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.
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.
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.
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.
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.