Authors:William P. Nobis, Karina A. González Otárula, Jessica W. Templer, Elizabeth E. Gerard, Stephen VanHaerents, Gregory Lane, Guangyu Zhou, Joshua M. Rosenow, Christina Zelano and Stephan Schuele
The authors studied the association between apnea and seizure activity by investigating recorded data from patients in an epilepsy monitoring unit. They found that central apnea was correlated with seizure spread to the amygdala, which suggests that this region is important for the onset of respiratory dysfunction in epilepsy patients and may be important in the pathophysiology of sudden unexpected death in epilepsy.
Authors:Victoria L. Morgan, Baxter P. Rogers, Adam W. Anderson, Bennett A. Landman and Dario J. Englot
The authors identified differences in brain networks prior to temporal lobe epilepsy surgery that lead to different seizure outcomes. This information can be used to identify the patients who will most benefit from surgical treatment.
Authors:Shan Wang, Yingying Tang, Thandar Aung, Cong Chen, Masaya Katagiri, Stephen E. Jones, Richard A. Prayson, Balu Krishnan, Jorge A. Gonzalez-Martinez, Richard C. Burgess, Imad M. Najm, Andreas V. Alexopoulos, Shuang Wang, Meiping Ding and Zhong Irene Wang
The authors examined the yield of noninvasive modalities such as voxel-based morphometric MRI postprocessing, FDG-PET, subtraction ictal SPECT coregistered to MRI (SISCOM), and magnetoencephalography (MEG) in a cohort of patients with operculoinsular epilepsy and negative MRI. Presurgical evaluation of operculoinsular epilepsy presents particular challenges, which the authors attempted to meet in this study.
Authors:Michele Rizzi, Martina Revay, Piergiorgio d’Orio, Pina Scarpa, Valeria Mariani, Veronica Pelliccia, Martina Della Costanza, Matteo Zaniboni, Laura Castana, Francesco Cardinale, Giorgio Lo Russo and Massimo Cossu
The authors performed a retrospective analysis of a prospectively collected series of 42 consecutive patients undergoing posterior quadrant disconnection for epilepsy surgery. In the field of posterior quadrant disconnection, this represents the largest series with the longest follow-up. For the first time, outcome predictor analysis, neuropsychological outcome, and SEEG methodology application are described. Moreover, surgery was tailored based on the anatomo-electro-clinical correlations.
Authors:Chao-Hung Kuo, Timothy M. Blakely, Jeremiah D. Wander, Devapratim Sarma, Jing Wu, Kaitlyn Casimo, Kurt E. Weaver and Jeffrey G. Ojemann
The authors used micro-electrocorticography (µECoG) on the sensorimotor cortex to examine corresponding patterns of neural activity associated with finger movements. The findings may provide insight into the tuning of the motor cortex toward specific types of motor behaviors and may aid in the refinement of brain-computer interface control algorithms, which are highly relevant for overall therapeutic efficacy and application to neuroprosthetics.
Authors:Günther Deuschl, Kenneth A. Follett, Ping Luo, Joern Rau, Frances M. Weaver, Steffen Paschen, Frank Steigerwald, Lisa Tonder, Valerie Stoker and Domenic J. Reda
The authors compared two large-scale clinical trials of deep brain stimulation for Parkinson’s disease to determine which factors account for differences in the reported outcomes. This analysis reveals that differences between these two major studies can be attributed to preoperative patient characteristics, most notably levodopa responsiveness, and emphasizes the importance of the preoperative selection criterion of levodopa response.
Authors:Zoe E. Teton, Daniel Blatt, Amr AlBakry, James Obayashi, Gulsah Ozturk, Vural Hamzaoglu, Philippe Magown, Nathan R. Selden, Kim J. Burchiel and Ahmed M. Raslan
For the first time, researchers have reported comparative device and therapy failure rates out to 15 years for hundreds of DBS, SCS, and VNS patients at a single institution over 22 years. These results provide the fundamental statistics necessary for clinicians to answer patients when asked how long they can expect to utilize both their device and therapy and, by analyzing these aspects separately, the authors have demonstrated that all three therapies maintain therapeutic efficacy beyond initial device failures - an important distinction to emphasize when counseling patients in light of the well-established complication rates associated with these devices.
Authors:Marissa D’Souza, Kevin S. Chen, Jarrett Rosenberg, W. Jeffrey Elias, Howard M. Eisenberg, Ryder Gwinn, Takaomi Taira, Jin Woo Chang, Nir Lipsman, Vibhor Krishna, Keiji Igase, Kazumichi Yamada, Haruhiko Kishima, Rees Cosgrove, Jordi Rumià, Michael G. Kaplitt, Hidehiro Hirabayashi, Dipankar Nandi, Jaimie M. Henderson, Kim Butts Pauly, Mor Dayan, Casey H. Halpern and Pejman Ghanouni
Magnetic resonance–guided focused ultrasound (MRgFUS) is shown to be both a safe and effective treatment of essential tremor (ET) for patients previously excluded from treatment due to presumed unsuitable skull density ratios (SDRs). Because an SDR cutoff of 0.45 ± 0.05 served as exclusion criterion from past clinical trials evaluating MRgFUS for ET, these findings represent an immediate opportunity for more patients to access this modality as an alternative to current therapy.
Authors:Adam T. Leibold, Jonathan Weyhenmeyer and Albert Lee
The authors report on a series of cases in which they were able to treat infection of intrathecal baclofen pumps by explanting the infected pump and reimplanting a new pump in the same procedure. This allows for optimal resolution of the infection, while minimizing the risk of baclofen withdrawal.
Authors:Michael D. Staudt, Holger Joswig, Gwynedd E. Pickett, Keith W. MacDougall and Andrew G. Parrent
Authors of this study examined the effectiveness of treating patients with trigeminal neuralgia and multiple sclerosis via initial or repeated percutaneous glycerol injections. This is the largest study to assess the efficacy of these procedures, totaling 401 injections over 35 years, and to show that patients with multiple sclerosis can achieve meaningful and lasting pain relief with efficacy comparable to that in patients with idiopathic trigeminal neuralgia.
Authors:Adel Elnashar, Smruti K. Patel, Almaz Kurbanov, Kseniya Zvereva, Jeffrey T. Keller and Andrew W. Grande
The authors undertook this study to further understanding of the complex anatomy of the foramen ovale as related to treatments such as percutaneous stereotactic radiofrequency rhizotomy. Six anatomical foramen ovale shapes appeared to change predictably in the surgical perspective and to affect accessibility. Anatomical illustrations and photographs reinforce understanding of normal and variable anatomy. Morphometric findings bring insights from both anatomical and surgical perspectives, which are important for surgeons performing percutaneous stereotactic radiofrequency rhizotomy cannulation of this foramen.
Authors:Cecilia L. Dalle Ore, Stephen T. Magill, Adam J. Yen, Maryam N. Shahin, David S. Lee, Calixto-Hope G. Lucas, William C. Chen, Jennifer A. Viner, Manish K. Aghi, Philip V. Theodosopoulos, David R. Raleigh, Javier E. Villanueva-Meyer and Michael W. McDermott
The authors retrospectively reviewed their experience treating 1139 meningioma patients and report the observed incidence of extracranial meningioma metastases. They also report their results of screening meningioma patients for extracranial metastases; using their screening criteria (greater than two prior recurrences), they found that the number needed to screen is 3.83 to identify one patient with extracranial metastases. This is important because it will help guide the management of patients with multiply recurrent meningioma, and it provides a proposed screening algorithm for meningioma metastases.
Authors:Fengming Lan, Qing Qin, Huiming Yu and Xiao Yue
The authors examined the effects of regulation of glycolysis by miR-448 in the response of glioma cells to radiation treatment. The results suggest that miR-448 can promote radiosensitivity by negatively regulating glycolysis in glioma through a newly identified miR-448–HIF-1α axis that may be a valuable therapeutic target in glioma treatment.
Authors:Chao Li, Shuo Wang, Jiun-Lin Yan, Turid Torheim, Natalie R. Boonzaier, Rohitashwa Sinha, Tomasz Matys, Florian Markowetz and Stephen J. Price
Using magnetic resonance spectroscopy and perfusion imaging, the authors compared the anisotropic abnormality revealed by diffusion tensor imaging to the contrast-enhancing (CE) tumor region. The results showed that the anisotropic abnormality may indicate a hypoxic region, while the CE volume showed aberrant neovascularization. A prognostic quantitative measure can be obtained to evaluate glioblastoma aggressiveness, by integrating the volumes of two regions. The findings suggest that combining both tumor regions may lead to better surgical targeting.
Authors:Eun Young Han, He Wang, Dershan Luo, Jing Li and Xin Wang
The authors conducted a radiosurgical treatment planning study, comparing parameters for the treatment of multiple large brain metastases using Gamma Knife and CyberKnife systems to parameters from treatment plans that had been generated for patients undergoing radiosurgery with a linear accelerator. It is important to identify the most suitable treatment modality for the individual patient, in terms of both plan quality and efficiency of delivery.
Using the updated Japanese Leksell Gamma Knife study 0901 data set plus detailed enhanced MRI observations, the authors applied sophisticated statistical methods, such as competing risk analysis and propensity score matching, and performed a case-matched study. The authors proved that the incidences of local tumor progression after Gamma Knife radiosurgery without whole-brain radiation therapy, as well as tumor recurrence and radiation necrosis, does not differ between patients with 5–10 brain metastases and those with 2–4.
Authors:Samuel Romano-Feinholz, Víctor Alcocer-Barradas, Alejandra Benítez-Gasca, Ernesto Martínez-de la Maza, Cristopher Valencia-Ramos and Juan Luis Gómez-Amador
The authors performed the first study regarding the use of sodium fluorescein to guide the resection of pituitary adenomas. Their results imply an important advancement in pituitary surgery, minimizing its risks and maximizing safe resection, which translates into better outcomes for the patients.
Authors:I. Jonathan Pomeraniec, Davis G. Taylor, Or Cohen-Inbar, Zhiyuan Xu, Mary Lee Vance and Jason P. Sheehan
The authors studied the prognostic role of doses to neuroanatomical structures in Gamma Knife radiosurgery of pituitary adenomas for long-term clinical outcomes and pituitary function. Patients who are treated with a high dose of radiation to the pituitary stalk relative to the normal gland are at a higher risk of developing endocrinopathy. Optimization of the gradient index toward the stalk and normal gland may help preserve endocrine function.
Authors:Nasser Mohammed, Dale Ding, Yi-Chieh Hung, Zhiyuan Xu, Cheng-Chia Lee, Hideyuki Kano, Roberto Martínez-Álvarez, Nuria Martínez-Moreno, David Mathieu, Mikulas Kosak, Christopher P. Cifarelli, Gennadiy A. Katsevman, L. Dade Lunsford, Mary Lee Vance and Jason P. Sheehan
The role of primary stereotactic radiosurgery in patients with medically refractory acromegaly who are not operative candidates or refuse resection is poorly understood. Currently, there are few studies that have analyzed the results of primary stereotactic radiosurgery for acromegaly, and the effectiveness of primary versus conventional postoperative stereotactic radiosurgery for these patients is unknown. Therefore, the aim of this multicenter, retrospective matched cohort study was to compare the outcomes of primary versus postoperative stereotactic radiosurgery for the treatment of patients with acromegaly who had similar radiological and endocrinological disease burdens prior to stereotactic radiosurgery.
Authors:Michael E. Ivan, Michael M. Safaee, Nikolay L. Martirosyan, Ana Rodríguez-Hernández, Barbara Sullinger, Priyanka Kuruppu, Julian Habdank-Kolaczkowski and Michael T. Lawton
The authors reviewed their surgical experience with anterior communicating artery aneurysms and introduce the A1-A2 junctional triangle and A1-A1 precommunicating triangle to identify safe corridors for access and microsurgical clipping.
Authors:Sahin Hanalioglu, Balkan Sahin, Omer Selcuk Sahin, Abdulbaki Kozan, Melih Ucer, Ulas Cikla, Steven L. Goodman and Mustafa K. Baskaya
The authors retrospectively analyzed the medical records of 1291 patients who underwent elective intracranial tumor surgery by a single surgeon with respect to their use of aspirin (ASA) and found no effect on complication rate. This is important because the data suggest that patients under ASA treatment can maintain ASA in elective craniotomy without increased risk of complication.
Authors:Lukas Goertz, Christina Hamisch, Christoph Kabbasch, Jan Borggrefe, Marion Hof, Anna-Katharina Dempfle, Moritz Lenschow, Pantelis Stavrinou, Marco Timmer, Gerrit Brinker, Roland Goldbrunner and Boris Krischek
The current study analyzes the impact of aneurysm shape and configuration of the aneurysm neck on cerebral infarction in patients undergoing microsurgical clipping of intracranial aneurysms. A better understanding of the factors that increase the risk of infarction should help to improve outcomes for patients with intracranial aneurysms.
Authors:Tonje Haug Nordenmark, Tanja Karic, Cecilie Røe, Wilhelm Sorteberg and Angelika Sorteberg
The authors explored the use of the Rivermead Post-Concussion Symptom Questionnaire as a means of identifying patients with a cluster of residual symptoms after aneurysmal subarachnoid hemorrhage (aSAH), which they have termed post-aSAH syndrome. This symptom cluster, which has not been previously described, has important negative effects on patient’s quality of life and overall function. Identifying patients with post-aSAH syndrome is a key step in providing appropriate rehabilitation that addresses the complexity of their needs.
Authors:Philip Cheng, Li Ma, Sonali Shaligram, Espen J. Walker, Shun-Tai Yang, Chaoliang Tang, Wan Zhu, Lei Zhan, Qiang Li, Xiaonan Zhu, Michael T. Lawton and Hua Su
The authors provide direct evidence to support the hypothesis that elevation of vascular endothelial growth factor increases the chance of bleeding from brain arteriovenous malformation lesions, which is unpredictable and life threatening. This study indicates that inhibition of angiogenesis could reduce bleeding from malformed vessels.
Authors:Te Ming Lin, Huai Che Yang, Cheng Chia Lee, Hsiu Mei Wu, Yong Sin Hu, Chao Bao Luo, Wan Yuo Guo, Yi Hsuan Kao, Wen Yuh Chung and Chung Jung Lin
The authors compared hemodynamic analysis using quantitative digital subtraction angiography (QDSA) with angioarchitecture analyses using conventional DSA for evaluating the risk of supratentorial arteriovenous malformation (AVM) hemorrhage. Important findings were that a stasis index (ratio of the inflow to outflow gradient) of the most dominant drainage vein, measured with QDSA hemodynamic analysis, is an independent risk factor for AVM hemorrhage and that the hemorrhagic risk models established based on angioarchitecture and hemodynamics exhibited equivalent diagnostic performance.
Authors:Shyam S. Rao, David Y. Chung, Zoe Wolcott, Faheem Sheriff, Ayaz M. Khawaja, Hang Lee, Mary M. Guanci, Thabele M. Leslie-Mazwi, W. Taylor Kimberly, Aman B. Patel and Guy A. Rordorf
The authors compared 2 external ventricular drain (EVD) management strategies in patients with subarachnoid hemorrhage, continuous drain with gradual wean and intermittent drain with rapid wean. This study is important because it will help determine optimal strategies for management and discontinuation of EVDs.
Authors:James C. Dickerson, Katherine L. Harriel, Robert J. Dambrino IV, Lorne I. Taylor, Jordan A. Rimes, Ryan W. Chapman, Andrew S. Desrosiers, Jason E. Tullis and Chad W. Washington
The authors compared data from before and after an institutional policy change to determine whether routine screening for deep venous thrombosis affects the rates of pulmonary embolism or mortality in a neurosurgical population. They found that in their neurosurgical ICU, routine screening with ultrasonography does not appear to confer a benefit to patients beyond that obtained with selective use of ultrasonography.
Authors:Georgios A. Maragkos, Luis C. Ascanio, Mohamed M. Salem, Sricharan Gopakumar, Santiago Gomez-Paz, Alejandro Enriquez-Marulanda, Abhi Jain, Clemens M. Schirmer, Paul M. Foreman, Christoph J. Griessenauer, Peter Kan, Christopher S. Ogilvy and Ajith J. Thomas
The authors searched for factors to predict if an intracranial aneurysm will occlude after Pipeline embolization. This can help in choosing the patients who will receive the maximum benefit from this procedure.
Authors:Omer Doron, Tal Or, Limor Battino, Guy Rosenthal and Ofer Barnea
The authors have developed a novel method to improve brain perfusion. This method may assist in offering a new modality of treatment for neurocritically ill patients suffering from reduced cerebral blood flow states such as in traumatic brain injury or vasospasm.
Authors:Elizabeth N. Alford, Lauren E. Rotman, Matthew S. Erwood, Robert A. Oster, Matthew C. Davis, H. Bruce C. Pittman, H. Evan Zeiger and Winfield S. Fisher III
The authors describe the development of a scoring system to predict mortality due to subdural hematoma in elderly patients with a history of minor or no prior trauma. The Subdural Hematoma in the Elderly (SHE) score considers patient age, admission neurological status, and subdural hematoma size, and shows significant predictive ability.
Authors:Jacques J. Lara-Reyna, Rafael Uribe-Cardenas, Imali Perera, Nicholas Szerlip, Anastasios Giamouriadis, Nicole Savage, Therese Haussner and Mark M. Souweidane
The authors compared the outcomes of endoscopic treatment of patients with a recurrent colloid cyst with those of patients with a primary colloid cyst. This study is important because the data show that the minimally invasive endoscopic technique for removal of primary colloid cysts is feasible and equally safe in patients with recurrent cysts.
Authors:Daniel Dutra Cavalcanti, Bárbara Albuquerque Morais, Eberval Gadelha Figueiredo, Robert F. Spetzler and Mark C. Preul
In this study the authors used cadaveric dissections to quantify the surgical area and angular and linear exposures to the lateral mesencephalic sulcus by subtemporal, paramedian, and extreme-lateral variants of the supracerebellar infratentorial approach. The findings of this study provide an important source for supporting the selection of surgical approaches to access the lateral mesencephalic sulcus.
Authors:Shahan Momjian, Rémi Tyrand, Basile N. Landis and Colette Boëx
Intraoperative neuromonitoring of olfaction has never been performed. A standard olfactometer was used in the surgical theater with hydrogen sulfide. Contributive recordings were obtained for 5 of 8 patients (3 patients had fewer than 70 epochs with an amplitude < 45 μV). Olfactory-evoked potentials showed N1 responses (mean 442.8 ± 40.0 msec). The study shows that olfactory-evoked potentials can be measured in response to olfactory stimuli under general anesthesia.
The authors found that the application of chondroitin sulfate proteoglycan (CSPG) coverage to the nerve stump helps to block irregular axon regeneration in terminal neuroma, and it is beneficial to relieve neuroma-related pain symptoms after sciatic nerve transection in Sprague Dawley rats. The results indicate that covering the proximal nerve stump with CSPGs may be a new and promising strategy to prevent traumatic painful neuroma formation in a clinical setting.
The authors compared a noninvasive method of language localization in the human brain to the current gold standard, which involves electrical stimulation of the cortex during awake surgery. The development of reliable noninvasive methods of language localization can reduce risks during awake surgery and can increase our understanding of how language functions.
The supercharged end-to-side (SETS) nerve transfer is a surgical technique with great potential to improve functional outcomes after peripheral nerve injuries. However, its widespread use by peripheral nerve surgeons is hindered by a complicated and poorly understood biology. This review gives a structured approach for surgeons and scientists to evaluate the current applications and limitations of the SETS transfer. It also highlights opportunities for further investigation into the underlying mechanisms.
Through a combined tumor tissue analysis and MRI study of tumor vascularity, the researchers sought to compare differences in the tumoral microenvironment between sporadic and NF2-related vestibular schwannomas (VSs). They demonstrate that despite the considerable variation in clinical behavior between these tumors, in terms of their underlying inflammatory and microvascular characteristics, they are strikingly similar. These findings suggest that in both sporadic and NF2-related VSs, inflammation may be a relevant therapeutic target.
This survey is the first nationwide study of female neurosurgeons' experiences with and attitudes toward pregnancy. Respondents described the myriad challenges posed by pregnancy to the advancement of women in neurosurgery. Critically, the authors found that a minority of respondents endorsed the presence of any family leave policy at their institution. The results of this survey catalyzed the recent American Board of Neurological Surgery statement on family leave.
The authors have conducted the first study of the outcomes of the treatment of hydrocephalus across all age groups and across the United States. Hydrocephalus is predominantly a disease of adulthood. Outcomes of CSF shunt surgery in unselected practices are worse than the research literature suggests.
The authors developed a "Safe Transitions Pathway" (STP) for postoperative recovery after elective craniotomies so that selected neurosurgical patients were able to bypass the ICU. STP patients had shorter lengths of stay and no serious adverse events or complications. Patients and nursing staff did not report adverse recovery experiences, and direct costs were lower for the hospital. This report will be useful for other institutions interested in creating a recovery pathway that maximizes patient safety and resources to deliver efficient and effective care.
This study assessed the clinical risk of intraoperative seizures and afterdischarges in the setting of awake mapping. This work is important as it provides clinical insight to a known complication within awake mapping.
In this study, the authors compared long-term patency rates between autologous and cadaveric saphenous vein grafts (SVGs) in cerebral revascularization surgery. In the largest series to date, they demonstrated that patency rates of cadaveric SVGs are similar to those with autologous grafts and that cadaveric SVGs are a reasonable graft option for cerebral bypass procedures.
In this study the authors first clarified the underlying mechanism of spontaneous angiogenesis after indirect bypass surgery for moyamoya disease. The findings strongly suggest that platelet-derived growth factor receptor–α signal may play an important role in developing spontaneous angiogenesis between the temporal muscle and neocortex after encephalomyosynangiosis in moyamoya disease.
In this study, the authors evaluated changes in weight following deep brain stimulation surgery. Changes in weight can be alarming or distressing to patients. Understanding the associations with such changes following deep brain stimulation surgery can help clinicians inform patients and mitigate such changes.
The authors found that intraarterial indocyanine green (ICG) videoangiography was more useful than intravenous ICG videoangiography in surgery for cerebral arteriovenous malformations. It was especially effective in the identification of the feeders, nidi, and drainers and in the assessment of the flow dynamics of the nidus. Use of Flow 800 made it simpler and easier to evaluate these findings.
In this post hoc analysis, the authors identified patients at high risk for vasospasm-related morbidity and mortality, as well as poor long-term clinical outcome, based on the burden of subarachnoid hemorrhage shown on CT scans, using the data from the CONSCIOUS-2 and CONSCIOUS-3 studies. Future clinical trials may consider directing attention to the group of high-risk patients with thick, diffuse clots, given their high tendency for vasospasm-related morbidity and mortality.
The authors assessed risk factors for rapid growth in neurofibromatosis type 2 (NF2)–associated intracranial meningiomas and validated the recently published Asan Intracranial Meningioma Scoring System score. They found that the scoring system provides a good estimate of the overall risk of rapid tumor growth in these meningiomas. One of the challenges of managing multiple meningiomas in NF2 patients is to choose which tumor to treat, allowing best benefit/risk balance. Thus, estimating which meningiomas are most likely to grow rapidly is of great interest.
This study illustrates the usefulness of invasive neuromonitoring (INM) in patients who cannot be examined due to their poor-grade subarachnoid hemorrhage (SAH). In patients who underwent INM, delayed cerebral ischemia events were detected earlier and therefore treated faster than events in a group of patients treated before the introduction of INM, resulting in a better outcome. To the authors' knowledge, this is the largest SAH cohort in which INM has been examined. The authors believe the results of this trial can upgrade existing evidence and recommendations concerning the use of brain tissue oxygen monitoring and cerebral microdialysis in SAH patients.
For patients with resected brain metastases, the authors compared clinical outcomes (local disease control, distant brain disease control, and survival) for treatment with radioactive cesium-131 brachytherapy seeds and postoperative radiosurgery. The authors showed improved local control of disease with brachytherapy. This potentially provides an alternative or possibly superior treatment choice for these patients.
This article highlights the predictors of visual outcomes in patients with cavernous sinus meningioma and further signifies the importance of pretreatment visual functional assessment in these patients.
The authors compared the capability of magnetic source imaging (MSI) and EEG–functional MRI (fMRI) in localizing the seizure onset lobe (SL). Interestingly, the additive results of MSI and EEG-fMRI tests confer high capability in identifying the SL. The authors found a lower rate of false identification by using the intersecting areas of both methods. The combination of both tests can help in focusing implantation of intracranial EEG electrodes targeting the seizure onset zone.
Temporopolar amygdalohippocampectomy (TP-AH) is a natural evolution of the traditional transsylvian approach for the authors' group, and they believe that TP-AH can be a valuable alternative surgical technique for those groups who perform the transsylvian approach and are observing TP atrophy and temporal stem damage.