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.

April 2024

Rapid brain MRI for image-guided ventricular catheter placement in pediatric patients: protocol and preliminary clinical outcomes
Grace Y. Lai, Andria Powers, Taylor Chung, and Peter P. Sun

IN BRIEF
Imaging used for neuronavigation for neurosurgical procedures typically involves long MRI sequences or CT scans. Researchers report a rapid 1-minute MRI protocol and clinical application for image-guided ventricular access for children. The use of rapid MRI for neuronavigation in pediatric neurosurgery may minimize the need for anesthesia and radiation.

 

The safety and accuracy of intratumoral catheter placement to infuse viral immunotherapies in children with malignant brain tumors: a multi-institutional study
Ariana Barkley, Eric Butler, Christine Park, Allan Friedman, Daniel Landi, David M. Ashley, Darell Bigner, Joshua D. Bernstock, Gregory K. Friedman, James M. Johnston, and Eric M. Thompson

IN BRIEF
The objective of this study was to describe the adverse event profile and accuracy associated with the stereotactic placement and subsequent removal of intratumoral catheters for the infusion of viral immunotherapy. Nineteen patients with 49 catheters were analyzed. There was only 1 event that required intervention, oversew of a CSF leak. Only 3 catheters were “misplaced.” The stereotactic intratumoral placement of catheters for viral immunotherapy infusion in pediatric tumor patients is safe and accurate.

 

neuroGPT-X: toward a clinic-ready large language model
Edward Guo, Mehul Gupta, Sarthak Sinha, Karl Rössler, Marcos Tatagiba, Ryojo Akagami, Ossama Al-Mefty, Taku Sugiyama, Philip E. Stieg, Gwynedd E. Pickett, Madeleine de Lotbiniere-Bassett, Rahul Singh, Sanju Lama, and Garnette R. Sutherland

IN BRIEF
As large language models became openly available, a curiosity arose: Could they be tested and used as an expert opinion for complex neurosurgical disease? The publicly available, context-enriched ChatGPT model revealed that such a trained model could indeed generate comprehensive responses to curated questions on vestibular schwannoma, similar to a cadre of international neurosurgical experts. The study is only a beginning and heralds the inevitable utility of machine intelligence in medicine.

 

Is single-level cervical disc arthroplasty associated with a lower reoperation rate than anterior cervical discectomy and fusion?
Alexander Tuchman, Ida Chen, Corey T. Walker, Linda E. Kanim, Hyun W. Bae, and David L. Skaggs

IN BRIEF
Researchers used a large administrative database to follow patients longitudinally after single-level cervical disc arthroplasty and anterior cervical discectomy and fusion. In contradiction to the available data from cervical disc replacement randomized control trials, no difference out to 10 years was found in the cervical reoperation rates between the two procedures. This is the largest long-term outcome data study to compare the two procedures as they are actually used in clinical practice.

 

What predicts the best 24-month outcomes following surgery for cervical spondylotic myelopathy? A QOD prospective registry study
Andrew K. Chan, Christine Park, Christopher I. Shaffrey, Oren N. Gottfried, Khoi D. Than, Erica F. Bisson, Mohamad Bydon, Anthony L. Asher, Domagoj Coric, Eric A. Potts, Kevin T. Foley, Michael Y. Wang, Kai-Ming Fu, Michael S. Virk, John J. Knightly, Scott Meyer, Paul Park, Cheerag D. Upadhyaya, Mark E. Shaffrey, Avery L. Buchholz, Luis M. Tumialán, Jay D. Turner, Giorgos Michalopoulos, Brandon A. Sherrod, Nitin Agarwal, Dean Chou, Regis W. Haid Jr., and Praveen V. Mummaneni

IN BRIEF
The aim of this paper was to identify predictors of the best 24-month improvements in disability, quality of life, and functional status in patients undergoing surgery for cervical spondylotic myelopathy. Shorter preoperative symptom duration, arm-pain only complaints, lower body mass index, and anterior operative approaches were associated with the best outcomes. The finding that shorter preoperative symptom duration was associated with the best disability outcomes suggests that early surgery may be beneficial for patients with cervical spondylotic myelopathy.

 


March 2024

Awake craniotomy for supratentorial tumors or epileptogenic lesions in pediatric patients: a 16-year retrospective cohort study
Hope M. Reecher, Jennifer I. Koop, Ahmed J. Awad, Irene Kim, Andrew B. Foy, Bruce A. Kaufman, Nicholas A. Meier, and Sean M. Lew

OBJECTIVE
Awake craniotomy with intraoperative mapping is the widely accepted procedure for adult patients undergoing supratentorial tumor or epileptogenic focus resection near eloquent cortex. In children, awake craniotomies are notably less common due to concerns for compliance and emotional or psychological repercussions. Despite this, successfully tolerated awake craniotomies have been reported in patients as young as 8 years of age, with success rates comparable to those of adults. The authors sought to describe their experience with pediatric awake craniotomies, including insight regarding feasibility and outcomes.

 

Impact of subthalamic nucleus stimulation on urinary dysfunction and constipation in Parkinson’s disease
Asra Askari, Brandon J. Zhu, Jordan L. W. Lam, Kara J. Wyant, Kelvin L. Chou, and Parag G. Patil

IN BRIEF
This study examined the impact of subthalamic nucleus (STN) deep brain stimulation (DBS) on urinary dysfunction and constipation in Parkinson's disease, as well as the impact of DBS lead localization on autonomic dysfunction. Anterior STN DBS improved constipation, and brain atrophy was correlated with worsening of urinary dysfunction. These findings may enhance STN DBS targeting, programming, and patient selection with respect to autonomic symptoms in Parkinson's disease.

 

Safety and effectiveness of stent-assisted coiling with adjunctive techniques in ruptured acute aneurysms: a propensity score–matched cohort study
Ziwei Chen, Yanhong Xin, Liang Zou, Ji Ma, and Chengbao Yang

IN BRIEF
The effects of stent-assisted coiling on the degree of embolization, complications, and prognosis in the treatment of patients with ruptured intracranial aneurysms were evaluated. The use of stent-assisted coils in the treatment of ruptured intracranial aneurysms did not increase the incidence of complications and did not improve the prognosis, but it significantly improved the degree of embolization. It was demonstrated that stent-assisted coils are a safe and effective method for the treatment of ruptured intracranial aneurysms.

 

Is single-level cervical disc arthroplasty associated with a lower reoperation rate than anterior cervical discectomy and fusion?
Alexander Tuchman, Ida Chen, Corey T. Walker, Linda E. Kanim, Hyun W. Bae, and David L. Skaggs

IN BRIEF
Researchers used a large administrative database to follow patients longitudinally after single-level cervical disc arthroplasty and anterior cervical discectomy and fusion. In contradiction to the available data from cervical disc replacement randomized control trials, no difference out to 10 years was found in the cervical reoperation rates between the two procedures. This is the largest long-term outcome data study to compare the two procedures as they are actually used in clinical practice.

 

Comparison of lumbar microdiscectomy and unilateral biportal endoscopic discectomy outcomes: a single-center experience
Mehmet İlker Özer and Oğuz Kağan Demirtaş

IN BRIEF
This study demonstrates that unilateral biportal endoscopic discectomy (UBE) is a safe and effective alternative to traditional lumbar microscopic discectomy (LMD) for treating lumbar disc herniation. UBE offers benefits such as shorter hospital stay and reduced postoperative pain while maintaining high patient satisfaction. This research contributes valuable insights into minimally invasive spine surgery techniques, aiding clinicians in making informed treatment decisions.

 


February 2024

Safety and efficacy of intrathecal baclofen trials for the treatment of hypertonia: a retrospective cohort study
Sunny Abdelmageed, Victoria Jane Horak, James Mossner, Ryan Wang, Timothy Krater, and Jeffrey S. Raskin

IN BRIEF
The objective of this retrospective case series was to assess the safety and efficacy of bolus intrathecal baclofen (ITB) trials in a pediatric population with mixed hypertonia. Bolus ITB trials are very effective and have high conversion rates to ITB pump implantation; however, minor complications may significantly affect family satisfaction, leading to a decreased rate of implantation. Patients with mixed hypertonia overwhelmingly respond to ITB bolus trials, and nonclinical oversight is unnecessary when appropriately indicated by movement disorder subspecialists.

 

Grade 3 meningioma survival and recurrence outcomes in an international multicenter cohort
Kira Tosefsky, Alexander D. Rebchuk, Justin Z. Wang, Yosef Ellenbogen, Richard Drexler, Franz L. Ricklefs, Thomas Sauvigny, Ulrich Schüller, Christopher B. Cutler, Brandon Lucke-Wold, Yusuf Mehkri, Sanju Lama, Garnette R. Sutherland, Michael Karsy, Brian L. Hoh, Manfred Westphal, Gelareh Zadeh, Stephen Yip, and Serge Makarenko

OBJECTIVE
Grade 3 meningioma represents a rare meningioma subtype, for which limited natural history data are available. The objective of this study was to identify demographics and pathologic characteristics, clinical and functional status outcomes, and prognostic factors in an international cohort of grade 3 meningioma patients.

 

Diagnostic predictive values for sport-related concussions: a systematic review and diagnostic meta-analysis
Rajiv Dharnipragada, Anant Naik, Lalitha Saahiti Denduluri, Maria Bederson, Adam Akkad, Samuel W. Cramer, Stefan W. Koester, Joshua S. Catapano, Scott L. Zuckerman, Laura Snyder, and Paul M. Arnold

IN BRIEF
The objective of this study was to assess various methods for the diagnosis of concussion and which methods were most effective. These methods were evaluated via a systematic review as well as a network meta-analysis.

 

Risk factors for C5 palsy: a systematic review and multivariate analysis
Vincent C. Traynelis, Ricardo B. V. Fontes, Manish K. Kasliwal, Won Hyung A. Ryu, Lee A. Tan, Christopher D. Witiw, Joseph R. Dettori, Erika D. Brodt, and Andrea C. Skelly

IN BRIEF
The objective of this work was to perform a systematic literature review and critical appraisal of existing evidence to determine risk factors for C5 palsy (C5P). C5P is clearly associated with foraminal stenosis, especially when posterior procedures are performed. C5P is also related to decreased AP diameter, but the association is less clear. These data are helpful in preoperative discussions and may lead to surgical strategies to limit the risk of postoperative C5P.

 

Durable responses at 24 months with high-frequency spinal cord stimulation for nonsurgical refractory back pain
Naresh P. Patel, Jessica Jameson, Curtis Johnson, Daniel Kloster, Aaron Calodney, Peter Kosek, Julie Pilitsis, Markus Bendel, Erika Petersen, Chengyuan Wu, Taissa Cherry, Shivanand Lad, Cong Yu, Dawood Sayed, Johnathan Goree, Mark K. Lyons, Andrew Sack, Diana Bruce, Manish Bharara, Rose Province-Azalde, David Caraway, and Leonardo Kapural

IN BRIEF
Two-year outcomes are presented for 125 patients implanted with 10-kHz high-frequency spinal cord stimulation within a randomized controlled trial evaluating treatment for chronic nonsurgical back pain (NSBP). The study is the first to publish long-term outcomes in a large cohort of NSBP patients where all participants had a spine surgeon consultation for inclusion. Results demonstrated a durable 2-year 82% responder rate (≥ 50% pain relief) and clinically important improvements in quality of life and function.

 


January 2024

Systematic review of transcranial and endoscopic endonasal approaches for craniopharyngiomas in children: is there an evolution?
Elena d’Avella, Francesca Vitulli, Jacopo Berardinelli, Giuseppe Cinalli, Domenico Solari, Paolo Cappabianca, and Luigi Maria Cavallo

OBJECTIVE
The optimal surgical approach for pediatric craniopharyngiomas (CPs) remains a matter of debate, with selection bias classically precluding a fair comparison of outcomes between the transcranial approach (TCA) and endoscopic endonasal approach (EEA). The purpose of this systematic review was to analyze the current role of EEA in the treatment of pediatric CPs and to determine whether, upon expansion of its indications, a comparison with TCA is valid.

 

Laser interstitial thermal therapy compared with open resection for treating subependymal giant cell astrocytoma
Diane J. Aum, Rebecca A. Reynolds, Sean D. McEvoy, Michael Wong, Jarod L. Roland, and Matthew D. Smyth

IN BRIEF
This paper reports on the authors' single-institution 15-year experience with laser interstitial thermal therapy (LITT) and open approaches for the treatment of subependymal giant cell astrocytoma (SEGA). The small size of this case series limits generalizability or adequate comparison of safety, but the series adds to the literature supporting LITT as a less invasive surgical alternative to open resection of SEGAs and demonstrates that LITT has similar recurrence and/or progression rates to open resection. Additional studies with more data are necessary for comprehensive comparisons between open resection and LITT for treating SEGA.

 

Preserving the cerebellar hemispheric tentorial bridging veins through a novel tentorial cut technique for supracerebellar approaches
Berk Burak Berker, Yücel Doğruel, Abuzer Güngör, Seda Yağmur Karataş Okumuş, Mehmet Erdal Coşkun, Hatice Türe, and Uğur Türe

IN BRIEF
The objective of this study was to demonstrate the distribution pattern of cerebellar hemispheric tentorial bridging (CHTB) veins and describe a novel microsurgical technique to preserve these veins. The key finding was that it is possible to preserve all CHTB veins through supracerebellar approaches. The value of this study lies in its contribution to understanding the anatomy and distribution pattern of CHTB veins and demonstrating a novel microsurgical technique to preserve these veins.

 

Nonoperative versus operative management of type II odontoid fracture in older adults: a systematic review and meta-analysis
Mauricio J. Avila, S. Harrison Farber, Nicholas M. Rabah, Morgan J. Hopp, Kristina M. Chapple, R. John Hurlbert, and Luis M. Tumialán

IN BRIEF
Type II odontoid fracture treatment in adults older than 65 years remains controversial. The authors compared outcomes between operative and nonoperative treatments. This meta-analysis demonstrated that patients had higher fusion rates with surgery and more stable nonunion with nonoperative management. Complications and length of stay were greater with surgery. Mortality was lower in surgically treated patients, possibly related to surgical selection bias. Treatment failure after nonoperative management was rare, suggesting that stable nonunion is an acceptable treatment goal.

 

Hospital cost differences between open and endoscopic lumbar spine decompression surgery
Matthew C. Findlay, Forrest A. Hamrick, Robert B. Kim, Spencer Twitchell, and Mark A. Mahan

IN BRIEF
Endoscopic decompression surgery for degenerative spine disease has become increasingly popular; however, within the US, it remains unknown how endoscopic surgery costs compare with those of the traditional open approach. After adjustment for relevant factors, endoscopic surgery bore a significantly greater (+15.9%) total cost compared with open surgical procedures. This was the first investigation of its kind within the US and offers insights into the financial considerations of adopting an endoscopic approach for lumbar decompression.

 


December 2023

Predicting endoscopic third ventriculostomy success in pediatric shunt dysfunction: a monocentric retrospective case series of 70 consecutive children, systematic review, and meta-analysis
Lelio Guida, Flavie Grenier-Chartrand, Sandro Benichi, Syril James, Giovanna Paternoster, Marie Bourgeois, Volodia Dangouloff-Ros, Antonio Messina, Nathalie Boddaert, Stéphanie Puget, Kevin Beccaria, and Thomas Blauwblomme

IN BRIEF
The authors conducted a retrospective analysis of 70 patients undergoing evaluation during shunt failure to find predictors of ETV success. They found that age < 36 months, primary inflammatory hydrocephalus, and obstruction at fourth ventricle outlets were associated with ETV failure. A meta-analysis is also provided, confirming the results. Finally, the authors focus on patients experiencing signs and symptoms of global rostral midbrain dysfunction syndrome during shunt dysfunction, in which ETV is effective in improving clinical outcome.

 

Real-world benefit of intracranial pressure monitoring in the management of severe traumatic brain injury: a propensity score matching analysis using a nationwide inpatient database
Keita Shibahashi, Hiroyuki Ohbe, Hiroki Matsui, and Hideo Yasunaga

IN BRIEF
Using a Japanese nationwide inpatient database, the authors performed a propensity score matched analysis to investigate the real-world impact of intracranial pressure (ICP) monitoring in managing severe traumatic brain injury (TBI). ICP monitoring was associated with significantly more frequent medical interventions and lower in-hospital mortality (within-hospital difference -7.2%). In the real-world setting, active ICP monitoring may improve outcomes after TBI.

 

Clinical and genomic differences in supratentorial versus infratentorial NF2 mutant meningiomas
Joanna K. Tabor, Joseph O’Brien, Sagar Vasandani, Shaurey Vetsa, Haoyi Lei, Muhammad I. Jalal, Neelan J. Marianayagam, Lan Jin, Miguel Millares Chavez, Joseph Haynes, Alper Dincer, Kanat Yalcin, Stephanie M. Aguilera, Sacit Bulent Omay, Ketu Mishra-Gorur, Declan McGuone, Saul F. Morales-Valero, Robert K. Fulbright, Murat Gunel, E. Zeynep Erson-Omay, and Jennifer Moliterno

IN BRIEF
Researchers sought to determine whether the behavior of NF2 mutant sporadic meningiomas varies based on intracranial location. They found that infratentorial tumors, as compared to their supratentorial counterparts, have more benign clinical and genomic features. Despite undergoing less extensive resection, infratentorial NF2 mutant sporadic meningiomas had similar rates of recurrence. These findings underscore the importance of achieving maximal resection, only when safe, and suggest that there may be additional biological mechanisms related to tumor location.

 

Economic burden of nonoperative treatment of adult spinal deformity
Peter G. Passias, Waleed Ahmad, Pooja Dave, Renaud Lafage, Virginie Lafage, Jamshaid Mir, Eric O. Klineberg, Khaled M. Kabeish, Jeffrey L. Gum, Breton G. Line, Robert Hart, Douglas Burton, Justin S. Smith, Christopher P. Ames, Christopher I. Shaffrey, Frank Schwab, Richard Hostin, Thomas Buell, D. Kojo Hamilton, and Shay Bess, on behalf of International Spine Study Group

IN BRIEF
Researchers quantified the value of operative management for adult spinal deformity in terms of its economic impact on patients as predicted by patients' quality of life. Those who underwent surgical treatment often had a greater degree of baseline deformity, but then reported a greater degree of improvement in life quality measures and utility gained. The present study informs cost-effective patient selection based on extent of existing deformity and likelihood of long-term functional and economic gains.

 

A comparison of modern-era anterior lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion at the lumbosacral junction
S. Harrison Farber, Robert K. Dugan, Michael D. White, Corey T. Walker, Luke K. O’Neill, Nima Alan, James J. Zhou, Jay D. Turner, Luis M. Tumialán, and Juan S. Uribe

IN BRIEF
This study compared changes in radiographic and clinical parameters between patients undergoing single-level anterior lumbar interbody fusion (ALIF) and minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF) at L5-S1. The authors found that ALIF significantly increased segmental lordosis (6×), L5-S1 disc angle (5×), and neuroforaminal height (2×) compared with MIS TLIF. Improvements in clinical parameters, complications, and reoperation rates were similar between the 2 techniques. This study demonstrates the amount of radiographic correction possible with current techniques.

 


November 2023

Determinants of epileptogenic zone identification and seizure outcome in children with refractory epilepsy undergoing stereoelectroencephalography
Jason K. Hsieh, Swetha J. Sundar, Elaine Lu, Ansh Desai, Ajay Gupta, Ahsan N. Moosa, William Bingaman, Lara Jehi, and Juan Bulacio

 

The role of surgery in recurrent ependymomas
Guillermo Aldave, M. Fatih Okcu, Lucia Ruggieri, Arnold C. Paulino, Susan McGovern, William Whitehead, Howard L. Weiner, and Murali Chintagumpala

IN BRIEF
The objective of this study was to investigate whether gross-total resection (GTR) can prolong survival after pediatric ependymoma recurrence, not only for first recurrence but also subsequent relapses. The authors' findings suggest that GTR can result in long-term survival for both first local relapses and second recurrences. To the best of their knowledge, this is the first study to analyze the role of surgery in recurrent ependymomas on multiple recurrences.

 

Data-efficient resting-state functional magnetic resonance imaging brain mapping with deep learning
Patrick H. Luckett, Ki Yun Park, John J. Lee, Eric J. Lenze, Julie Loebach Wetherell, Lisa T. Eyler, Abraham Z. Snyder, Beau M. Ances, Joshua S. Shimony, and Eric C. Leuthardt

IN BRIEF
Researchers developed a deep learning model (3D convolutional neural network [3DCNN]) capable of mapping resting-state networks (RSNs) in healthy controls and tumor patients with minimal quantities of resting-state functional MRI data. The 3DCNN accurately mapped RSNs using only 2.5 minutes of data in controls and tumor patients, representing an approximately 60% decrease in the quantity of data conventionally thought necessary to map RSNs. Functional maps produced by the 3DCNN can inform surgical planning in patients with brain tumors in a time-efficient manner.

 

Use of differential stimulation of the nucleus accumbens and anterior limb of the internal capsule to improve outcomes of obsessive-compulsive disorder
Botao Xiong, Bin Li, Rong Wen, Yuan Gao, Feilong Gong, Denghui Li, Yangyang Xu, Hao Deng, Linglong Xiao, Senlin Yin, Wei Zhang, Andres M. Lozano, and Wei Wang

IN BRIEF
The authors examined a novel designed electrode and implantable pulse generator that could achieve differential stimulation parameters on different contacts that were implanted into the nucleus accumbens (NAc) and anterior limb of the internal capsule (ALIC) of a cohort of patients with obsessive-compulsive disorder (OCD). Ten of 13 patients were categorized as responders (76.9%). These preliminary findings indicate that differential stimulation of the NAc-ALIC can improve the efficacy of deep brain stimulation for OCD.

 

Risk factors for sacral fracture following en bloc chordoma resection
Anthony L. Mikula, Zach Pennington, Nikita Lakomkin, Marc Prablek, Behrang Amini, S. Mohammed Karim, Shalin S. Patel, Daniel Lubelski, Daniel M. Sciubba, Christopher Alvarez-Breckenridge, Robert Y. North, Claudio E. Tatsui, Mohamad Bydon, Jeremy L. Fogelson, Benjamin D. Elder, William E. Krauss, Justin E. Bird, Peter S. Rose, Michelle J. Clarke, and Laurence D. Rhines

IN BRIEF
This study analyzes risk factors for sacral fracture following partial sacral amputation for en bloc chordoma resection. The authors found S1–2 sacral amputation, a combined anterior-posterior surgical approach, low superior S1 Hounsfield units, and partial sacroiliac joint resection to be independent predictors of sacral fracture. This study can help guide which patients may benefit from upfront spinopelvic instrumentation at the index procedure, and is important for patient optimization, surgical planning, and counseling.

 

Selective thoracolumbar fusion in adult spinal deformity double curves with circumferential minimally invasive surgery: 2-year minimum follow-up
Neel Anand, Jerry Robinson, Andrew Chung, David Gendelberg, José H. Jiménez-Almonte, Sheila Kahwaty, Babak Khandehroo, and Corey Walker

IN BRIEF
The authors detail their experience performing selective minimally invasive thoracolumbar fusion constructs on adult spinal deformity patients with double curves (presence of both a lumbar and thoracic curve). Limited constructs involving only the lumbar and/or lower thoracic spine performed well at minimum 2-year follow-up with low complication rates. This technique is a departure from the traditional viewpoint that both curves need to be included to avoid complications.

 


October 2023

Awake craniotomies in the pediatric population: a systematic review
Debarati Bhanja, Bao Y. Sciscent, Lekhaj C. Daggubati, Casey A. Ryan, Natalie K. Pahapill, Sprague W. Hazard, and Elias B. Rizk

IN BRIEF
The authors performed a systematic review to analyze clinical outcomes and anesthetic procedures for children undergoing awake craniotomy (AC). AC is used to maximize resection while protecting vital brain structures. However, concerns for safety and tolerability in children limit its use. The authors analyzed 30 articles for data that included incidences of intraoperative seizures, conversion to general anesthesia, completion of monitoring tasks, and postoperative complications in pediatric patients who underwent AC. Overall, the study results suggest that AC can be safe and tolerable in children.

 

Clinical characteristics of familial and sporadic pediatric cerebral cavernous malformations and outcomes
Emade Jaman, Hussein M. Abdallah, Xiaoran Zhang, and Stephanie Greene

IN BRIEF
Researchers summarized the natural history, symptomatology, and predictors of hemorrhage of 131 patients treated at a single pediatric tertiary care center over a 17-year period. The familial cases (27% of the total) and patients with larger lesions were more likely to have progression of disease over a shorter time interval. Surgical intervention was effective in producing symptom resolution.

 

Surgical, functional, and oncological considerations regarding awake resection for giant diffuse lower-grade glioma of more than 100 cm3
Sidonie Sauvageot, Julien Boetto, and Hugues Duffau

IN BRIEF
The authors investigated postoperative results in a consecutive cohort of 108 patients who underwent awake resection for giant lower-grade glioma (LGG) > 100 cm3. Three months after surgery, all patients but one had a normal neurological examination, with 85.1% of patients having returned to work. The mean extent of resection was 88.9% ± 7.0%, with a median survival of 138 months. Resection of huge LGGs can be reproducibly achieved with patients under awake mapping, with favorable long-term functional and oncological outcomes.

 

Endovascular treatment as first-line therapy in Spetzler-Martin grade III brain arteriovenous malformations: a multicenter retrospective study
Julien Burel, Chrysanthi Papagiannaki, Nader Sourour, Atika Talbi, Matthieu Garnier, Capucine Hermary, Maichael Talaat, Anne-Laure Boch, Aurélien Nouet, Stéphanie Lenck, Kévin Premat, Eimad Shotar, and Frédéric Clarençon

IN BRIEF
Spetzler-Martin grade (SMG) III brain arteriovenous malformations (bAVMs) are a heterogeneous group for which exclusion treatment is controversial. This study aimed to evaluate embolization as first-line treatment in 116 consecutive patients with SMG III bAVMs. Complete obliteration by embolization alone was achieved in 42.2% of the cases. Major complications occurred in 4.3% of the cases. Embolization thus provides encouraging results but needs further improvement. When the embolization procedure appears risky, a combined technique (with microsurgery or radiosurgery) may be a safe and effective alternative.

 

Robot-assisted percutaneous pedicle screw placement accuracy compared with alternative guidance in lateral single-position surgery: a systematic review and meta-analysis
Neal A. Patel, Cathleen C. Kuo, Zach Pennington, Nolan J. Brown, Julian Gendreau, Rohin Singh, Shane Shahrestani, Candler Boyett, Luis Daniel Diaz-Aguilar, and Martin H. Pham

IN BRIEF
The authors aimed to compare the accuracy rates of pedicle screws placed with robotic assistance in the lateral decubitus position versus fluoroscopy, O-arm, or CT-based navigation. The results of the meta-analysis showed that robot-assisted placement is as accurate as the other methods and may offer additional benefits in dealing with the technical challenges of this position. These findings advocate for the use of single-position surgery with robotic technologies that can better facilitate the placement of pedicle screws.

 


September 2023

A quantitative model of the cerebral windkessel and its relevance to disorders of intracranial dynamics
Michael Egnor, Liu Yang, Racheed M. Mani, Susan M. Fiore, and Petar M. Djurić

IN BRIEF
Researchers used mathematical analysis to compare the intracranial pressure dynamics of dogs to the dynamics of a simple electrical tank circuit. The dynamics were very similar. This study provides insight into the means by which the arterial pulse is buffered in the cranium, and suggests a new understanding of hydrocephalus and other disorders of intracranial dynamics.

 

Comparison of outcomes in the management of abdominal pseudocyst in children with shunted hydrocephalus: a Hydrocephalus Clinical Research Network study
Vijay M. Ravindra, Hailey Jensen, Jay Riva-Cambrin, John C. Wellons III, David D. Limbrick Jr., Jonathan Pindrik, Eric M. Jackson, Ian F. Pollack, Todd C. Hankinson, Jason S. Hauptman, Mandeep S. Tamber, Abhaya V. Kulkarni, Brandon G. Rocque, Curtis Rozzelle, William E. Whitehead, Jason Chu, Mark D. Krieger, Tamara D. Simon, Ron Reeder, Patrick J. McDonald, Nichol Nunn, John R. W. Kestle, and for the Hydrocephalus Clinical Research Network

IN BRIEF
The authors' objective was to investigate shunt management in children with abdominal pseudocysts–peritoneal reimplantation versus implantation in a nonperitoneal site. The primary outcome was shunt failure (infection/malfunction). No differences were found in overall shunt failure rate; however, noninfectious shunt revisions were more common in the nonperitoneal distal catheter sites and infection was a more common reason for failure after reimplantation in the abdomen. This study will inform the management of abdominal pseudocysts in children with hydrocephalus.

 

Magnetic resonance–guided focused ultrasound central lateral thalamotomy against chronic and therapy-resistant neuropathic pain: retrospective long-term follow-up analysis of 63 interventions
Marc N. Gallay, Anouk E. Magara, David Moser, Milek Kowalski, Mélanie Kaeser, and Daniel Jeanmonod

IN BRIEF
The goal of this study was to demonstrate the efficacy and risk profile of the MR-guided focused ultrasound central lateral thalamotomy (MRgFUS CLT) against chronic and therapy-resistant neuropathic pain in a large series. The results suggest that MRgFUS CLT against neuropathic pain is a safe approach, and its results are stable over time. At a mean follow-up of 55 months, > 50% of patients still reported ≥ 50% pain relief.

 

On the stability of Leksell Vantage stereotactic head frame fixation in Gamma Knife radiosurgery: a study based on cone-beam computed tomography imaging and the High Definition Motion Management system
Mohammed Ghazal, Marcus Fager, Amir Samadi, Michael Gubanski, and Hamza Benmakhlouf

IN BRIEF
Based on pretreatment stereotactic computed tomography (CT), as well as pretreatment and posttreatment cone-beam CT (CBCT) coupled with intrafractional motion tracking using the built-in High Definition Motion Management system, it has been shown that the geometric stability, both prefractional and intrafractional, of the newly introduced stereotactic Vantage frame is submillimeter. Hence, the use of the Vantage frame to define the stereotactic coordinate system and to minimize intrafractional motion in frame-based Gamma Knife radiosurgery treatments is concluded to be safe and feasible.

 

Comparison of pedicle subtraction osteotomy and vertebral column decancellation for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis
Haopeng Luan, Cong Peng, Kai Liu, and Xinghua Song

IN BRIEF
The goal of this study was to evaluate the efficacy of vertebral column decancellation and pedicle subtraction osteotomy in patients with ankylosing spondylitis with kyphotic deformity. Vertebral column decancellation was superior in terms of operative time and intraoperative blood loss. This study can give clinicians a better reference in the selection of surgical methods.

 

Comparison of minimally invasive decompression alone versus minimally invasive short-segment fusion in the setting of adult degenerative lumbar scoliosis: a propensity score–matched analysis
Murray Echt, Adewale A. Bakare, Jesus R. Varela, Andrew Platt, Mohammed Abdul Sami, Joseph Molenda, Mena Kerolus, and Richard G. Fessler

IN BRIEF
The clinical outcomes of patients with degenerative scoliosis undergoing decompression alone or short-segment fusion were compared using propensity score matching. For matched patients, a tradeoff was seen for reduced perioperative morbidity for decompression versus greater improvement in back pain, disability, and mental health 1 year after short-segment fusion. In the first propensity score–matched comparison of MISDEF2 (minimally invasive spinal deformity surgery revision 2) class I patients, future directions are provided to further refine treatment algorithms.

 


September 2023

Outcomes and surgical approaches for pineal region tumors in children: 30 years’ experience
Sergio Cavalheiro, Linoel Curado Valsechi, Patricia Alessandra Dastoli, Jardel Mendonça Nicácio, Andrea Maria Cappellano, Nasjla Saba da Silva, and Marcos Devanir Silva da Costa

IN BRIEF
The authors analyzed their outcomes from the management of pineal region tumors over the last 30 years. They concluded that gross-total resection provides the best survival, and there is no superiority of supracerebellar infratentorial approach over the occipital transtentorial approach. Neuroendoscopy was an essential tool for diagnosis and treatment. The authors have one of the largest case series of pediatric pineal region tumors in Latin America, and they hope that their expertise can help other centers around the world in the management of such challenging tumors.

 

Endoscopic third ventriculostomy with choroid plexus cauterization: predictors of long-term success and comparison with shunt placement for primary treatment of infant hydrocephalus
Benjamin C. Warf, Daniel S. Weber, Emily L. Day, Coleman P. Riordan, Steven J. Staffa, Lissa C. Baird, Katie P. Fehnel, and Scellig S. D. Stone

IN BRIEF
This study examined long-term outcomes after ventriculoperitoneal shunt (VPS) placement and endoscopic third ventriculostomy (ETV)/choroid plexus cauterization (CPC) in 82 and 266 infants with hydrocephalus, respectively, estimating that 59% of patients would have shunt freedom at 11 years of follow-up after ETV/CPC. ETV/CPC success exceeded that predicted with ETV alone, and corrected age < 2.5 months, severe ventriculomegaly, excess intraoperative bleeding, and prior CSF diversion predicted both reoperation and VPS placement. These results define long-term outcomes after ETV/CPC relative to VPS and can assist with patient selection.

 

Establishing ranked priorities for future hydrocephalus research
Noriana E. Jakopin, Elliot Myong, Trish Bogucki, Diana Gray, Paul Gross, J. Gordon McComb, Chevis N. Shannon, Mandeep S. Tamber, Maiko Toyama, Tessa van der Willigen, Amir Yazdani, Mark G. Hamilton, and Jenna E. Koschnitzky

IN BRIEF
In this initiative the Hydrocephalus Association (HA) used a standardized methodology that included sequential surveys and an iterative process of consensus building to produce a ranked list of the top 20 hydrocephalus research priorities. The process engaged the hydrocephalus patient community in conjunction with the healthcare and scientific community. Several themes within this list were also identified. The HA will use this ranked list to guide future research programs and encourages the healthcare and scientific community to do the same.

 

Use of adhesive cranial bone flap fixation without hardware to improve mechanical strength, resist cerebrospinal fluid leakage, and maintain anatomical alignment: a laboratory study
Timothy R. Smith, Kevin T. Foley, Sourabh Boruah, Jonathan R. Slotkin, Eric Woodard, John B. Lazor, Christy Cavaleri, Michael C. Brown, Brittany McDonough, Brian Hess, and Douglas W. Van Citters

IN BRIEF
Biomechanical testing and computed tomography were used to evaluate the efficacy of an osteoconductive mineral-organic bone adhesive for cranial bone flap fixation, as well as to compare this adhesive with titanium plates and screws, in a human cadaveric study. Superior mechanical strength, improved resistance to simulated CSF leakage, and better cosmetic outcomes were demonstrated with the bone adhesive. This novel material has the potential to improve cranial surgery.

 

Outcomes following anterior odontoid screw versus posterior arthrodesis for odontoid fractures: a systematic review and meta-analysis
Pavlos Texakalidis, Stavros Matsoukas, Constantine L. Karras, Hyman G. Frankel, Kevin Swong, Geoffrey P. Stricsek, and Nader S. Dahdaleh

 

Bone morphogenetic proteins in spine surgery: a scientometric analysis to date
Ali Shoushtari, Megan M. J. Bauman, Sulaman Durrani, Karim Rizwan Nathani, and Mohamad Bydon

 


August 2023

Outcomes and surgical approaches for pineal region tumors in children: 30 years’ experience
Sergio Cavalheiro, Linoel Curado Valsechi, Patricia Alessandra Dastoli, Jardel Mendonça Nicácio, Andrea Maria Cappellano, Nasjla Saba da Silva, and Marcos Devanir Silva da Costa

IN BRIEF
The authors analyzed their outcomes from the management of pineal region tumors over the last 30 years. They concluded that gross-total resection provides the best survival, and there is no superiority of supracerebellar infratentorial approach over the occipital transtentorial approach. Neuroendoscopy was an essential tool for diagnosis and treatment. The authors have one of the largest case series of pediatric pineal region tumors in Latin America, and they hope that their expertise can help other centers around the world in the management of such challenging tumors.

 

Endoscopic third ventriculostomy with choroid plexus cauterization: predictors of long-term success and comparison with shunt placement for primary treatment of infant hydrocephalus
Benjamin C. Warf, Daniel S. Weber, Emily L. Day, Coleman P. Riordan, Steven J. Staffa, Lissa C. Baird, Katie P. Fehnel, and Scellig S. D. Stone

IN BRIEF
This study examined long-term outcomes after ventriculoperitoneal shunt (VPS) placement and endoscopic third ventriculostomy (ETV)/choroid plexus cauterization (CPC) in 82 and 266 infants with hydrocephalus, respectively, estimating that 59% of patients would have shunt freedom at 11 years of follow-up after ETV/CPC. ETV/CPC success exceeded that predicted with ETV alone, and corrected age < 2.5 months, severe ventriculomegaly, excess intraoperative bleeding, and prior CSF diversion predicted both reoperation and VPS placement. These results define long-term outcomes after ETV/CPC relative to VPS and can assist with patient selection.

 

Establishing ranked priorities for future hydrocephalus research
Noriana E. Jakopin, Elliot Myong, Trish Bogucki, Diana Gray, Paul Gross, J. Gordon McComb, Chevis N. Shannon, Mandeep S. Tamber, Maiko Toyama, Tessa van der Willigen, Amir Yazdani, Mark G. Hamilton, and Jenna E. Koschnitzky

IN BRIEF
In this initiative the Hydrocephalus Association (HA) used a standardized methodology that included sequential surveys and an iterative process of consensus building to produce a ranked list of the top 20 hydrocephalus research priorities. The process engaged the hydrocephalus patient community in conjunction with the healthcare and scientific community. Several themes within this list were also identified. The HA will use this ranked list to guide future research programs and encourages the healthcare and scientific community to do the same.

 

Use of adhesive cranial bone flap fixation without hardware to improve mechanical strength, resist cerebrospinal fluid leakage, and maintain anatomical alignment: a laboratory study
Timothy R. Smith, Kevin T. Foley, Sourabh Boruah, Jonathan R. Slotkin, Eric Woodard, John B. Lazor, Christy Cavaleri, Michael C. Brown, Brittany McDonough, Brian Hess, and Douglas W. Van Citters

IN BRIEF
Biomechanical testing and computed tomography were used to evaluate the efficacy of an osteoconductive mineral-organic bone adhesive for cranial bone flap fixation, as well as to compare this adhesive with titanium plates and screws, in a human cadaveric study. Superior mechanical strength, improved resistance to simulated CSF leakage, and better cosmetic outcomes were demonstrated with the bone adhesive. This novel material has the potential to improve cranial surgery.

 

Outcomes following anterior odontoid screw versus posterior arthrodesis for odontoid fractures: a systematic review and meta-analysis
Pavlos Texakalidis, Stavros Matsoukas, Constantine L. Karras, Hyman G. Frankel, Kevin Swong, Geoffrey P. Stricsek, and Nader S. Dahdaleh

 

Bone morphogenetic proteins in spine surgery: a scientometric analysis to date
Ali Shoushtari, Megan M. J. Bauman, Sulaman Durrani, Karim Rizwan Nathani, and Mohamad Bydon

 


July 2023

Effect of antisiphon devices on ventriculoperitoneal shunt drainage dynamics in growing children
Nikolaos Tachatos, Sandra Fernandes Dias, Elisabeth Jehli, Dennis Lübben, Martin Ulrich Schuhmann, and Marianne Schmid Daners

IN BRIEF
Children growing up with a ventriculoperitoneal (VP) shunt face changing conditions. A child-adapted patient simulator was used to assess the drainage dynamics of VP shunts. The results indicated that unprotected differential pressure valves can lead to overdrainage in infants, while low-pressure valves with gravitational units (GU) may prevent overdrainage through 5 years of age and medium-pressure valves with GU admit physiological intracranial pressures through at least 10 years of age. Devices preventing overdrainage should be included in the first shunt, and opening pressures should be adjusted as children grow.

 

Differences in spinal cord biomechanics after laminectomy, laminoplasty, and laminectomy with fusion for degenerative cervical myelopathy
Aditya Vedantam, Balaji Harinathan, Ali Warraich, Matthew D. Budde, and Narayan Yoganandan

IN BRIEF
The objective of this study was to use a patient-specific finite element model to compare changes in spinal cord biomechanics after laminectomy with fusion, laminectomy, and laminoplasty. Spinal cord stress and strain were lowest after laminectomy with fusion compared with motion-preserving approaches such as laminoplasty and laminectomy. This study highlights the potential utility of patient-specific finite element modeling of the spinal cord to predict postsurgical spinal cord stress/strain using simulated surgical interventions.

 

Leptomeningeal metastases in glioma revisited: incidence and molecular predictors based on postcontrast fluid-attenuated inversion recovery imaging
Yae Won Park, Kyunghwa Han, Ji Eun Park, Sung Soo Ahn, Eui Hyun Kim, Jinna Kim, Seok-Gu Kang, Jong Hee Chang, Se Hoon Kim, and Seung-Koo Lee

IN BRIEF
Researchers aimed to investigate the real-world incidence of leptomeningeal metastasis (LM) using CSF-sensitive imaging, namely postcontrast fluid-attenuated inversion recovery imaging, and to analyze molecular predictors for LM. CSF-sensitive imaging demonstrated a high incidence of LM in adult gliomas, and molecular markers were associated with LM development in glioma. These findings highlight the high incidence of LM and multiple risk factors contributing to the development of LM; therefore, patients with aggressive molecular markers warrant imaging surveillance for LM.

 

Analysis of intracranial pressure pulse waveform in traumatic brain injury patients: a CENTER-TBI study
Agnieszka Uryga, Arkadiusz Ziółkowski, Agnieszka Kazimierska, Agata Pudełko, Cyprian Mataczyński, Erhard W. Lang, Marek Czosnyka, Magdalena Kasprowicz, and the CENTER-TBI High-Resolution ICU (HR ICU) Sub-Study Participants and Investigators

IN BRIEF
This study aimed to compare different measures describing the intracranial pressure (ICP) pulse waveform in traumatic brain injury patients: pulse amplitude (AMP), high frequency centroid (HFC), higher harmonics centroid (HHC), and pulse shape index (PSI). AMP, HFC, and PSI could be used as predictors of mortality, whereas HHC may serve as an early indicator of intracranial hypertension. These findings support the importance of analyzing the ICP pulse waveform in addition to monitoring mean ICP.

 

Focused ultrasound–mediated blood-brain barrier opening in Alzheimer’s disease: long-term safety, imaging, and cognitive outcomes
Ali R. Rezai, Manish Ranjan, Marc W. Haut, Jeffrey Carpenter, Pierre-François D’Haese, Rashi I. Mehta, Umer Najib, Peng Wang, Daniel O. Claassen, J. Levi Chazen, Vibhor Krishna, Gerard Deib, Zion Zibly, Sally L. Hodder, Kirk C. Wilhelmsen, Victor Finomore, Peter E. Konrad, Michael Kaplitt, and for the Alzheimer’s Disease Neuroimaging Initiative

IN BRIEF
Researchers used noninvasive focused ultrasound technology to open the blood-brain barrier (BBB) in a feasibility trial in patients with Alzheimer's disease. The investigators demonstrated safe, conformal, reproducible, and reversible BBB openings in the hippocampus, frontal lobe, and parietal lobe. There was reduction in β-amyloid plaques in treated regions and no cognitive worsening compared with the control group. Focused ultrasound is a noninvasive technology that can safely open the BBB, thus providing new opportunities for precision delivery of targeted therapeutics.

 


June 2023

Safety of vagus nerve stimulation and responsive neurostimulation used in combination for multifocal and generalized onset epilepsy in pediatric patients
Cameron P. Beaudreault, Eris Spirollari, Alexandria F. Naftchi, Vishad Sukul, Ankita Das, Sima Vazquez, Steven M. Wolf, Patricia E. McGoldrick, and Carrie R. Muh

IN BRIEF
Researchers evaluated pediatric patients who have intractable epilepsy and were treated with a combination of vagus nerve stimulation and brain-responsive neurostimulation. Multiple forms of neuromodulation are used to treat drug-resistant epilepsies, but there are little data showing how these devices interact with each other or if they are safe to use together in adolescents. This study demonstrates that the concomitant use of two neurostimulation devices can be safe and potentially effective for this difficult-to-treat population.

 

Cerebellar tonsil reduction for surgical treatment of Chiari malformation type I in children
Bruno P. Braga, Eric Y. Montgomery, Bradley E. Weprin, Angela V. Price, Brett A. Whittemore, Mark N. Pernik, Frederick Sklar, Rafael De Oliveira Sillero, and Dale M. Swift

IN BRIEF
The authors retrospectively compared the efficacy and safety of different surgical techniques used in pediatric Chiari malformation type I (CM-I) patients. Cerebellar tonsil reduction, by coagulation or resection, resulted in superior improvement of syringomyelia without increased complications. Current debate focuses on duraplasty versus bone-only decompression and the notion that the former is more efficacious despite increased complication rates. On the basis of this investigation, the authors concluded that more invasive techniques, such as tonsil coagulation or resection, may provide greater objective radiological efficacy yet similar safety in the treatment of CM-I patients.

 

Can semirigid fixation of the rostral instrumented segments prevent proximal junctional kyphosis in the case of long thoracolumbar fusions? A finite element study
Mate Turbucz, Jennifer Fayad, Agoston J. Pokorni, Peter P. Varga, Peter E. Eltes, and Aron Lazary

IN BRIEF
Researchers used finite element analysis to assess the biomechanical effect of semirigid spinal fixation techniques on developing mechanical complications. The analysis has shown that the semirigid fixation techniques increase mobility and therefore provide a more gradual transition in motion between the instrumented and healthy spinal segments. After successful biomechanical testing and clinical trials, the findings of this study could impact research strategies and clinical practice, given the high incidence of proximal junctional kyphosis.

 

Perception of frailty in spinal metastatic disease: international survey of the AO Spine community
Mark A. MacLean, Miltiadis Georgiopoulos, Raphaële Charest-Morin, C. Rory Goodwin, Ilya Laufer, Nicolas Dea, John H. Shin, Ziya L. Gokaslan, Laurence D. Rhines, John E. O’Toole, Daniel M. Sciubba, Michael G. Fehlings, Byron F. Stephens, Chetan Bettegowda, Sten Myrehaug, Alexander C. Disch, Cordula Netzer, Naresh Kumar, Arjun Sahgal, Niccole M. Germscheid, Michael H. Weber, and on behalf of the AO Spine Knowledge Forum Tumor

IN BRIEF
The objective of this study was to determine how the international AO Spine community conceptualizes and characterizes frailty in the context of spinal metastatic disease. Respondents from the community indicated that they commonly evaluate frailty based on general impressions rather than using frailty tools. The authors attained consensus regarding the association between numerous preoperative clinical variables and frailty. This study represents an important first step toward defining the multidimensional nature of frailty. The results will inform the development of an objective tool for evaluating frailty in the context of spinal metastatic disease.

 

Characterization of patients with idiopathic normal pressure hydrocephalus using natural language processing within an electronic healthcare record system
Jonathan P. Funnell, Kawsar Noor, Danyal Z. Khan, Linda D’Antona, Richard J. B. Dobson, John G. Hanrahan, Christopher Hepworth, Eleanor M. Moncur, Benjamin M. Thomas, Lewis Thorne, Laurence D. Watkins, Simon C. Williams, Wai Keong Wong, Ahmed K. Toma, and Hani J. Marcus

IN BRIEF
This paper describes the development of a natural language processing algorithm to recognize features of idiopathic normal pressure hydrocephalus in electronic health records. The trained model showed high precision and recall, most frequently extracting symptoms and signs relating to mobility, cognitive impairment, and falls or balance. This is valuable to the development of natural language processing tools in neurosurgery and suggests future potential for the automated detection of patients with idiopathic normal pressure hydrocephalus from electronic health records.

 

Best practices for the pregnant neurosurgical resident: balancing safety and education
Krystal L. Tomei, Tiffany R. Hodges, Ellie Ragsdale, Tyler Katz, Marjorie Greenfield, and Jennifer A. Sweet

IN BRIEF
As the number of women in the neurosurgical workforce increases, unique circumstances that may disproportionately impact their training and safety must be considered. The objective of this paper was to examine risks inherent to the pregnant neurosurgical resident from occupational exposures and pregnancy physiology. The authors have come up with recommendations for both the pregnant resident and their residency programs to mitigate these risks with a focus on the impact on their education as well as on their colleagues.

 


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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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 BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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)

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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 BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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 BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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.

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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

IN BRIEF
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 BRIEF
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

IN BRIEF
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)

IN BRIEF
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

IN BRIEF
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

OBJECTIVE
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

OBJECTIVE
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

OBJECTIVE
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

OBJECTIVE
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.