Philipp Dammann, Adib A. Abla, Rustam Al-Shahi Salman, Hugo Andrade-Barazarte, Vladimir Benes, Marco Cenzato, E. Sander Connolly Jr., Jan F. Cornelius, William T. Couldwell, Rafael G. Sola, Santiago Gomez-Paz, Erik Hauck, Juha Hernesniemi, Juri Kivelev, Giuseppe Lanzino, R. Loch Macdonald, Jacques J. Morcos, Christopher S. Ogilvy, Hans-Jakob Steiger, Gary K. Steinberg, Alejandro N. Santos, Laurèl Rauschenbach, Marvin Darkwah Oppong, Börge Schmidt, Robert F. Spetzler, Karl Schaller, Michael T. Lawton, and Ulrich Sure
Joshua S. Catapano, Caleb Rutledge, Kavelin Rumalla, Kunal P. Raygor, Visish M. Srinivasan, Stefan W. Koester, Anna R. Kimata, Kevin L. Ma, Mohamed A. Labib, Robert F. Spetzler, and Michael T. Lawton
This study validates the Lawton brainstem cavernous malformation grading system in a large cohort of 277 patients from two high-volume surgeons. Brainstem cavernous malformation grade predicted neurological outcomes with accuracy comparable to that of other grading systems in widespread use. The brainstem cavernous malformation grading system establishes categories of low-, intermediate-, and high-grade brainstem cavernous malformations and a cutoff for surgery at grade V. Brainstem cavernous malformation grading guides the analysis of a patient's condition, but treatment recommendations must be individualized.
Yifei Duan, Berje Shammassian, Shaarada Srivatsa, Kerrin Sunshine, Arunit Chugh, Jonathan Pace, Amanda Opaskar, and Nicholas C. Bambakidis
The objective of the study was to identify clinical and radiological variables that predict the need for critical care intervention in patients after mechanical thrombectomy. A combination of clinical and radiological factors were identified that can be used to identify a group of postthrombectomy patients who may not require intensive care admission. The authors designed an intensive care unit clearance protocol that can be used to optimize resource utilization and improve care for postthrombectomy patients.
Joshua S. Catapano, Stefan W. Koester, Visish M. Srinivasan, Mohamed A. Labib, Neil Majmundar, Candice L. Nguyen, Caleb Rutledge, Tyler S. Cole, Jacob F. Baranoski, Andrew F. Ducruet, Felipe C. Albuquerque, Robert F. Spetzler, and Michael T. Lawton
This study compared the outcomes associated with microsurgical versus endovascular treatment of unruptured ophthalmic artery aneurysms. Compared with endovascular therapy, microsurgical clipping of unruptured ophthalmic artery aneurysms was associated with a higher rate of visual deficits but a lower rate of residual and recurrent aneurysms. The study demonstrates the benefits of specialized centers where expertise can be fostered, all treatment modalities can be offered, and selection decisions can be made to achieve optimal outcomes.
Ben A. Strickland, Giuseppe Barisano, Aidin Abedi, Mark S. Shiroishi, Steven Cen, Benjamin Emanuel, Sebina Bulic, May Kim-Tenser, Peggy Nguyen, Steven L. Giannotta, William Mack, and Jonathan Russin
In this study the authors sought to demonstrate that minocycline can decrease blood-brain barrier (BBB) permeability after aneurysmal subarachnoid hemorrhage (aSAH). Important findings were that high-dose minocycline was well tolerated and resulted in reduced BBB permeability after aSAH. This first in-human demonstration of the effect of minocycline on BBB permeability after aSAH provides support for investigating this treatment strategy to reduce the risk of delayed cerebral ischemia.
Jae Ho Kim, Sung Jun Ahn, Mina Park, Yong Bae Kim, Bio Joo, Woosung Lee, and Sang Hyun Suh
The authors aimed to evaluate the clinical efficacy of using pointwise encoding time reduction with radial acquisition (PETRA) subtraction-based magnetic resonance angiography (MRA) to minimize metallic artifact and its use as a follow-up imaging tool for clipped aneurysms. Compared with 3D time-of-flight (TOF) MRA, PETRA-MRA showed comparable image quality and had greater visibility of adjacent vessels near titanium clips. Therefore, PETRA-MRA may be a suitable alternative to TOF-MRA for follow-up imaging of clipped aneurysms.
Nikolaos Mouchtouris, David Hasan, Edgar A. Samaniego, Fadi Al Saiegh, Ahmad Sweid, Rawad Abbas, Kareem El Naamani, Rizwan Tahir, Mario Zanaty, Omaditya Khanna, Nohra Chalouhi, Stavropoula Tjoumakaris, M. Reid Gooch, Robert Rosenwasser, and Pascal Jabbour
The authors report their experience with the Woven EndoBridge (WEB) device, the latest endovascular option for the treatment of wide-neck bifurcation aneurysms. The WEB device achieved a higher rate of successful aneurysm occlusion on 6-month follow-up angiography than prior endovascular options. This study offers the authors' real-life experience with this new device since its FDA approval, including technical nuances and complication management. More research is needed to determine how this device compares with clip ligation for treatment of these aneurysms.
Sungho Lee, Aditya Srivatsan, Visish M. Srinivasan, Stephen R. Chen, Jan-Karl Burkhardt, Jeremiah N. Johnson, Daniel M. S. Raper, Jeffrey S. Weinberg, and Peter Kan
Middle meningeal artery embolization outcomes were evaluated in cancer patients with refractory thrombocytopenia who presented with chronic subdural hematoma. After the procedure, 24 of 31 chronic subdural hematomas improved, which was associated with a significant survival benefit. Middle meningeal artery embolization is a potential therapeutic option for thrombocytopenic cancer patients with chronic subdural hematoma, especially those with contraindication to surgical evacuation.
Jacob S. Young, Andrew J. Gogos, Alexander A. Aabedi, Ramin A. Morshed, Matheus P. Pereira, Samuel Lashof-Regas, Ziba Mansoori, Tracy Luks, Shawn L. Hervey-Jumper, Javier E. Villanueva-Meyer, and Mitchel S. Berger
The objective of this study was to define which patients with supplementary motor area (SMA) gliomas would go on to develop a postoperative SMA syndrome. Patients with resection cavities located posteriorly in the SMA and cingulate gyrus were more likely to develop SMA syndrome. Frontal aslant tract preservation does not prevent SMA syndrome. The authors believe that the results of this study advocate for resection of disease in these higher-risk SMA regions to maximize the oncological benefit of cytoreduction.
Robert J. Macielak, Katherine P. Wallerius, Skye K. Lawlor, Christine M. Lohse, John P. Marinelli, Brian A. Neff, Jamie J. Van Gompel, Colin L. W. Driscoll, Michael J. Link, and Matthew L. Carlson
Detection of vestibular schwannoma growth during observation usually leads to definitive treatment. Although ≥ 2 mm represents an established benchmark of tumor growth, this small difference is unlikely to alter microsurgical outcomes. The authors sought to determine whether there was a critical tipping point regarding tumor size, at which microsurgical outcomes most significantly deteriorate. They found that the intersection for facial nerve outcomes, hearing outcomes, and the ability to achieve gross-total resection was between 1.4 and 2.0 cm in cerebellopontine angle tumor size.
Chih-Ying Huang, Syu-Jyun Peng, Hsiu-Mei Wu, Huai-Che Yang, Ching-Jen Chen, Mao-Che Wang, Yong-Sin Hu, Yu-Wei Chen, Chung-Jung Lin, Wan-Yuo Guo, David Hung-Chi Pan, Wen-Yuh Chung, and Cheng-Chia Lee
Researchers developed an algorithm that can automatically segment and differentiate cystic and solid tumor components of vestibular schwannomas to investigate associations between the quantified radiological features of each component and tumor response after radiosurgery. Quantified radiological features on pretreatment MRI were associated with tumor response after radiosurgery. Further refinement of the algorithm may allow direct prediction of tumor response of vestibular schwannomas after radiosurgery.
Stylianos Pikis, Adomas Bunevicius, Cheng-Chia Lee, Huai-Che Yang, Brad E. Zacharia, Roman Liščák, Gabriela Simonova, Manjul Tripathi, Narendra Kumar, David Mathieu, Rémi Perron, Selcuk Peker, Yavuz Samanci, Jason Gurewitz, Kenneth Bernstein, Douglas Kondziolka, Ajay Niranjan, L. Dade Lunsford, Nikolaos Mantziaris, and Jason P. Sheehan
Michael B. Avery, Regin Jay Mallari, Garni Barkhoudarian, and Daniel F. Kelly
This study compared the anatomical reach of the supraorbital and mini-pterional craniotomies for brain tumor removal. Heatmap analysis in 204 cases showed that the supraorbital route (used in 85% of cases) provided far greater reach than the mini-pterional route despite its smaller scalp incision and bone flap. Endoscopy allowed further tumor resection in the 50% of patients in whom it was applied. This analysis may help neurosurgeons determine which of these complementary approaches should be used for a given patient.
Robert C. Osorio, Matheus P. Pereira, Rushikesh S. Joshi, Kevin C. Donohue, Patricia Sneed, Steve Braunstein, Philip V. Theodosopoulos, Ivan H. El-Sayed, José Gurrola II, Sandeep Kunwar, Lewis S. Blevins Jr., and Manish K. Aghi
Researchers examined how socioeconomic variables (race, ethnicity, insurance, primary care physician [PCP] status, and estimated income) impact patients with nonfunctional pituitary adenomas (NFPAs). They found that while all 5 variables affected the patients, having a PCP was the most significant factor, affecting multiple outcome measures and even protecting against other healthcare disparities uncovered. This study sheds light on an underresearched field and suggests that addressing socioeconomic disparities in the US may lead to better NFPA outcomes.
Siyuan Yu, Mohammad Taghvaei, Sarah Collopy, Keenan Piper, Michael Karsy, Pascal Lavergne, Blair Barton, Chandala Chitguppi, Glen D’Souza, Marc R. Rosen, Gurston G. Nyquist, Mindy Rabinowitz, Christopher J. Farrell, and James J. Evans
The rate of postoperative day 1 discharge in patients undergoing endoscopic transsphenoidal approaches for pituitary adenoma resection was evaluated. The results showed most patients can be safely discharged within 24 hours from surgery without increased risk of complications. Criteria that can help select the safest cohorts for early discharge were also analyzed.
Saniya S. Godil, Umberto Tosi, Mina Gerges, Andrew L. A. Garton, Georgiana A. Dobri, Ashutosh Kacker, Abtin Tabaee, Vijay K. Anand, and Theodore H. Schwartz
The authors compared long-term outcomes after gross-total resection (GTR) with those after subtotal resection of craniopharyngiomas via an endoscopic endonasal approach. GTR resulted in better tumor control and improved overall functional outcomes. Therefore, the goal of surgery should be aggressive but maximum safe resection to balance surgical outcomes and morbidity.
Salomon Cohen-Cohen, Ahmed Helal, Ziying Yin, Matthew K. Ball, Richard L. Ehman, Jamie J. Van Gompel, and John Huston III
Knowing the consistency of a tumor in the preoperative setting can have multiple clinical applications. In this study, the authors investigated the utility of MR elastography in predicting consistency of pituitary adenomas. They demonstrated that although other MRI sequences have proven unreliable, MR elastography is a reliable tool and can be helpful in the preoperative setting.
Adel Azghadi, Megan M. Rajagopal, Kelsey A. Atkinson, and Kathryn L. Holloway
The objective of this paper was to demonstrate the utility of simultaneous globus pallidus internus and ventral intermediate nucleus of the thalamus (GPI+VIM) deep brain stimulation lead placement in Parkinson's disease patients who suffer from on-medication tremor. Tremor symptoms were significantly reduced with the combination of GPI+VIM stimulation compared to GPI stimulation alone. Therefore, dual stimulation was shown to be an effective treatment option for patients who are candidates for a GPI lead based on their comorbidities and who suffer from medication-resistant tremor.
Jennifer Muller, Mahdi Alizadeh, Caio M. Matias, Sara Thalheimer, Victor Romo, Justin Martello, Tsao-Wei Liang, Feroze B. Mohamed, and Chengyuan Wu
Prospective targeting of the ventral intermediate nucleus (VIM) of the thalamus was performed using probabilistic tractography in patients with essential tremor. Researchers then performed a systematic comparison of probabilistic and deterministic tractography for preoperative VIM targeting. Deterministic tractography was unable to clearly distinguish motor and sensory fibers in the majority of patients, suggesting that probabilistic methods may be preferable to provide distinct separation. Clinically, prospective probabilistic targeting successfully and significantly reduced tremor in all patients.
Ken Iijima, Hajime Yokota, Toshio Yamaguchi, Masayuki Nakano, Takahiro Ouchi, Futaba Maki, Masahito Takasaki, Yasuhiro Shimizu, Hiroki Hori, Hirokazu Iwamuro, Jinichi Sasanuma, Kazuo Watanabe, and Takashi Uno
The objective of this study was to identify predictors of thermal increase better than the mean skull density ratio in magnetic resonance–guided focused ultrasound treatment. Skull density ratio skewness was a new predictor of preoperative thermal increase. Skull density ratio skewness might allow for the inclusion of treatable patients with essential tremor who were screened out based on the exclusion criterion with the mean skull density ratio.
Guozhen Luo, Brent D. Cameron, Li Wang, Hong Yu, Joseph S. Neimat, Peter Hedera, Fenna Phibbs, Elise B. Bradley, Anthony J. Cmelak, and Austin N. Kirschner
Researchers studied patients with severe essential tremor and parkinsonian tremor who were treated by linear accelerator–based stereotactic radiosurgery to stop the malfunctioning site in the brain. By comparing early responders to nonresponders, a detailed neuroanatomy atlas using patient-specific MRI series revealed the critical importance of extremely precise targeting within the brain. This work can guide neurosurgery and radiotherapy practices to improve targeting and enhance the success of stereotactic radiosurgical thalamotomy for the treatment of severe tremor.
Robert J. Morecraft, Kimberly S. Stilwell-Morecraft, Jizhi Ge, Alexander Kraskov, and Roger N. Lemon
The authors made a systematic and quantitative investigation of macaque corticospinal tract (CST) organization in the craniovertebral junction (CVJ) and cervical spinal cord. They found no evidence for somatotopic organization of CST fibers at these levels, and therefore reject the concept that somatotopy explains the greater impairment of upper-limb movement, compared with lower-limb movement, following CVJ/cervical spinal cord injury. Other explanations must be considered, including the greater CST contribution to upper- versus lower-limb movement.
Juan Leonardo Serrato-Avila, Juan Alberto Paz Archila, Marcos Devanir Silva da Costa, Paulo Ricardo Rocha, Sergio Ricardo Marques, Luis Otavio Carvalho de Moraes, Sergio Cavalheiro, Kaan Yağmurlu, Michael T. Lawton, and Feres Chaddad-Neto
The authors compared the exposure of the cerebellar interpeduncular region (CIPR) provided by the supracerebellar infratentorial approach (SCITa), the occipital transtentorial approach (OTa), and the subtemporal transtentorial approach (STa). To reach the cerebellar interpeduncular region, the STa provided a more extensive exposure area and more linear exposure than the SCITa did. The OTa offered a larger working area than the SCITa and the STa; however, the OTa had the most extensive surgical corridor. These data may help neurosurgeons select the most appropriate approach for lesions of the CIPR.
Jayme A. Bertelli, Mayur Sureshlal Goklani, Neehar Patel, and Elisa Cristiana Winkelmann Duarte
The authors described the anatomy of triceps motor branches in the anterior aspect of the arm and axilla. One branch to the lateral and long triceps heads and two to the triceps medial head were observed. The study results demonstrated that all triceps branches can be dissected via an axillary anterior approach.
Jayme Augusto Bertelli, Karine Rosa Gasparelo, and Anna Seltser
The authors describe two clinical tests based on the preoperative evaluation of scapular motion to detect viable roots for grafting in complete brachial plexus paralysis. The combination of scapular evaluation, Tinel's sign, and MRI findings predicted a C5 root grafting with a 100% certainty. The combination of these tests predicted a viable C6 root on 90% of occasions. For the prediction of graftable C5 and/or C6 roots, clinical examination performed better than MRI studies.
Jenna-Lynn B. Senger, Karyne N. Rabey, Leah Acton, Ying-Ho S. Lin, Susanne Lingrell, K. Ming Chan, and Christine A. Webber
Regeneration following chronic axotomy is impaired due to downregulation of the proregenerative environment generated acutely following nerve injury. The authors' objective was to determine if conditioning electrical stimulation could foster a proregenerative environment for chronic nerve repair. Conditioning electrical stimulation prior to chronically injured nerve reconstruction upregulated regeneration-associated genes and accelerated axon regeneration, resulting in significant improvements in sensory and motor functional recovery. Percutaneous conditioning electrical stimulation may be a preoperative strategy for patients undergoing delayed nerve reconstruction.
Jubran H. Jubran, Lena Mary Houlihan, Ann J. Staudinger Knoll, Dara S. Farhadi, Richard Leblanc, and Mark C. Preul
The objective of the paper was to elucidate Dorothy Russell's foundational experience in neuropathology and neurosurgery as one of Wilder Penfield's and William Cone's original research fellows at McGill's Royal Victoria Hospital. This historical examination of archival material from Canada, the United States, and the United Kingdom illustrates Dorothy Russell's profound influence on neurosurgery and the establishment of one of the key colleges of neurosurgery. Dorothy Russell's life and achievements were extraordinary and pivotal in their impact on the evolution of neurosurgical practice.
Sarfraz Akmal, Fareed Jumah, Elizabeth E. Ginalis, Bharath Raju, and Anil Nanda
The authors present a historical perspective on the life and career of Charles Bouchard, a prominent French neuropathologist of the 19th century who is credited with the description of Charcot-Bouchard intracranial aneurysms and their role in the pathogenesis of intracranial hemorrhage. They further shed light on events surrounding the deterioration of the student-mentor dynamic between Bouchard and his mentor Jean-Martin Charcot.
Faith C. Robertson, Raahil M. Sha, Jose M. Amich, Walid Ibn Essayed, Avinash Lal, Benjamin H. Lee, Paola Calvachi Prieto, Junichi Tokuda, James C. Weaver, Ramez W. Kirollos, Min Wei Chen, and William B. Gormley
Researchers introduce a novel computer vision–based registration system with real-time tracking for frameless stereotactic neuronavigation and intervention in nonimmobilized subjects. In 30 catheter placements in 5 cadaver heads, image tracking recalibration time was less than one-quarter of a second with submillimetric accuracy. Catheter placements had millimetric accuracy (mean 1.67 mm). Using this approach to guide bedside ventriculostomy could reduce complications, improve safety, and be extrapolated to other frameless stereotactic applications in awake, nonimmobilized patients.
Florian Ebel, Stefan Wanderer, C. Marvin Jesse, Ralph T. Schär, Irena Zubak, Christian T. Ulrich, and Andreas Raabe
The authors developed an in vitro model that was able to test different dural closure techniques and materials in a standardized fashion. It could be shown that a running suture combined with DuraSeal or TachoSil was the technique achieving the highest watertightness for the primary dural closure. For the duraplasty, a double-layer technique showed the highest efficacy. These findings can help the surgeon determine which technique and material should be chosen for appropriate dural closure.
Tiit Mathiesen, Jeppe Haslund-Vinding, Jane Skjøth-Rasmussen, Lars Poulsgaard, Kåre Fugleholm, Christian Mirian, Andrea Daniela Maier, Thomas Santarius, Frantz Rom Poulsen, Vibeke Andrée Larsen, Bjarne Winther Kristensen, David Scheie, Ian Law, and Morten Ziebell
This retrospective study aimed to find a predictive factor associated with postoperative hemorrhage after stereotactic biopsy (STB). Intratumoral susceptibility signal (ITSS) refers to linear or dot-like areas of low signal within the tumor on non-contrast-enhanced susceptibility-weighted imaging. The authors found that ITSS assessed by preoperative MRI is associated with hemorrhage after STB. ITSS can be used to predict postoperative hemorrhage risk, which can assist with preoperative planning and explaining risks to the patient.
In a single-center cohort of 90 patients who had undergone minimally invasive endoscopic evacuation of spontaneous supratentorial intracerebral hemorrhage, long-term functional independence was associated with a shorter time to evacuation. In fact, 36% of patients undergoing evacuation within 24 hours of ictus attained functional independence (modified Rankin Scale score= 2). This is the first study to report factors associated with functional independence after minimally invasive endoscopic evacuation of intracerebral hemorrhage and can be used to better guide protocols of future clinical trials.
In this dual-center study, the authors present their real-world experience with carotid revascularization using three different techniques performed by dual-trained surgeons with expertise in all the techniques. A total of 780 patients were included (583 with carotid artery stenting, 165 with carotid endarterectomy, and 32 with transcarotid artery revascularization). The study reflects current hybrid neurosurgery practice at two high-volume tertiary care centers and suggests that all three treatment modalities carry comparable safety and effectiveness if patients are properly selected.
The objective of this study was to define the cutoff values for each prognostic factor for MRgFUS ablation. An intraoperatively high maximum mean temperature (cutoff value 52.5°C) and postoperatively large lesion size (cutoff values of 3.9 mm in the anterior-posterior direction and 5.0–5.55 mm in the superior-inferior direction) were associated with improved tremor control. These cutoff values may be useful for achieving good treatment outcomes, even in Asian patients with relatively low SDR.
The aim of this study was to identify prognostic factors for postoperative hearing improvement and characteristics of hearing function in patients with cerebellopontine angle (CPA) tumors other than vestibular schwannoma. Preoperative retrocochlear hearing disturbance was a significant positive factor for hearing improvement and was observed frequently in patients with jugular foramen schwannoma and CPA meningioma. Because patients with such tumors have a high chance of achieving hearing improvement, approaches sacrificing hearing function and the cochlear nerve section should be avoided whenever possible.
Microsurgical treatment options are limited for patients with trigeminal neuralgia without intraoperative neurovascular conflict. Here, the authors discovered that internal neurolysis is a more effective treatment than intraoperative glycerin rhizotomy. For patients undergoing microvascular decompression but are found intraoperatively to have no nerve compression, internal neurolysis is more effective at achieving improved pain relief, with better facial numbness at last follow-up and with lower rates of pain recurrence compared with intraoperative glycerin rhizotomy.
Carotid body tumors (CBTs) are rare, slow-growing neoplasms derived from the parasympathetic paraganglia of the carotid bodies. This series reveals that endovascular embolization of CBT is a safe and effective technique for tumor devascularization, making preoperative angiography and embolization an important consideration in the management of CBT. Moreover, the successful management of CBT involves a multidisciplinary approach whereby endovascular surgeons, neurosurgeons, and otolaryngology–head and neck surgeons work together to optimally manage each patient.
This paper carefully maps the 70-year journey of the founding and evolution of the New England Neurosurgical Society (NENS), one of the first regional neurosurgical societies in America. A wealth of primary source material is used and presented, including original photographs, correspondences with leadership, and archived NENS documents. This historical vignette highlights the relevance of regional neurosurgical societies, an often-overlooked aspect of neurosurgical history, and provides the first published account of this society’s history.
Patients with moyamoya vasculopathy may experience cognitive problems. In this prospective study the authors investigated the profile of cognitive impairment and its relation with ischemic brain lesions and hemodynamic compromise. They found that 73% of patients had an impairment in at least one domain of cognitive functioning. The cognitive profile differed between adults and children: adults performed better in visuospatial functioning, and children in processing speed. Brain imaging and cerebrovascular reactivity findings were not related to cognitive functioning.
The investigators used a quantitative method based on a noncontrast head CT scan to differentiate perimsenecephalic subarachnoid hemorrhage (SAH) from aneurysmal causes. The proposed model, which was externally validated in a separate cohort, has high accuracy in differentiating perimesencephalic from aneurysmal etiology. In selected cases the use of this model in conjunction with dedicated vascular imaging may lead to prevention of unnecessary and expensive diagnostic workups and reduction in hospital length of stay.
Researchers used presurgical patient-specific functional MRI combined with a brain connectivity mapping technique to predict outcome of deep brain stimulation of the globus pallidus internus for Parkinson disease. Connectivities between the stimulated portion of the globus pallidus internus and primary motor area, supplementary motor area, presupplementary motor area, and premotor cortex were identified as predictive of outcome. These findings could contribute to improving clinical effectiveness and could also supplement practices that use normative connectomes.
The authors assessed the utility of endoscope assistance in 5-aminolevulinic acid (5-ALA) fluorescence-guided resection of brain metastases. The endoscope, capable of inducing fluorescence, enabled visualization of strongly fluorescent tumor tissue at the margins of the resection cavity that could not be visualized under the microscope, allowing the identification of metastatic infiltration with great sensitivity and acceptable specificity. Endoscope assistance may overcome the technical limitations of the conventional microscopic exposure of 5-ALA–fluorescent tumor tissue in brain metastases.
This study aimed to identify clinical, demographic, and morphologic variables associated with preoperative and postoperative seizures in patients with surgically treated brain metastases. The multivariate model demonstrated the independent effects of tumor location in the frontal lobe and presence of intratumoral hemorrhage as predictors of preoperative seizures, and checkpoint inhibitor use and parietal lobe location were identified as significant predictors of seizures at 6 months postoperatively. These findings should be explored further in clinical studies focused on seizure control in these patients. Hopefully, the results of this study can be used to improve the quality of life of patients with metastatic brain tumors.
Cerebral cavernous malformations (CCMs) lack a definition for giant lesions. The authors defined giant CCM on the basis of surgical outcomes in a cohort of 183 patients. CCM with a diameter = 3 cm was associated with greater risk of severe postoperative decline (> 2-point increase in modified Rankin Scale score) (odds ratio 4.5). The authors propose that giant CCM be defined as = 3 cm in diameter on the basis of this inflection point for neurological outcome. A giant CCM does not contraindicate surgery because patients with a resected giant CCM can have favorable outcomes.
The authors conducted a decision analysis study to assess the impact of collateral flow on cost-effectiveness of thrombectomy in acute stroke. Thrombectomy was found to be cost-effective irrespective of collateral status in the early time window for acute ischemic stroke. Despite relatively lower benefits of thrombectomy in patients with poor collaterals, even small differences in better outcomes have significant long-term financial implications for making thrombectomy cost-effective.
Researchers investigated the relationship between cortical stimulation parameters (number, amplitude, density, duration, number of positive stimulation sites) and afterdischarges (ADs), intraoperative seizures, and postoperative seizures in patients undergoing awake glioma resection. The number and duration of stimulations were associated with a higher prevalence of ADs. Authors report stimulation settings that may allow surgeons to avoid these perioperative adverse events, enabling more accurate brain mapping and safer resections.
The objective of this paper was to describe the details of complications, with special reference to ischemic complications, associated with treatments for craniocervical junction (CCJ) arteriovenous fistulas (AVFs). The key findings indicated that neurosurgery was safer than endovascular treatment because of the lower rates of spinal cord and brainstem infarctions. This study adds to the growing body of literature demonstrating scientific evidence for the treatment choice for CCJ AVFs.
A causal relationship between delayed cerebral ischemia (DCI) and neuropsychological function after subarachnoid hemorrhage (SAH) has not been proven. Researchers in this Swiss multicenter study used neuropsychological examinations before and after the DCI period and found that DCI itself was responsible for a temporary and clinically meaningful decline in neuropsychological function. Because conducting a baseline examination before DCI requires conscious patients, it remains unclear whether the findings also apply to high-grade SAH with prolonged coma.
Data on the natural history of meningiomas have been ambiguous. In a volumetric analysis of 240 meningiomas with thin-slice MRI, the majority of meningiomas grew eventually. Moreover, T2 iso-/hyperintensity and absence of calcifications are the most important predictors of growth.