial. The second National Acute Spinal Cord Injury Study (NASCIS2) and Sygen studies used identical MP dosages, which allowed for construction of a case-level pooled data set. The original 1990 NASCIS2 study had a large percentage of patients without an ATSCI, and the positive results reported were only in a sub-subgroup. No MP drug effect was noted in the combined data set, removing the rationale for the use of MP in ATSCI.


Growth risk classification and typical growth speed of convexity, parasagittal, and falx meningiomas: a retrospective cohort study
Shuhei Yamada, Ryuichi Hirayama, Takamitsu Iwata, Hideki Kuroda, Tomoyoshi Nakagawa, Tomofumi Takenaka, Noriyuki Kijima, Yoshiko Okita, Naoki Kagawa, and Haruhiko Kishima

The purpose of this study was to describe the biological characteristics of supratentorial meningiomas using tumor volume growth rate as an indicator of growth degree. The combination of known risk factors for growth (age, gender, and MRI signal intensity) allowed the authors to stratify growth rates and generate predictive maps of tumor volume. The results of these analyses may be used as a reference for deciding whether and when to intervene in the treatment of meningiomas.


A flow self-regulating superficial temporal artery–middle cerebral artery bypass based on side-to-side anastomosis for adult patients with moyamoya disease
Jianjian Zhang, Jin Yu, Can Xin, Miki Fujimura, Tsz Yeung Lau, Miao Hu, Xiao Tian, Mingrui Luo, Tianshu Tao, Ling Li, Changyin Wang, Wei Wei, Xiang Li, and Jincao Chen

The authors aimed to investigate the possibility of routine use of a novel side-to-side (S-S) bypass technique for adult moyamoya disease (MMD). Compared with standard end-to-side (E-S) anastomosis, S-S anastomosis had comparable clinical effects, milder cerebral hyperperfusion symptoms with short duration, and the potential to arouse all scalp arteries as donor sources for revascularization via a flow self-regulating fashion. This technique may be a new option for bypass in MMD patients.


April 2023

Hydrocephalus in patients with encephalocele: introduction of a scoring system for estimating the likelihood of hydrocephalus based on an 11-year experience from a tertiary center
Samuel B. Kankam, Amirhosein Nejat, Amin Tavallaii, Keyvan Tayebi Meybodi, Zohreh Habibi, and Farideh Nejat

The authors tried to develop a scoring system to predict the probability of hydrocephalus in patients with encephalocele (EC). Their findings resulted in a highly accurate scoring system consisting of 5 variables: history of meningitis, patient sex, location and size of EC, and presence of other accompanying anomalies. Predicting the likelihood of hydrocephalus in patients with EC can help treating physicians tailor their treatment strategies to ensure lower mortality and morbidity rates in affected patients.


Postoperative seizure freedom after vagus nerve stimulator placement in children 6 years of age and younger
Pedram Maleknia, Timothy D. McWilliams, Ariana Barkley, Dagoberto Estevez-Ordonez, Curtis Rozzelle, and Jeffrey P. Blount

In this retrospective study, the authors followed up their previously reported cohort to review the longer-term safety and efficacy of vagus nerve stimulator placement in children younger than 6 years of age with generalized medically refractory epilepsy, providing the largest cohort with > 2 years of follow-up to date in this age group. This study establishes feasibility, illustrates an acceptable safety profile in children younger than 6 years, and demonstrates efficacy comparable to that reported in older patients.


A computer vision approach to identifying the manufacturer of posterior thoracolumbar instrumentation systems
Adrish Anand, Alex R. Flores, Malcolm F. McDonald, Ron Gadot, David S. Xu, and Alexander E. Ropper

Knowledge of the manufacturer of implanted pedicle screw systems may facilitate faster and safer revision surgery. The authors propose an automated computer vision approach to classify posterior thoracolumbar instrumentation systems. This model demonstrates greater accuracy and efficiency over the current practice, with future studies aimed at prospective use.


Defining postoperative C5 palsy and recovery: a systematic review
Nachiket Deshpande, Amro M. Stino, Brandon W. Smith, Ann A. Little, Lynda J. S. Yang, Paul Park, and Yamaan S. Saadeh

The objective of this paper was to clarify the existing definitions of postoperative C5 palsy within the literature. The key finding is that the definitions of postoperative C5 palsy had significant heterogeneity, and the definitions of C5 palsy were often unrelated to clinical significance. This study adds value to the field by proposing standardized criteria for defining severity of postoperative C5 palsy and recovery.


Development and validation of a new disease-specific quality of life instrument for sporadic vestibular schwannoma: the Mayo Clinic Vestibular Schwannoma Quality of Life Index
Matthew L. Carlson, Christine M. Lohse, Michael J. Link, Nicole M. Tombers, Devin L. McCaslin, Aniket A. Saoji, Melanie Hutchins, and Kathleen J. Yost

Motivated by reported limitations of prior quality of life instruments, researchers developed a new disease-specific measure, the Vestibular Schwannoma Quality of Life Index, that consists of 40 items evaluating the impact of vestibular schwannoma diagnosis and its management on quality of life, satisfaction, and employment. Through shared decision-making, scores from this valid and reliable index can be used to assist patients and clinicians when selecting the optimal management for this disease.


Magnetic resonance imaging–guided focused ultrasound thalamotomy for essential tremor: 5-year follow-up results
G. Rees Cosgrove, Nir Lipsman, Andres M. Lozano, Jin Woo Chang, Casey Halpern, Pejman Ghanouni, Howard Eisenberg, Paul Fishman, Takaomi Taira, Michael L. Schwartz, Nathan McDannold, Michael Hayes, Susie Ro, Binit Shah, Ryder Gwinn, Veronica E. Santini, Kullervo Hynynen, and W. Jeff Elias

Researchers examined the 5-year clinical outcomes of patients with medically refractory essential tremor (ET) who had previously undergone MRI-guided focused ultrasound (MRgFUS) thalamotomy in a randomized, blinded, sham-controlled trial. Improvement in tremor control was measured at 73.1% from baseline with only mild or moderate side effects and no delayed complications. Unilateral MRgFUS thalamotomy demonstrates sustained and significant tremor improvement with an overall improvement in the quality of life of patients with medically refractory ET.


March 2023

Stereoelectroencephalography followed by combined electrode removal and MRI-guided laser interstitial thermal therapy or open resection: a single-center series in pediatric patients with medically refractory epilepsy
Anna L. Slingerland, Melissa M. J. Chua, Jeffrey Bolton, Steven J. Staffa, Melissa Tsuboyama, Sanjay P. Prabhu, Phillip L. Pearl, Joseph R. Madsen, and Scellig S. D. Stone


Increasing precision in the management of pediatric neurosurgical cerebrovascular diseases with molecular genetics
Kristopher T. Kahle, Daniel Duran, and Edward R. Smith

Recent advances in our laboratories and others have focused on the genetic drivers of neurosurgical disease. The early adoption of this work in neuro-oncology has proven its value, and the next frontier for neurosurgery centers on cerebrovascular disease. Current findings are reviewed here, and a new taxonomy of classifying cerebrovascular lesions using these data is presented.


Multilevel cervical disc arthroplasty: a review of optimal surgical management and future directions
Tsung-Hsi Tu, Ching-Ying Wang, Yu-Chun Chen, and Jau-Ching Wu

Two or more levels of cervical disc arthroplasty (CDA) have become a popular treatment for cervical disc herniation or spondylosis, especially in Asia and Europe. Multilevel CDA outscores anterior cervical discectomy and fusion, in appropriately selected patients, for preservation of mobility and a decrease in adjacent-segment disease. Levels of kyphotic deformity or ossification of the posterior longitudinal ligament should undergo fusion rather than arthroplasty. Consideration of individual level and use of hybrid CDA–fusion constructs are suggested for multilevel uneven degeneration.


A novel scoring system concept for de novo spinal infection treatment, the Spinal Infection Treatment Evaluation Score (SITE Score): a proof-of-concept study
Jonathan Pluemer, Yevgeniy Freyvert, Nathan Pratt, Jerry E. Robinson, Jared A. Cooke, Zachary L. Tataryn, Clifford A. Pierre, Periklis Godolias, Sven Frieler, Alexander von Glinski, Emre Yilmaz, Zeyad A. Daher, Hamzah A. Al-Awadi, Mitchell H. Young, Rod J. Oskouian, and Jens R. Chapman

The authors present an evidence-based scoring system called the "Spinal Infection Treatment Evaluation Score" (SITE Score) to assess the emerging population with de novo spinal infections. Nonsurgical or surgical treatment for de novo spinal infections is often decided case by case on the basis of personal preference, affiliation, and experience rather than evidence-based variables. The authors built a foundation for an evidence-based treatment decision process using the SITE scoring system, which is intended to be a helpful tool to guide physicians' therapeutic decisions about de novo spinal infections.


Conventionally fully fractionated Gamma Knife Icon re-irradiation of primary recurrent intracranial tumors: the first report indicating feasibility and safety
Michael Yan, Lori Holden, Jay Detsky, Chia-Lin Tseng, Hany Soliman, Sten Myrehaug, Zain Husain, Sunit Das, Collins Yeboah, Nir Lipsman, Mark Ruschin, and Arjun Sahgal

The authors report a novel approach using Gamma Knife Icon technology to fractionate daily treatment, even over 6 weeks, to patients with primary brain tumors that progressed after prior surgery and radiation and were located adjacent to critical dose-limiting organs at risk. The authors took advantage of radiosurgical dosimetric characteristics, and the principles of radiation oncology, to essentially escalate the intratumoral dose, maximally spare the surrounding normal tissues, and achieve preliminary but encouraging results.


Dissociation of Broca’s area from Broca’s aphasia in patients undergoing neurosurgical resections
John P. Andrews, Nathan Cahn, Benjamin A. Speidel, Jason E. Chung, Deborah F. Levy, Stephen M. Wilson, Mitchel S. Berger, and Edward F. Chang

The authors' objective was to determine whether Broca's aphasia is associated with resections of anatomically defined Broca's area (Brodmann's areas 44/45). They found that Broca's aphasia is not associated with resections of Broca's area. Instead, transient Broca's aphasia is associated with resection of the ventral rolandic cortex and supramarginal gyrus, and also the underlying white matter tracts. These findings have significant implications for understanding the risks to language that are associated with surgery in eloquent brain areas.


February 2023

The neurodevelopmental outcomes of children with encephalocele: a series of 102 patients
Samuel Berchi Kankam, Amin Tavallaii, Esmaeil Mohammadi, Amirhosein Nejat, Zohreh Habibi, and Farideh Nejat

This study is a retrospective review of 102 children with encephalocele whose neurodevelopmental status and the factors affecting outcome were evaluated. Of the variables including posterior location, size of sac, presence of neural tissue, ventriculomegaly, symptomatic hydrocephalus, and postoperative infection, which were found to have effects on neurodevelopmental outcome on univariate analysis, only neural tissue presence had a statistically significant association with neurodevelopmental delay on multivariate analysis.


Sagittal synostosis: does choice of intervention and its timing affect the long-term aesthetic and neurodevelopmental outcome? A single-institution study of 167 children
Adnan-Mustafiz Chowdhury, Ryan Patel, Adikarige Haritha Dulanka Silva, David J. Dunaway, Noor ul Owase Jeelani, Juling Ong, Richard Hayward, and Greg James


Predictive risk factors for mechanical complications after multilevel posterior cervical instrumented fusion
Sun-Joon Yoo, Jeong-Yoon Park, Dong-Kyu Chin, Keun-Su Kim, Yong-Eun Cho, and Kyung-Hyun Kim

Researchers investigated the risk factors of mechanical complications after multilevel posterior cervical instrumented fusion surgery based on cervical alignment parameters and patient factors. Low body mineral density, a large number of fused vertebrae, a large preoperative C2-7 sagittal vertical axis, and low C2-7 lordosis were significant risk factors for mechanical complications after posterior cervical fusion surgery.


Cost-effectiveness of 10-kHz spinal cord stimulation therapy compared with conventional medical management over the first 12 months of therapy for patients with nonsurgical back pain: randomized controlled trial
Naresh P. Patel, Chengyuan Wu, Shivanand P. Lad, Jessica Jameson, Peter Kosek, Dawood Sayed, Erik I. Waldorff, Laura C. Shum, Rose Province-Azalde, and Leonardo Kapural

The authors analyzed the cost-effectiveness of conventional medical management (CMM) versus 10-kHz spinal cord stimulation (SCS) in the treatment of nonsurgical refractory back pain. Treatment with 10-kHz SCS was found to be cost-effective compared with CMM in the 2.1-year time frame. This is the first analysis of cost-effectiveness of SCS in this nonsurgical refractory back pain population, with the added value of prospectively collected healthcare utilization data from a randomized controlled trial.


Changes in patterns of traumatic brain injury in the Michigan Trauma Quality Improvement Program database early in the COVID-19 pandemic
Reid A. Johnson, Anne Eaton, Christopher J. Tignanelli, Kailey J. Carrabre, Christina Gerges, George L. Yang, Mark R. Hemmila, Laura B. Ngwenya, James M. Wright, Ann M. Parr, and in affiliation with the Council of State Neurosurgical Societies (CSNS)

The Michigan Trauma Quality Improvement Program database was queried to investigate rates of traumatic brain injuries (TBIs) early in the COVID-19 pandemic (March 13, 2020, through July 2, 2020). TBIs occurred at rates similar to those of the pre–COVID-19 years of 2017–2019, but patients presented later and were less frequently discharged with supervision during the pandemic. These findings underscore the importance of maintaining access to high-acuity care and rehabilitation services during the COVID-19 pandemic.


A standardized infection prevention bundle for reduction of CSF shunt infections in adult ventriculoperitoneal shunt surgery performed without antibiotic-impregnated catheters
Sandeep Muram, Albert M. Isaacs, Nicholas Sader, Richard Holubkov, Annie Fong, John Conly, and Mark G. Hamilton

The authors evaluated the implementation of a standardized shunt infection prevention bundle in 621 consecutive shunt surgeries performed in an adult patient population without the use of antibiotic-impregnated shunt catheters. This standardized bundle significantly reduced the rate of shunt infections from 5.8% to 0%, a reduction that was sustained over many years. The use of 2% chlorhexidine gluconate in 70% isopropyl alcohol for preoperative antisepsis may have played a significant role in the effectiveness of this procedure.


January 2023

Developing consensus for the management of pediatric cervical spine disorders and stabilization: a modified Delphi study
Yosef M. Dastagirzada, Nikita G. Alexiades, David B. Kurland, Sebastián N. Anderson, Douglas L. Brockmeyer, David B. Bumpass, Sandip Chatterjee, Mari L. Groves, Todd C. Hankinson, David Harter, Daniel Hedequist, Andrew Jea, Jeffrey R. Leonard, Jonathan E. Martin, Matthew E. Oetgen, Joshua Pahys, Curtis Rozzelle, Jennifer M. Strahle, Dominic Thompson, Burt Yaszay, and Richard C. E. Anderson

A group of international, multidisciplinary pediatric cervical spine experts aimed to provide a clinical framework for clinicians caring for children with cervical spine disorders. Using a modified Delphi approach, they developed consensus statements addressing various aspects of clinical management and decision-making (e.g., preoperative planning, radiographic thresholds of instability, perioperative management, and nonoperative management) for this unique patient population. These statements reflect current practices and can serve as a foundation for further studies in the field.


Completion of disconnective surgery for refractory epilepsy in pediatric patients using robot-assisted MRI-guided laser interstitial thermal therapy
Santiago Candela-Cantó, Jordi Muchart, Carlos Valera, Cristina Jou, Diego Culebras, Mariana Alamar, Victoria Becerra, David Artés, Georgina Armero, Javier Aparicio, José Hinojosa, and Jordi Rumià

The authors report their initial experience with MRI-guided laser interstitial thermal therapy (MRIgLITT) to complete hemispherotomy and temporoparietooccipital (TPO) disconnections. Six pediatric patients with seizure persistence or recurrence due to an incomplete hemispherotomy (4 patients) or TPO (2 patients) underwent 8 surgical procedures with MRIgLITT. Five patients achieved successful seizure control after MRIgLITT. This technique has been proven to be safe and will become a good technical option to complete disconnective surgeries in select cases.


Recruitment of women in neurosurgery: a 7-year quantitative analysis
James Feghali, Albert Antar, Elizabeth E. Wicks, Shahab Aldin Sattari, Sean Li, Timothy F. Witham, Henry Brem, and Judy Huang

The authors used univariable and stepwise multivariable linear regression to study yearly trends for women entering neurosurgery residency programs from 2014 to 2020 and associations between recruitment percentages for women and medical school characteristics, with the aim of providing insights into reducing gender disparities. Important findings were that a top 10 U.S. News & World Report ranking was the most important independent factor predicting percentages of female medical school graduates entering a neurosurgery residency program. During the study period, the Cleveland Clinic had the most graduating women neurosurgery residents.


Target Ultra and Nano coils in the endovascular treatment of small intracranial aneurysms (ULTRA Registry)
Gaurav Jindal, Ranyah Almardawi, Rishi Gupta, Geoffrey P. Colby, Clemens M. Schirmer, Sudhakar R. Satti, Bryan Pukenas, Ferdinand K. Hui, Justin Caplan, Timothy Miller, Jacob Cherian, Francois Aldrich, Gulam Kibria, J. Marc Simard, and for the ULTRA Study Investigators

In the ULTRA Registry 100-patient cohort (mean aneurysm size 3.5 mm), researchers performed an investigator-initiated, multicenter US prospective study of aneurysm occlusion rates and safety profiles of Target Ultra and Nano coils for treatment of ruptured and unruptured small intracranial aneurysms, most with irregular shape and wide-neck morphology. Coils were safe and reliable, with only moderate aneurysm recurrence at follow-up, occurring mostly in ruptured aneurysms. There were no intraoperative aneurysm ruptures, coil-related complications, or crossovers from coiling to other treatment methods. This study provides additional prospective evidence that even challenging, tiny aneurysms can be safely treated via coil embolization, highlighting recent advancements in endovascular technology.


Effect of surgical experience and spine subspecialty on the reliability of the AO Spine Upper Cervical Injury Classification System
Mark J. Lambrechts, Gregory D. Schroeder, Brian A. Karamian, Jose A. Canseco, F. Cumhur Oner, Lorin M. Benneker, Richard J. Bransford, Frank Kandziora, Shanmuganathan Rajasekaran, Mohammad El-Sharkawi, Rishi Kanna, Andrei Fernandes Joaquim, Klaus Schnake, Christopher K. Kepler, Alexander R. Vaccaro, and the AO Spine Upper Cervical Injury Classification International Members

The recently proposed AO Spine Upper Cervical Injury Classification System underwent an international validation with relatively equal participation from orthopedic spine surgeons and neurosurgeons. Both groups of surgeons had similar accuracy and reliability when interpreting upper cervical spine injury films. This indicates that the classification may be used by either surgical subspecialty without significant differences between their accuracy and reliability.


Prediction of 2-year clinical outcome trajectories in patients undergoing anterior cervical discectomy and fusion for spondylotic radiculopathy
Jeffrey J. Hébert, Tyler Adams, Erin Cunningham, Dana El-Mughayyar, Neil Manson, Edward Abraham, Niels Wedderkopp, Erin Bigney, Eden Richardson, Amanda Vandewint, Chris Small, George Kolyvas, Andre le Roux, Aaron Robichaud, Michael H. Weber, Charles Fisher, Nicolas Dea, Stephan du Plessis, Raphaele Charest-Morin, Sean D. Christie, Christopher S. Bailey, Y. Raja Rampersaud, Michael G. Johnson, Jerome Paquet, Andrew Nataraj, Bernard LaRue, Hamilton Hall, and Najmedden Attabib

The authors described the 24-month postoperative trajectories of arm pain, neck pain, and pain-related disability in patients undergoing anterior cervical discectomy and fusion, and they identified the predictors of poor outcome. Outcome trajectories were variable, with 15.5%–23.5% of patients experiencing a poor result. Demographic, health, clinical, and surgery-related prognostic factors predicted outcomes. This information informs future research and may assist surgeons with patient selection and in setting realistic expectations with patients.


December 2022

Postoperative MRI features of cerebellar mutism syndrome: a retrospective cohort study
Wei Yang, Hong Zhang, Yingjie Cai, Xiaojiao Peng, Hailang Sun, Jiashu Chen, Zesheng Ying, Kaiyi Zhu, Yun Peng, and Ming Ge

Postoperative cerebellar mutism syndrome (pCMS) is a common complication of posterior fossa surgery. This study aimed to investigate the relationship between postoperative MRI features and cerebellar mutism syndrome. The results showed that damage to the cerebro-cerebellar circuit was associated with pCMS. Furthermore, the extent of damage to the cerebro-cerebellar circuit was related to the duration of mutism. These results help in understanding the mechanism of pCMS and the variation of the duration of mutism.


Impact of age at endoscopic metopic synostosis repair on anthropometric outcomes
Sarah N. Chiang, Erin C. Peterson, David C. Lauzier, Sean D. McEvoy, Gary B. Skolnick, Sybill D. Naidoo, Matthew D. Smyth, and Kamlesh B. Patel

The authors set out to compare morphological outcomes of endoscopic strip craniectomy for metopic craniosynostosis in patients treated prior to 4 months of age and at 4 or 5 months of age. Age at repair was not associated with the 1-year postoperative interfrontal divergence angle or frontal width. These results suggest that endoscopic repair of metopic synostosis may be performed up to 5 months of age with satisfactory results.


Single low-dose targeted bevacizumab infusion in adult patients with steroid-refractory radiation necrosis of the brain: a phase II open-label prospective clinical trial
Shervin R. Dashti, Robert J. Kadner, Bradley S. Folley, Jason P. Sheehan, Dong Y. Han, Richard J. Kryscio, Mary B. Carter, Lisa B. E. Shields, Brian M. Plato, Renato V. La Rocca, Aaron C. Spalding, Tom L. Yao, and Justin F. Fraser

In this phase II trial, researchers studied the safety and efficacy of a one-time low-dose targeted bevacizumab infusion for the treatment of adult patients with disabling steroid-refractory radiation necrosis (RN) of the brain. After 12 months of follow-up, 80% of patients experienced durable clinical and imaging improvements with no serious adverse events attributed to bevacizumab. A single targeted intra-arterial bevacizumab infusion may potentially be a more efficient alternative than multiple infusions of intravenous bevacizumab for refractory brain RN.


Effects of clazosentan on cerebral vasospasm–related morbidity and all-cause mortality after aneurysmal subarachnoid hemorrhage: two randomized phase 3 trials in Japanese patients
Hidenori Endo, Yasushi Hagihara, Naoto Kimura, Katsumi Takizawa, Kuniyasu Niizuma, Osamu Togo, and Teiji Tominaga

Two randomized, placebo-controlled phase 3 studies were performed to investigate the efficacy of clazosentan in reducing vasospasm-related morbidity and all-cause mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH), that was secured by endovascular coiling in one study and surgical clipping in the other. A significant relative risk reduction in vasospasm-related morbidity and all-cause mortality was observed in both studies 6 weeks after aSAH. These studies supported the approval of clazosentan in Japan for the prevention of cerebral vasospasm, vasospasm-related cerebral infarction, and cerebral ischemic symptoms after aSAH surgery.


A phase 1/2a dose-escalation study of oligodendrocyte progenitor cells in individuals with subacute cervical spinal cord injury
Richard G. Fessler, Reza Ehsanian, Charles Y. Liu, Gary K. Steinberg, Linda Jones, Jane S. Lebkowski, Edward D. Wirth III, and Stephen L. McKenna

This study was designed to demonstrate the safety of intraspinal cord injection of an oligodendrocyte progenitor cell line in individuals with subacute cervical spinal cord injury (SCI). The secondary goal was to evaluate efficacy to return neurological function. The results clearly demonstrate safety and, although not a randomized controlled study, also suggested efficacy in returning one level of neurological function in nearly all patients, and two levels on at least one side in one-third of the patients. This study provides valuable information that can be applied in the next steps in evaluating stem cell treatment of subacute SCI.


Evolution of the AO Spine Sacral and Pelvic Classification System: a systematic review
Barry Ting Sheen Kweh, Jin W. Tee, F. Cumhur Oner, Klaus J. Schnake, Emiliano N. Vialle, Frank Kanziora, Shanmuganathan Rajasekaran, Marcel Dvorak, Jens R. Chapman, Lorin M. Benneker, Gregory Schroeder, and Alexander R. Vaccaro

The authors describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of every historical sacral and pelvic grading system to date. The novel AO Spine classification is universally applicable and redefines as well as reorders traditional fracture morphologies into a rational hierarchical system. This is the first classification to simultaneously address the biomechanical stability of the posterior pelvic complex and spinopelvic stability, while also taking neurological status into consideration.


November 2022

Radiological and clinical outcomes of stereotactic radiosurgery for gangliogliomas: an international multicenter study
Georgios Mantziaris, Joshua Diamond, Stylianos Pikis, Farid M. El Hefnawi, Ghusn Al Sideiri, François-Louis Coupé, David Mathieu, Cheng-Chia Lee, Jaromir May, Roman Liščák, Selcuk Peker, Yavuz Samanci, Ajay Niranjan, L. Dade Lunsford, and Jason P. Sheehan


The demography of idiopathic normal pressure hydrocephalus: data on 3000 consecutive, surgically treated patients and a systematic review of the literature
Nina Sundström, Fredrik Lundin, Lisa Arvidsson, Mats Tullberg, and Carsten Wikkelsø

The demographic characteristics of 3000 patients with idiopathic normal pressure hydrocephalus and a systematic review of the literature are presented. Patients were diagnosed in their 70s, were severely impaired (women more than men), and had long diagnostic delays, and men had more comorbidities. The disorder has a very low incidence of treatment and may account for a considerable portion of cases of dementia, findings that stress the importance of diagnosis and treatment in this patient group.


Initial experience with Pipeline embolization of intracranial pseudoaneurysms in pediatric patients
Karol P. Budohoski, Raj Thakrar, Zoya Voronovich, Robert C. Rennert, Craig Kilburg, Ramesh Grandhi, William T. Couldwell, Douglas L. Brockmeyer, and Philipp Taussky

Intracranial pseudoaneurysms are extremely challenging lesions for the neurosurgeon because of their poor natural history and difficulty repairing a true defect in the vessel wall. Flow diversion offers a novel treatment option by creating a scaffold for neointimal growth over the defective vessel wall, but it has rarely been used and studied in the pediatric population. In the largest pediatric series to date, the authors share their surgical experience and illustrate technical and management nuances.


Association between synthetic sealants and increased complication rates in posterior fossa decompression with duraplasty for Chiari malformations regardless of graft type
Ziyad Makoshi, Nathaniel Toop, Luke G. F. Smith, Annie Drapeau, Jonathan Pindrik, Eric A. Sribnick, Jeffrey Leonard, and Ammar Shaikhouni


Perioperative risk stratification of spine trauma patients with ankylosing spinal disorders: a comparison of 3 quantitative indices
Nikita Lakomkin, Anthony L. Mikula, Zachariah W. Pinter, Elizabeth Wellings, Mohammed Ali Alvi, Kristen M. Scheitler, Zach Pennington, Nathan J. Lee, Brett A. Freedman, Arjun S. Sebastian, Jeremy L. Fogelson, Mohamad Bydon, Michelle J. Clarke, and Benjamin D. Elder


Determining the time frame of maximum clinical improvement in surgical decompression for cervical spondylotic myelopathy when stratified by preoperative myelopathy severity: a cervical Quality Outcomes Database study
Connor Berlin, Alexandria C. Marino, Praveen V. Mummaneni, Juan Uribe, Luis M. Tumialán, Jay Turner, Michael Y. Wang, Paul Park, Erica F. Bisson, Mark Shaffrey, Oren Gottfried, Khoi D. Than, Kai-Ming Fu, Kevin Foley, Andrew K. Chan, Mohamad Bydon, Mohammed Ali Alvi, Cheerag Upadhyaya, Domagoj Coric, Anthony Asher, Eric A. Potts, John Knightly, Scott Meyer, and Avery Buchholz

Researchers set out to determine if retrospective analysis of prospectively collected patient-reported outcomes (PROs) following surgery for cervical spondylotic myelopathy (CSM) differed when stratified by preoperative myelopathy status. Three months after surgical decompression for CSM appears to be an adequate time to achieve maximum improvement in PROs in most patients. This study adds value by providing new insight and more accurate time resolution into how and when patients can be expected to achieve clinical improvement following surgical decompression for CSM and provides the surgeon and patient with more accurate information for counseling and expected postoperative recovery time course.


October 2022

Double dose of 5-aminolevulinic acid and its effect on protoporphyrin IX accumulation in low-grade glioma
Eric Suero Molina, David Black, Sadahiro Kaneko, Michael Müther, and Walter Stummer

The authors evaluated the effect of a higher dose of 40 mg/kg instead of 20 mg/kg body weight of 5-aminolevulinic acid (5-ALA) in the occurrence of fluorescence (visible to the human eye and measured by spectroscopy) in a cohort of patients with low-grade glioma (LGG). Higher 5-ALA doses lead to a higher protoporphyrin IX (PPIX) concentration in different tumor regions, leading to more tissue surpassing the visibility threshold of PPIX, an observation with implications for future dosing in patients with LGG.


Stereotactic radiosurgery for intracranial chordomas: an international multiinstitutional study
Stylianos Pikis, Georgios Mantziaris, Selcuk Peker, Yavuz Samanci, Ahmed M. Nabeel, Wael A. Reda, Sameh R. Tawadros, Amr M. N. El-Shehaby, Khaled Abdelkarim, Reem M. Emad Eldin, Darrah Sheehan, Kimball Sheehan, Roman Liscak, Tomas Chytka, Manjul Tripathi, Renu Madan, Herwin Speckter, Wenceslao Hernández, Gene H. Barnett, Yusuke S. Hori, Nisha Dabhi, Salman Aldakhil, David Mathieu, Douglas Kondziolka, Kenneth Bernstein, Zhishuo Wei, Ajay Niranjan, Charles R. Kersh, L. Dade Lunsford, and Jason P. Sheehan

Endoscopic third ventriculostomy in previously shunt-treated patients
Brandon G. Rocque, Hailey Jensen, Ron W. Reeder, Abhaya V. Kulkarni, Ian F. Pollack, John C. Wellons III, Robert P. Naftel, Eric M. Jackson, William E. Whitehead, Jonathan A. Pindrik, David D. Limbrick Jr., Patrick J. McDonald, Mandeep S. Tamber, Todd C. Hankinson, Jason S. Hauptman, Mark D. Krieger, Jason Chu, Tamara D. Simon, Jay Riva-Cambrin, John R. W. Kestle, Curtis J. Rozzelle, and for the Hydrocephalus Clinical Research Network

Researchers from the Hydrocephalus Clinical Research Network (HCRN) queried the HCRN core data set for children who had undergone endoscopic third ventriculostomy (ETV) after previously undergoing shunt placement. The overall success rate of ETV in patients who previously received a shunt was 41%. The only variable to show significant association with ETV success was a surgeon's report of a clear view of the basilar artery. The observed rate of success was lower than predicted by the ETV Success Score.


Effects of local intraoperative epidural use of triamcinolone acetonide–soaked Gelfoam on postoperative outcomes in patients undergoing posterolateral lumbar spinal fusion surgery: a randomized, placebo-controlled, double-blind trial
Roozbeh Tavanaei, Pooria Ahmadi, Bahador Malekipour, Bijan Herfedoust Biazar, Mohsen Keikhaee, Kaveh Oraii Yazdani, Alireza Zali, and Saeed Oraee-Yazdani

This study aimed to evaluate the impact of local epidural administration of triamcinolone acetonide–soaked Gelfoam on postoperative pain and patient-reported outcomes in patients undergoing instrumented posterolateral lumbar spinal fusion. Local intraoperative epidural administration of steroids using a Gelfoam carrier did not affect the study outcome measures significantly in instrumented posterolateral lumbar spinal fusion. This study was the first to evaluate the efficacy of local intraoperative epidural use of triamcinolone acetonide–soaked Gelfoam in posterolateral lumbar spinal fusion.


September 2022

Initial experience with magnetic resonance–guided focused ultrasound stereotactic surgery for central brain lesions in young adults
Travis S. Tierney, Kambiz N. Alavian, Nolan Altman, Sanjiv Bhatia, Michael Duchowny, Ann Hyslop, Prasanna Jayakar, Trevor Resnick, Shelly Wang, Ian Miller, and John Ragheb

MRI-guided high-frequency focused ultrasound can pass through the scalp and skull to precisely heat and destroy tissue in the brain. Currently, this treatment is approved only for use in adults with movement disorders. This study showed that deep brain lesions can be treated safely in subjects aged 15–22 years old. The trial is ongoing and hopes to enroll children as young as 8 years old and lead to an expanded trial to show efficacy.


Predictors of vagus nerve stimulation complications among pediatric patients with drug-resistant epilepsy
Nallammai Muthiah, Nikhil Sharma, Lena Vodovotz, Gretchen E. White, and Taylor J. Abel

Researchers evaluated vagus nerve stimulator (VNS) complications in pediatric patients with drug-resistant epilepsy. Overall, 1% and 6% of VNS surgeries resulted in minor and major complications, respectively; 3% of procedures resulted in infection. The incident rate of infection for VNS revisions preceded by ≥ 2 VNS procedures was 19 times that of first-time revisions. VNS is a safe treatment option for pediatric patients with drug-resistant epilepsy, although this study highlights a need for transcutaneously chargeable or longer-lasting pulse generators.

August 2022

Comparison of intrathecal baclofen pump insertion and selective dorsal rhizotomy for nonambulatory children with predominantly spastic cerebral palsy
Ann Mansur, Benjamin Morgan, Alexandre Lavigne, Nicolas Phaneuf-Garand, Jocelyne Diabira, Han Yan, Unni G. Narayanan, Darcy Fehlings, Golda Milo-Manson, Blythe Dalziel, Sara Breitbart, Claude Mercier, Dominic Venne, Pierre Marois, Alexander G. Weil, Jeffrey S. Raskin, Sruthi P. Thomas, and George M. Ibrahim

The authors present a large comparative study of ITB and SDR for nonambulant children with primarily spastic CP. Even within this highly selected population, significant baseline differences were found between patients who underwent ITB and those who underwent SDR. Children undergoing SDR tended to be younger and have better baseline functional performance than those undergoing ITB. SDR was associated with fewer complications, but with less improvement in pain.


Invasive brain tissue oxygen and intracranial pressure (ICP) monitoring versus ICP-only monitoring in pediatric severe traumatic brain injury
Shih-Shan Lang, Nankee K. Kumar, Chao Zhao, David Y. Zhang, Alexander M. Tucker, Phillip B. Storm, Gregory G. Heuer, Avi A. Gajjar, Chong Tae Kim, Ian Yuan, Susan Sotardi, Todd J. Kilbaugh, and Jimmy W. Huh

There are limited data on brain tissue oxygen tension (PbtO2) monitoring and management in pediatric severe traumatic brain injury. This retrospective, single-institution study compares functional outcomes between patients who received intracranial pressure (ICP)–only versus ICP + PbtO2 monitoring. The findings reveal that ICP and PbtO2 are weakly correlated and independently affect functional outcomes, supporting the use of both invasive neuromonitoring techniques.

July 2022

The impact of multiple lesions on progression-free survival of meningiomas: a 10-year multicenter experience
Andres Ramos-Fresnedo, Ricardo A. Domingo, Jesus E. Sanchez-Garavito, Carlos Perez-Vega, Oluwaseun O. Akinduro, Mark E. Jentoft, Sujay A. Vora, Paul D. Brown, Alyx B. Porter, Bernard R. Bendok, Michael J. Link, Erik H. Middlebrooks, Daniel M. Trifiletti, Kaisorn L. Chaichana, Alfredo Quiñones-Hinojosa, and Wendy J. Sherman

Researchers sought to evaluate progression-free survival (PFS) differences in patients with multiple meningiomas (MMs). Patients with MMs demonstrated a worse PFS than those with single lesions. This study provides differences in the clinical outcomes of patients with meningiomas. These findings could shift the way in which these patients are managed in the future, as well as provide a baseline for future research in multiple meningiomas.


Glibenclamide in aneurysmal subarachnoid hemorrhage: a randomized controlled clinical trial
Bruno Braga Sisnando da Costa, Isabela Costola Windlin, Edwin Koterba, Vitor Nagai Yamaki, Nícollas Nunes Rabelo, Davi Jorge Fontoura Solla, Antonio Carlos Samaia da Silva Coelho, João Paulo Mota Telles, Manoel Jacobsen Teixeira, and Eberval Gadelha Figueiredo

Glibenclamide has been shown to improve outcomes in cerebral ischemia, traumatic brain injury, and subarachnoid hemorrhage (SAH). The authors sought to evaluate the effect of glibenclamide on mortality and functional outcomes of patients with aneurysmal SAH (aSAH). Glibenclamide was not associated with better functional outcomes after aSAH. Rates of mortality and delayed cerebral edema were also similar compared with placebo.


Patient-reported outcome measure clustering after surgery for adult symptomatic lumbar scoliosis
James P. Wondra II, Michael P. Kelly, Elizabeth L. Yanik, Jacob K. Greenberg, Justin S. Smith, Shay Bess, Christopher I. Shaffrey, Lawrence G. Lenke, and Keith Bridwell

A post hoc analysis from an NIH-sponsored trial of surgery for adult lumbar scoliosis was performed. The purpose was to examine for clustering of patient outcomes after surgery akin to ceiling effects with patient-reported outcome measures. Although many patients did improve after surgery, those with the worst disability were left with residual disability in the setting of substantial outcome improvement. The effect of baseline health-related quality-of-life measures has implications for future research and patient counseling.


Lateral versus prone robot-assisted percutaneous pedicle screw placement: a CT-based comparative assessment of accuracy
Islam Fayed, Alexander Tai, Matthew J. Triano, Daniel Weitz, Anousheh Sayah, Jean-Marc Voyadzis, and Faheem A. Sandhu


Endoscopic third ventriculostomy revision after failure of initial endoscopic third ventriculostomy and choroid plexus cauterization
Anastasia Arynchyna-Smith, Curtis J. Rozzelle, Hailey Jensen, Ron W. Reeder, Abhaya V. Kulkarni, Ian F. Pollack, John C. Wellons III, Robert P. Naftel, Eric M. Jackson, William E. Whitehead, Jonathan A. Pindrik, David D. Limbrick Jr., Patrick J. McDonald, Mandeep S. Tamber, Brent R. O’Neill, Jason S. Hauptman, Mark D. Krieger, Jason Chu, Tamara D. Simon, Jay Riva-Cambrin, John R. W. Kestle, Brandon G. Rocque, and for the Hydrocephalus Clinical Research Network

The purpose of this study was to describe the safety and efficacy of endoscopic third ventriculostomy (ETV) revision after failure of initial ETV and choroid plexus cauterization (CPC). ETV revision had a significantly lower 1-year success rate than initial ETV+CPC and ventriculoperitoneal shunt (VPS) implantation. The question is what treatment to offer patients after failed initial ETV+CPC. ETV revision carries a 29.5% rate of success in the 1st year and similar complications to other hydrocephalus surgeries. We observed no change to the performance of subsequent VPS.


Complications and outcomes of posterior fossa decompression with duraplasty versus without duraplasty for pediatric patients with Chiari malformation type I and syringomyelia: a study from the Park-Reeves Syringomyelia Research Consortium
S. Hassan A. Akbari, Alexander T. Yahanda, Laurie L. Ackerman, P. David Adelson, Raheel Ahmed, Gregory W. Albert, Philipp R. Aldana, Tord D. Alden, Richard C. E. Anderson, David F. Bauer, Tammy Bethel-Anderson, Karin Bierbrauer, Douglas L. Brockmeyer, Joshua J. Chern, Daniel E. Couture, David J. Daniels, Brian J. Dlouhy, Susan R. Durham, Richard G. Ellenbogen, Ramin Eskandari, Herbert E. Fuchs, Gerald A. Grant, Patrick C. Graupman, Stephanie Greene, Jeffrey P. Greenfield, Naina L. Gross, Daniel J. Guillaume, Todd C. Hankinson, Gregory G. Heuer, Mark Iantosca, Bermans J. Iskandar, Eric M. Jackson, George I. Jallo, James M. Johnston, Bruce A. Kaufman, Robert F. Keating, Nicklaus R. Khan, Mark D. Krieger, Jeffrey R. Leonard, Cormac O. Maher, Francesco T. Mangano, J. Gordon McComb, Sean D. McEvoy, Thanda Meehan, Arnold H. Menezes, Michael S. Muhlbauer, Brent R. O’Neill, Greg Olavarria, John Ragheb, Nathan R. Selden, Manish N. Shah, Chevis N. Shannon, Joshua S. Shimony, Matthew D. Smyth, Scellig S. D. Stone, Jennifer M. Strahle, Mandeep S. Tamber, James C. Torner, Gerald F. Tuite, Elizabeth C. Tyler-Kabara, Scott D. Wait, John C. Wellons III, William E. Whitehead, Tae Sung Park, and David D. Limbrick Jr.

The Park-Reeves Syringomyelia Research Consortium database was used to compare complications and outcomes between posterior fossa decompression with and without duraplasty for Chiari I malformations. The authors found that posterior fossa decompression was associated with fewer complications and shorter hospital stays than posterior fossa decompression with duraplasty, although it was associated with a higher revision rate and lower rates of headache and syrinx improvement. This study, coupled with the forthcoming results of a randomized controlled trial, should help improve understanding regarding the indications for each surgery.


June 2022

The role of vagus nerve stimulation in genetic etiologies of drug-resistant epilepsy: a meta-analysis
Sabastian Hajtovic, Melissa A. LoPresti, Lu Zhang, Kalman A. Katlowitz, Dominic J. Kizek, and Sandi Lam

Meta-analysis was used to examine the literature on the effectiveness of vagus nerve stimulation (VNS) in children with reported genetic etiologies of drug-resistant epilepsy. Tuberous sclerosis complex patients had substantial seizure reduction and improvements in quality of life. Dravet syndrome patients had less robust seizure reduction and variable improvements in cognition. Limited evidence exists regarding VNS outcomes in patients with other known genetic etiologies. This study highlights the increasing importance of genetic diagnosis. Long-term follow-up is needed.


The Hydrocephalus Clinical Research Network quality improvement initiative: the role of antibiotic-impregnated catheters and vancomycin wound irrigation
Jason Chu, Hailey Jensen, Richard Holubkov, Mark D. Krieger, Abhaya V. Kulkarni, Jay Riva-Cambrin, Curtis J. Rozzelle, David D. Limbrick Jr., John C. Wellons III, Samuel R. Browd, William E. Whitehead, Ian F. Pollack, Tamara D. Simon, Mandeep S. Tamber, Jason S. Hauptman, Jonathan Pindrik, Robert P. Naftel, Patrick J. McDonald, Todd C. Hankinson, Eric M. Jackson, Brandon G. Rocque, Ron Reeder, James M. Drake, John R. W. Kestle, and for the Hydrocephalus Clinical Research Network

Surgeons in the Hydrocephalus Clinical Research Network implemented a simplified infection prevention protocol for shunt surgery. Compliance was 79.4% and nonprotocol factors were recorded. In 4913 procedures, the infection rate was 5.1%. The presence of = 2 complex chronic conditions and recent shunt surgery (within 12 weeks) were independent predictors of infection. The use of antibiotic-impregnated catheters and vancomycin irrigation were independent factors protective against shunt infection.


Artificial disc replacement and adjacent-segment pathology: 10-year outcomes of a randomized trial
Michael Kontakis, Catarina Marques, Håkan Löfgren, Firas Mosavi, Martin Skeppholm, Claes Olerud, and Anna MacDowall

The objective was to investigate whether artificial disc replacement protects against adjacent-segment pathology at 10 years of follow-up in comparison with fusion surgery after anterior decompression due to cervical degenerative radiculopathy. Progression of degenerative changes on MRI and number of reoperations performed on adjacent segments were similar between groups. The authors concluded that the intrinsic disc aging processes may be more important for the progression of degenerative changes than fusion surgery.


March 2022

Impact of ventricle size on neuropsychological outcomes in treated pediatric hydrocephalus: an HCRN prospective cohort study
Jay Riva-Cambrin, Abhaya V. Kulkarni, Robert Burr, Curtis J. Rozzelle, W. Jerry Oakes, James M. Drake, Jessica S. Alvey, Ron W. Reeder, Richard Holubkov, Samuel R. Browd, D. Douglas Cochrane, David D. Limbrick, Robert Naftel, Chevis N. Shannon, Tamara D. Simon, Mandeep S. Tamber, Patrick J. McDonald, John C. Wellons III, Thomas G. Luerssen, William E. Whitehead, and John R. W. Kestle

The Hydrocephalus Clinical Research Network conducted a prospective cohort study of school-aged children with new hydrocephalus to determine if the treated ventricle size 6 months after surgery was associated with functional outcomes. Quality of life, school performance, and 23 of 25 neuropsychological tests, including full-scale IQ, were not associated with ventricle size. These findings have suggested that the resultant ventricle size after successful CSF diversion plays little role in predicting short-term functional outcomes in children with hydrocephalus.


The low utility of routine cranial imaging after pediatric shunt revision
Alexander F. C. Hulsbergen, Francesca Siddi, Malia McAvoy, Benjamin T. Lynch, Madeline B. Karsten, Brittany M. Stopa, Joanna Ashby, Jack McNulty, Marike L. D. Broekman, William B. Gormley, Scellig S. D. Stone, Benjamin C. Warf, and Mark R. Proctor

Routine imaging after ventriculoperitoneal shunt revision is relatively common, but it is unclear whether it leads to clinical interventions. Researchers examined a large cohort of patients who underwent shunt revision to determine the utility of postoperative imaging. In only 0.8% of revisions, postoperative imaging led to a change in management that was not otherwise heralded by clinical concerns, indicating a low utility for routine imaging.


Clinical accuracy and initial experience with augmented reality–assisted pedicle screw placement: the first 205 screws
Ann Liu, Yike Jin, Ethan Cottrill, Majid Khan, Erick Westbroek, Jeff Ehresman, Zach Pennington, Sheng-fu L. Lo, Daniel M. Sciubba, Camilo A. Molina, and Timothy F. Witham

In this study the authors report the accuracy of the first 205 consecutively placed pedicle screws inserted using augmented reality assistance with a unique head-mounted display navigation system at their institution. The authors describe an accuracy of 98.0% as determined by a Gertzbein-Robbins grade of A or B. Augmented reality depicted through a unique head-mounted display is a novel and clinically accurate technology for the navigated insertion of pedicle screws.


February 2022

Pediatric thalamic incidentalomas: an international retrospective multicenter study
Danil A. Kozyrev, Jehuda Soleman, Deki Tsering, Robert F. Keating, David S. Hersh, Frederick A. Boop, Pietro Spennato, Giuseppe Cinalli, Gianpiero Tamburrini, Ulrich-Wilhelm Thomale, Robert J. Bollo, Sandip Chatterjee, Harishchandra Lalgudi Srinivasan, Shlomi Constantini, and Jonathan Roth

The authors sought to evaluate the natural history and pathological spectrum of incidental thalamic tumors in children from eight pediatric centers. The key finding was that thalamic incidentalomas in children included mostly low-grade lesions; however, high-grade lesions may also present as incidentalomas. Thus, radiological follow-up of lesions is mandatory, as even lesions with a typical low-grade appearance may evolve over time.


Patient outcomes after circumferential minimally invasive surgery compared with those of open correction for adult spinal deformity: initial analysis of prospectively collected data
Dean Chou, Virginie Lafage, Alvin Y. Chan, Peter Passias, Gregory M. Mundis Jr., Robert K. Eastlack, Kai-Ming Fu, Richard G. Fessler, Munish C. Gupta, Khoi D. Than, Neel Anand, Juan S. Uribe, Adam S. Kanter, David O. Okonkwo, Shay Bess, Christopher I. Shaffrey, Han Jo Kim, Justin S. Smith, Daniel M. Sciubba, Paul Park, Praveen V. Mummaneni, and the International Spine Study Group (ISSG)

The objective of this study was to prospectively compare outcomes of long-segment fusion performed using minimally invasive and open techniques for adult scoliosis. The key finding was that long-segment fusion performed using modern minimally invasive techniques for adult scoliosis had comparable outcomes to open surgery at 1-year follow-up. This study adds value because it shows that minimally invasive adult scoliosis surgery may be a viable alternative to open surgery as a treatment of adult scoliosis.


Multiple-rod constructs and use of bone morphogenetic protein–2 in relation to lower rod fracture rates in 141 patients with adult spinal deformity who underwent lumbar pedicle subtraction osteotomy
Qiunan Lyu, Darryl Lau, Alexander F. Haddad, Vedat Deviren, and Christopher P. Ames

This study was performed to compare rod fracture rates among three types of rod constructs following lumbar pedicle subtraction osteotomy for patients with adult spinal deformity. Use of multiple-rod constructs in the satellite rod construct and nested rod construct groups was associated with lower rates of rod fracture, pseudarthrosis, and reoperations following lumbar pedicle subtraction osteotomy. The study is the largest to investigate the use of multiple-rod constructs for the prevention of rod fracture and reoperation in patients undergoing lumbar pedicle subtraction osteotomy at a single institution.


January 2022

Does ventricle size contribute to cognitive outcomes in posthemorrhagic hydrocephalus? Role of early definitive intervention
Mounica Paturu, Regina L. Triplett, Siddhant Thukral, Dimitrios Alexopoulos, Christopher D. Smyser, David D. Limbrick Jr., and Jennifer M. Strahle

Posthemorrhagic hydrocephalus (PHH) is associated with significant morbidity, smaller hippocampal volumes, and impaired neurodevelopment in preterm infants. The timing of temporary CSF (tCSF) diversion has been studied; however, the optimal time for permanent CSF (pCSF) diversion is unknown. The objective of this study was to determine whether cumulative ventricle size or timing of pCSF diversion is associated with neurodevelopmental outcome and hippocampal size in preterm infants with PHH.


Intermediate-grade brain arteriovenous malformations and the boundary of operability using the supplemented Spetzler-Martin grading system
Joshua S. Catapano, Fabio A. Frisoli, Candice L. Nguyen, Mohamed A. Labib, Tyler S. Cole, Jacob F. Baranoski, Helen Kim, Robert F. Spetzler, and Michael T. Lawton

Supplemented Spetzler-Martin grading (Supp-SM), which is the combination of Spetzler-Martin and Lawton-Young grades, was validated as being more accurate than stand-alone Spetzler-Martin grading, but an operability cutoff was not established. In this study, the authors surgically treated intermediate-grade AVMs to provide prognostic factors for neurological outcomes and to define AVMs at the boundary of operability.


Double tubular minimally invasive spine surgery: a novel technique expands the surgical visual field during resection of intradural pathologies
Ulrich Hubbe, Jan-Helge Klingler, Roland Roelz, Christoph Scholz, Katerina Argiti, Panagiotis Fistouris, Jürgen Beck, and Ioannis Vasilikos

A major challenge of a minimally invasive spinal approach (MIS) is maintaining freedom of maneuverability through small operative corridors. Unfortunately, during tubular resection of intradural pathologies, the durotomy and its accompanying tenting sutures offer a smaller operating window than the maximum surface of the tube’s base. The objective of this study was to evaluate if a novel double tubular technique could expand the surgical visual field during MIS resection of intradural pathologies.


Quality of life and satisfaction in surgical versus conservative treatment of nonsyndromic children with craniosynostosis
Nicholas Sader, Vivek Mehta, Shannon Hart, Lori Bliss, Hanna Moore, Melissa DaSilva, Ruksana Rashid, and Jay Riva-Cambrin

Craniosynostosis represents the second most common reason for referral to pediatric neurosurgery. However, the quality of life and neurodevelopmental impact of leaving this physical disorder uncorrected is poorly understood.