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Volume 131: Issue 4 (Oct 2019): Pages 993-1345
in Journal of Neurosurgery
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In Brief
The Hydrocephalus Association convened a summit including patients, families, pediatric and adult neurosurgeons and neurologists, and other experts to address barriers to health care transition (HCT) for youth with hydrocephalus. A lack of HCT to adult health services and longitudinal care is a significant problem in the US and Canada. Best practices are identified. Consensus recommendations are provided for local action by hospitals and health systems, and national action by neurosurgery and neurology professional societies.
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In Brief
The authors reviewed reports from hospitals in developing countries in which epilepsy surgery is performed and were able to show that 1) there are many places in the developing world where epilepsy surgery is performed; 2) seizure outcomes are just as good as those in developed countries; and 3) surgery is safe. They recommend that more support, resources, and funding are needed to promote timely access to surgery for people with seizures that do not respond to medications.
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In Brief
Patients who underwent initial endoscopic endonasal resection of craniopharyngioma were reviewed to compare outcomes associated with sacrificing the pituitary stalk, creating a hormone deficiency but potentially curing the tumor, or leaving the stalk in place at the risk of leaving tumor behind. Stalk preservation was found to maintain some endocrine function, but loss of function occurred in 85% of surgeries with attempted gross-total resection (GTR). Stalk preservation also reduced rates of GTR, increasing the prevalence of tumor progression and need for radiation. The study results suggest that stalk preservation should be attempted only if GTR is achievable.
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In Brief
Trigeminal neuralgia recurrence after stereotactic radiosurgery (SRS) can occur. In this study, the authors looked at outcomes when patients underwent either first-time microvascular decompression (MVD) or repeat SRS. The MVD cohort achieved pain control faster than the SRS cohort and had a longer duration of pain freedom. Both are safe and effective options, however. This study may help guide clinical decision-making for future patients who continue to have pain despite SRS.
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In Brief
In this study the authors applied machine learning techniques to eye movement data in order to identify patients with concussion and postconcussion syndromes. This approach may lead to the development of a method that can be used in the hospital or the community to diagnose concussions, for which no such objective tests are currently available.
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In Brief
In this animal study, the authors studied the effect of intravenous infusion of mesenchymal stem cells (MSCs) in rats 8 weeks after middle cerebral artery occlusion. The time point of 8 weeks was chosen in order to evaluate the effect of MSC administration in the chronic phase of stroke rather than the acute/subacute phase, which most previous studies have focused on. The findings suggest that MSC infusion may have therapeutic value during not only acute but also chronic cerebral ischemia.
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In Brief
The authors demonstrate that histotripsy, an ultrasound-based therapy for mechanically fractionating tissues, can be applied safely and effectively to ablate brain tissue in vivo in a swine model. Histotripsy has the potential to be used as a minimally- to non-invasive surgical tool for the treatment of a range of brain pathologies, including tumors, seizure foci, and intracerebral hemorrhage, and this is the first study demonstrating its basic safety in vivo in the brain.