Deborah L. Benzil, Karin M. Muraszko, Pranay Soni, Ellen L. Air, Katie O. Orrico, and James T. Rutka
The objective of this paper was to assess the depth and breadth of sexual harassment in neurosurgery. Neurosurgeons report significant sexual harassment across all ages and practice settings with tremendous impact on both men and women. The findings highlight the need for changing the culture through zero tolerance, new policies, awareness, and commitment to best practices by all neurosurgeons and neurosurgical leadership.
Uma V. Mahajan, Harsh Wadhwa, Parastou Fatemi, Samantha Xu, Judy Shan, Deborah L. Benzil, and Corinna C. Zygourakis
In this study, the authors evaluated different peer-review processes in two leading neurosurgery journals (single-blinding in Journal of Neurosurgery> vs double-blinding in Neurosurgery) as it related to author gender and analyzed recent trends in women in neurosurgery. Given the importance of inclusive diversity in the medical field, and within academic neurosurgery, the authors think that this research will be of great interest to the readership of the Journal of Neurosurgery.
Oliver Y. Tang, Krissia M. Rivera Perla, Rachel K. Lim, James S. Yoon, Robert J. Weil, and Steven A. Toms
In a national population of 472,938 cranial neurosurgery patients, the authors demonstrated that increased interhospital competition, measured by a validated metric called the Herfindahl-Hirschman Index, elevates charges (patient billing) despite no differences in underlying costs (resource utilization). Although earlier research has investigated the impact of interhospital competition on healthcare spending amidst growing expenditures and rising practice consolidation within the US healthcare system, to the authors' knowledge no previous study has examined this relationship in the neurosurgical setting.
Laura Berardo, Christina Gerges, James Wright, Amber Stout, Hamid Shah, Alexander Papanastassiou, Kristopher Kimmell, and in affiliation with the Council of State Neurosurgical Societies (CSNS)
In this systematic literature review, the authors examined neurosurgeon burnout at various levels of training and the outcomes of wellness interventions implemented for neurosurgical faculty and residents. Burnout in neurosurgery is prevalent at all stages of training, but wellness initiatives have been shown to mitigate the factors contributing to burnout. Initiatives should be implemented to combat this issue, which affects patient outcomes and neurosurgeon well-being and career satisfaction.
Philipp Dammann, Annika Herten, Alejandro N. Santos, Laurèl Rauschenbach, Bixia Chen, Marvin Darkwah Oppong, Börge Schmidt, Michael Forsting, Christoph Kleinschnitz, and Ulrich Sure
The authors assessed different outcome measures (e.g., health-related quality of life [HRQOL]) after surgery for brainstem cavernous malformations. Impairment in everyday HRQOL can be significant after surgery, even in patients attaining a "good" functional outcome (modified Rankin Scale score 0–2). Balance disturbances can be especially disabling. Surgeons and patients should be aware of the impact of surgery on outcome. The authors noted that absolute rather than relative outcome measures should be applied.
Alejandro N. Santos, Laurèl Rauschenbach, Marvin Darkwah Oppong, Bixia Chen, Annika Herten, Michael Forsting, Ulrich Sure, and Philipp Dammann
Researchers evaluated the performance and replicability of two proposed brainstem cavernous malformation grading systems (Lawton-Garcia and Dammann-Sure) for predicting neurological outcome after the resection of such lesions. Both grading systems appear to be robust, pertinent, and replicable tools to estimate neurological outcome after surgery, and the authors provide evidence supporting their combined use. Using these grading systems would be of clinical importance in further improving the selection of candidates for surgical treatment.
RNF213 is an important susceptibility gene for moyamoya disease, and cerebral hyperperfusion syndrome is a critical complication of the revascularization surgery for moyamoya disease. The authors investigated the correlation between RNF213 mutation and hyperperfusion in patients with moyamoya disease and found that prolonged/delayed cerebral hyperperfusion was exclusively evident in patients with the RNF213-mutant type. This result is the first to identify the significance of the RNF213 genotype in the outcome of revascularization surgery for moyamoya disease.
Christopher R. Pasarikovski, Jerry C. Ku, Julia Keith, Joel Ramjist, Yuta Dobashi, Stefano M. Priola, Leodante da Costa, Ashish Kumar, and Victor X. D. Yang
Researchers developed a novel swine cerebral venous sinus thrombosis model to test endovascular devices and techniques for the treatment of this disease. Residual bridging cortical vein thrombus and residual sinus thrombus, visualized on intravascular optical coherence tomography, may be present despite complete sinus recanalization on angiography.
Kavelin Rumalla, Visish M. Srinivasan, Monica Gaddis, Peter Kan, Michael T. Lawton, and Jan-Karl Burkhardt
In this study, the largest all-payer inpatient database in the US was analyzed to study readmissions following extracranial-intracranial (EC-IC) bypass surgery for moyamoya disease, intracranial atherosclerosis, and complex aneurysm. Readmission rates (30 and 90 days) were comparable to those for other common cranial procedures and were primarily driven by patient age, preexisting comorbidities, and treatment at low-volume centers. Centralization of care may significantly reduce perioperative complications, readmissions, and hospital resource utilization.
João Ferreira de Melo Neto, Eduardo E. Pelinca da Costa, Nilson Pinheiro Junior, André L. Batista, Georges Rodesch, Serge Bracard, and Antônio G. Oliveira
The authors aimed to determine which venous elements could contribute to the development of severe symptoms in patients with DAVF. Hemorrhage had a positive correlation with stenosis in the DAVF drainage veins. Severe nonhemorrhagic neurological symptoms had a positive correlation with insufficient cerebral venous drainage due to flow competition with the DAVF in one of the three final drainage pathways. This study adds additional objective elements to understanding fistulas, which will be useful in daily therapeutic decisions.
In this paper, the authors found that surgery, platinum-based chemotherapy, and radiotherapy result in favorable survival outcomes in patients with germinomatous germ cell tumors (GCTs). Furthermore, the multivariate survival models for overall survival (OS) in patients with nongerminomatous GCTs with intermediate prognosis and poor prognosis demonstrated that the alpha-fetoprotein status was significantly associated with worsened OS.
Carlo Serra, Hatice Türe, Cumhur Kaan Yaltırık, Mehmet Volkan Harput, and Uğur Türe
Thalamic lesions are often deemed not suitable for surgical removal. The aim of the study was to show that thalamic surgery can be safely performed with reasonable morbidity provided that one has solid anatomical knowledge and an adequate microneurosurgical technique. The results reported by the authors compare favorably with those in the available literature. Most noticeably, all patients were operated on via either a purely transcisternal or an anterior transcallosal approach. In no case was a transcortical approach adopted.
Laurent J. Livermore, Martin Isabelle, Ian M. Bell, Oliver Edgar, Natalie L. Voets, Richard Stacey, Olaf Ansorge, Claire Vallance, and Puneet Plaha
The authors investigated the optical technique of Raman spectroscopy to analyze fresh brain tissue samples directly from brain tumor operations. It was shown that Raman spectroscopy was highly accurate in determining if samples contained tumor or normal brain, and it significantly outperformed the fluorescence guidance surgery technique (5-ALA fluorescence). Raman spectroscopy could become an important intraoperative tool, aiding surgeons to accurately identify tumor, thus increasing the extent of resection that has been shown to improve patient survival.
Andrew J. Gogos, Jacob S. Young, Matheus P. Pereira, Ramin A. Morshed, Matthew B. Potts, Shawn L. Hervey-Jumper, and Mitchel S. Berger
The authors present the largest cohort of patients with incidentally discovered low-grade gliomas. They demonstrate that a greater extent of resection can be achieved and that overall survival is improved as compared with those for patients with symptomatic lesions. Operative morbidity was low, and thus the authors advocate upfront maximal safe resection of incidentally discovered low-grade gliomas.
The authors performed a critical analysis of the literature supporting the use of the Simpson grade, a scale used to establish the risk of recurrence after surgery for meningiomas developed more than 60 years ago, to see if the scale was still relevant and useful in modern meningioma surgery. The authors found that the literature supporting the scale is antiquated and inadequately substantiated by the existing data. They recommend its use be discontinued in favor of a more modern conception of meningioma surgery and its surgical goals.
During awake surgery for glioma in foreign-speaking patients, intraoperative cognitive evaluation can be complex. The authors report on an original and large cohort (84 foreign patients, 18 different native languages) that demonstrates the feasibility and safety of awake mapping thanks to the help of a trained interpreter in the operating theater. The functional results were favorable, with a high rate of return to work at 3 months despite a slight but significant decreased extent of resection.
Amar S. Shah, Peter T. Sylvester, Alexander T. Yahanda, Ananth K. Vellimana, Gavin P. Dunn, John Evans, Keith M. Rich, Joshua L. Dowling, Eric C. Leuthardt, Ralph G. Dacey, Albert H. Kim, Robert L. Grubb, Gregory J. Zipfel, Mark Oswood, Randy L. Jensen, Garnette R. Sutherland, Daniel P. Cahill, Steven R. Abram, John Honeycutt, Mitesh Shah, Yu Tao, and Michael R. Chicoine
This study investigates the impact of intraoperative MRI in surgical outcomes for glioblastoma patients using a large, multicenter neurosurgical database. Intraoperative MRI is frequently used as a surgical adjunct in glioblastoma and has been shown to increase extent of resection, yet its impact on overall and progression-free survival remains unclear.
Colin J. Przybylowski, Benjamin K. Hendricks, Fabio A. Frisoli, Xiaochun Zhao, Claudio Cavallo, Leandro Borba Moreira, Sirin Gandhi, Nader Sanai, Kaith K. Almefty, Michael T. Lawton, and Andrew S. Little
An analysis of the correlation between radiographic tumor recurrence and Simpson resection grade was performed in a modern series of intracranial meningioma patients, including patients who received postoperative radiosurgery after subtotal resection. Several publications have recently disputed the prognostic value of the Simpson resection grade in modern meningioma surgery. In contrast, this study confirms its predictive value in the current neurosurgical era and supports the historical standard to seek Simpson grade I resection where safe and feasible.
Sophie S. Wang, Friederike Selge, Martina Sebök, Pierre Scheffler, Yang Yang, Giovanna Brandi, Sebastian Winklhofer, and Oliver Bozinov
Intraoperative high-field MRI has been studied extensively in primary tumor lesions. The authors present a cohort study on its value in previously operated tumors. The results showed that the phenomenon of false-positive tumor-imitating MRI signals was significantly increased in surgery of recurrent tumor lesions compared to cases without prior surgery. These findings are very important for the decision-making process of neurosurgeons already applying intraoperative MRI and those centers considering its installation in the future.
Alexander Micko, Benjamin I. Rapoport, Brett E. Youngerman, Reginald P. Fong, Jennifer Kosty, Andrew Brunswick, Shane Shahrestani, Gabriel Zada, and Theodore H. Schwartz
This study investigates the utility of 5-aminolevulinic acid (5-ALA) fluorescence during endoscopic endonasal approaches (EEAs) using a blue-light endoscope to increase visibility and differentiate pathologic tissue. Twenty-eight skull base lesions with varying pathologies underwent blue-light EEA with preoperative 5-ALA, including 15 (54%) pituitary adenomas. Tumor fluorescence was detected in 7% of all cases, with strong fluorescence in 1 tuberculum sellae meningioma and vague fluorescence in 1 pituicytoma; in all other cases fluorescence was absent. While use of 5-ALA in meningioma surgery holds the most promise, limited fluorescence and utility for pituitary adenomas render its routine use unsupported for this indication.
Alexandrine Gagnon, Mathieu Laroche, David Williamson, Marc Giroux, Jean-François Giguère, and Francis Bernard
The authors directly measured brain oxygen during a few days after neurosurgery used to control brain pressure (monitoring of brain oxygenation is not usually done when intracranial pressure is normal) and found a high occurrence of brain complications (low oxygen) despite pressure in the cranium being controlled. Monitoring for brain oxygen after such surgery is important because the lack of oxygen can be reversed and the brain protected.
Hans Kristian Moe, Turid Follestad, Nada Andelic, Asta Kristine Håberg, Anne-Mari Holte Flusund, Kjell Arne Kvistad, Elin Hildrum Saksvoll, Øystein Olsen, Sebastian Abel-Grüner, Oddrun Sandrød, Toril Skandsen, Anne Vik, and Kent Gøran Moen
In this study, 490 patients with traumatic brain injury (TBI) were examined with early clinical MRI. The relationship between traumatic axonal injury on MRI, the admission Glasgow Coma Scale score, and the prolonged duration of posttraumatic amnesia was investigated. The results of this study are important because they can help physicians explain reduced consciousness in TBI patients without intracranial mass lesions or cerebral swelling, as well as identify patients with increased risk of prolonged posttraumatic amnesia.
Georgios Alexopoulos, Nabiha Quadri, Maheen Khan, Henna Bazai, Carla Formoso Pico, Connor Fraser, Neha Kulkarni, Joanna Kemp, Jeroen Coppens, Richard Bucholz, and Philippe Mercier
The authors studied the effect of distinct ballistic lobar trajectories on patient outcomes following a penetrating brain injury (PBI) due to a gunshot. This paper will add to the existing literature and help expand the indications for surgical versus nonsurgical treatment of patients with PBIs, as it highlights the significant projectile trajectories associated with poor and favorable outcomes. The study can also provide a useful prognostic tool for assessment of trauma patients, and it can lead toward the creation of an accurate predictive model of patient outcome based on different imaging characteristics and clinical variables.
Brittany M. Stopa, Maya Harary, Ray Jhun, Arun Job, Saef Izzy, Timothy R. Smith, and William B. Gormley
Researchers used two different US national databases to study and compare the incidence of traumatic brain injury. The estimates from these databases differed greatly, with an average 448% difference. Identifying this discrepancy is important because accurate estimates of traumatic brain injury burden are needed to inform research efforts, healthcare expenditures, and policy decisions.
Abhijith V. Matur, Laura B. Ngwenya, and Charles J. Prestigiacomo
In this article, the authors reviewed the history of head injury in motor vehicle collisions, which goes back as far as the beginning of modern neurosurgery. Initial reports described children being struck by passing cars. Later, efforts were made to improve automotive design or equipment in order to prevent head injury from happening.
Takashi Tsuboi, Janine Lemos Melo Lobo Jofili Lopes, Kathryn Moore, Bhavana Patel, Joseph Legacy, Adrianna M. Ratajska, Dawn Bowers, Robert S. Eisinger, Leonardo Almeida, Kelly D. Foote, Michael S. Okun, and Adolfo Ramirez-Zamora
This single-center study analyzed long-term outcomes of globus pallidus internus (GPi) deep brain stimulation (DBS) for 5 years and beyond in Parkinson's disease (PD). Long-term benefits were most persistent in the off- and on-medication tremor scores and motor complications, whereas health-related quality of life and the cardinal motor symptoms other than tremor worsened over time. When counseling patients, it is important to recognize long-term expected outcomes of GPi DBS.
Mathilde Devaluez, Melissa Tir, Pierre Krystkowiak, Mickael Aubignat, and Michel Lefranc
Researchers tried to demonstrate that volume of tissue activated (VTA) software can be used in clinical practice to help determine the clinical effectiveness of stimulation in patients with Parkinson's disease undergoing deep brain stimulation of the subthalamic nucleus. In 90.4% (95% CI 82%–98%) of the patients, the optimal contacts identified by the VTA software were concordant with the clinically effective contacts or with an effective contact in contact-by-contact testing. The VTA software appears to be a useful tool for selecting contacts and stimulation parameters.
Elisabeth Kaufmann, Kai Bötzel, Christian Vollmar, Jan-Hinnerk Mehrkens, and Soheyl Noachtar
Physicians from a European deep brain stimulation (DBS) center summarized their 8-year experience with DBS of the anterior nucleus of the thalamus in adult patients with drug-resistant focal epilepsy syndromes. The transventricular approach has been proved to be safe and effective, with a responder rate of 74%. As one of the largest single-center reports, this study adds valuable data on patient management, including promising results on individual parameter settings as well as double stimulation.
Olga Khazen, Marisa DiMarzio, Kelsey Platanitis, Heather C. Grimaudo, Maria Hancu, Miriam M. Shao, Michael D. Staudt, Lucy Maguire, Vishad V. Sukul, Jennifer Durphy, Era K. Hanspal, Octavian Adam, Eric Molho, and Julie G. Pilitsis
The authors aimed to explore sex differences in pain outcomes following deep brain stimulation (DBS) of the subthalamic nucleus in Parkinson's disease patients. Males had significantly more improvement in chronic pain and musculoskeletal pain, while both sexes had improvement in disability related to back pain. This study examined sex-specific DBS effects on pain, raising awareness to the fact that neuromodulation can have sex-specific effects, and patient differences should be considered when moving toward personalized care.
Marjorie C. Wang, Frederick A. Boop, Douglas Kondziolka, Daniel K. Resnick, Steven N. Kalkanis, Elizabeth Koehnen, Nathan R. Selden, Carl B. Heilman, Alex B. Valadka, Kevin M. Cockroft, John A. Wilson, Richard G. Ellenbogen, Anthony L. Asher, Richard W. Byrne, Paul J. Camarata, Judy Huang, John J. Knightly, Elad I. Levy, Russell R. Lonser, E. Sander Connolly Jr., Fredric B. Meyer, and Linda M. Liau
The objective of this paper is to describe the history, current state, and anticipated future direction of American Board of Neurological Surgery (ABNS) certification in the US. The key finding is that the ABNS continues to evolve in order to elevate standards for the practice of neurological surgery and to better serve public health and safety in a rapidly changing healthcare environment. The study adds value to the field by informing neurosurgeons and the public of the continuous efforts of the ABNS toward quality improvement and safety.
Michael R. Chicoine, Alexander T. Yahanda, and Ralph G. Dacey Jr.
This historical paper chronicles the long and distinguished career of the late Australian neurosurgeon Donald Simpson, who made contributions throughout neurosurgery and related disciplines. Simpson is probably best known for his paper describing the importance of the extent of resection in recurrence of intracranial meningioma, which is still impactful today, more than 60 years since publication in 1957 while Simpson was a trainee in Oxford, England. The current paper highlights the importance of neurosurgery's connections to the past to further our understanding of where this specialty now stands and how it can best advance in the future.
Krystof S. Bankiewicz, Tomasz Pasterski, Daniel Kreatsoulas, Jakub Onikijuk, Krzysztof Mozgiel, Vikas Munjal, J. Bradley Elder, Russell R. Lonser, and Mirosław Zabek
The authors evaluated the feasibility, accuracy, effectiveness, and safety of a novel skull-mounted MRI-compatible frameless stereotactic ball-joint guide array (BJGA) for cannula placement and real-time imaging monitoring of direct gene delivery in the brain. The BJGA permitted precise trajectory mapping from the burr hole entry point and allowed for on-the-fly angular adjustment to improve the trajectory and repositioning of the infusion cannula, when necessary. The BJGA provides significant advantages over other available frameless stereotactic systems, including elimination of dedicated software, lower production costs, a significantly smaller profile, multiple contemporaneous infusions, simplified workflow, and a universal platform for all navigation systems.
Chronic encapsulated expanding hematoma (CEEH) is a rare complication after stereotactic radiosurgery (SRS) for intracranial arteriovenous malformation (AVM). Researchers described the incidence, imaging features, management, and outcomes of this rare complication after reviewing their 30-year database of more than 1000 patients who had undergone AVM SRS. CEEH had an incidence rate of 0.0045 event per person-year in their experience. To prevent progressive neurological symptoms, enlargement, and recurrence, complete removal of the CEEH is necessary and is associated with gratifying outcomes.
Different protocols for diffusion tensor imaging–fiber tracking (DTI-FT) of important language tracts were evaluated for their respective clinical usefulness by 18 experienced neurosurgeons. Tractography based on anatomical landmarks reliably enabled visualization of the principal tracts. Integration of repetitive navigated transcranial magnetic stimulation (rTMS) language mapping data might provide additional useful information, but purely rTMS-based tractography is currently not robust. This study highlights individual strengths and weaknesses of the compared protocols, facilitating future research aimed at validating and establishing useful approaches for preoperative language tractography.
The authors sought to prospectively determine the rate of visual field deficit (VFD) in patients who underwent anteromedial temporal resection with continuous guidance provided with intraoperative microscope overlays showing optic radiation tractography. Guidance with microscope overlay had a VFD rate of 5%. A significant VFD occurred in a single patient owing to retractor placement. Optic radiation tractography has a low rate of VFD and still achieves excellent seizure-remission outcomes.
The current study evaluated predictors of long-term seizure outcome after surgery in 355 patients with drug-resistant epilepsy and focal cortical dysplasia after noninvasive multimodal evaluation. At the latest follow-up, 72% of patients were seizure free and 11.8% were not receiving antiepileptic drugs. Type III FCD was the strongest predictor of seizure freedom. Multiple types of seizure, acute postoperative seizures, and type I FCD were predictors of persistent seizures. About 80% of patients with persistent seizures had their first seizure within 6 months postsurgery.
The authors sought to determine whether routine fluid restriction reduces the rate of syndrome of inappropriate antidiuretic hormone secretion (SIADH) in patients with pituitary adenoma after transsphenoidal resection. In patients treated with routine postoperative fluid restriction, the SIADH rate was 5%; in patients treated without fluid restriction, the SIADH rate was 15% (p = 0.01). This study uniquely tested for confounders and found no associations between SIADH and characteristics such as use of selective serotonin reuptake inhibitor, anticonvulsant, diuretic, or antipsychotic medications; history of hypertension or lung cancer; or patient race.
The authors used Medicare data from 2009 to 2018 to elucidate trends in intracranial neoplasm treatment and compare reimbursements for stereotactic radiosurgery (SRS) and open resection. The authors found that the increase in the number of SRS procedures outpaced the baseline expansion of Medicare enrollees, while the relative number of comparable craniotomies declined. The authors also found that Medicare reimbursed 2.9 times as much for open resection than SRS during the study period.
The authors describe the birth of neurosurgery in the state of Oklahoma with the arrival of Harry Wilkins and his herculean efforts. He and others were pivotal to the development of what is now the Department of Neurosurgery at the University of Oklahoma, which has led through conflict and national tragedy. The University of Oklahoma, in productive community partnerships, has continued a long tradition of excellence in clinical care and investigation, and its educational program remains its cornerstone.
The exact method of defining the boundary in the optic nerve sheath diameter (ONSD) measurements has not been determined. The authors aimed to compare different methods of obtaining this measurement. They found that, compared with the ONSD excluding the dura mater, the ONSD including the dura mater better estimated the intracranial pressure (ICP). The ONSD/eyeball transverse diameter ratio including the dura mater with a cutoff value of 0.264 best predicted increased ICP. This measurement may be helpful in patients who require invasive ICP monitoring.
Insular gliomas invade surrounding structures not by chance but follow certain extension routes. The authors studied these patterns by analyzing the co-involvement of 12 anatomical structures at presentation in 59 patients with surgically treated gliomas and correlated these patterns with demographic, pathological, genetic, and survival data. The analysis indicated that most insular gliomas were confined to the olfactocentric girdle of the limbic system. Extension into the hippocampocentric girdle but not surrounding opercula was associated with a significantly poorer outcome.
The objective of this study was to establish platform-specific social media guidelines by investigating how stakeholders in the brain tumor community utilize Facebook, Twitter, and YouTube. The authors found that themes differed in popularity across platforms, and conscious incorporation of these themes into content may increase account visibility. The authors propose that medical professionals can increase online accessibility of evidence-based information and better connect with their patient populations on social media by incorporating the latest evidence from the literature and by following guidelines.
The object of this paper was to demonstrate the academic impact of international research fellows in the field of neurosurgery. Despite facing major challenges, international research fellows make substantial academic contributions and reciprocate mentorship in the neurosurgical department. This finding should encourage continued recruitment of global talents to the field of neurosurgery.
This study examined the differences in outcomes and risk factors for persistent symptoms between men and women in a community sample of adult patients with concussion who presented to three Canadian emergency departments. While demographic differences between the sexes were uncommon, women reported more symptoms and experienced a delay in recovery after discharge. These results represented real-world evidence of sex differences in patients with concussion and reinforced the need to consider patient sex in the management and future research.
This study aimed to determine the incidence of brain tumor–related epilepsy (BTE) associated with metastatic brain tumors and retrospectively investigate the risk factors. BTE was recorded in 24.6% of patients during the entire course of treatment. Logistic regression analysis identified young age, male sex, breast cancer, eloquent area, peritumoral edema, dissemination, and maximum tumor volume as significant risk factors. BTE was more common with tumor volumes greater than the cutoff value of 1.92 ml.
The authors asked whether nonrandom distributions of brain metastasis vary according to primary cancer subtype and stereotactic radiosurgery coordinates utilized for treatment of brain metastasis. The authors concluded that nonuniform spatial distributions of metastasis to preferential brain regions vary according to primary cancer subtype. These cancer-specific brain topographic patterns may underlie the ability of tumor cells to adapt to regional neural microenvironments in order to facilitate colonization and establish metastasis.
Researchers investigated the epidemiological characteristics, associated risk factors, and prognostic value of glioma-related epilepsy in patients with diffuse high-grade gliomas diagnosed after implementation of the 2016 updated World Health Organization classification. The occurrence of preoperative and postoperative glioma-related epilepsy was associated with 3 and 4 clinical characteristics, respectively. Postoperative glioma-related epilepsy predicted longer overall survival time. The results provided new insights into the management of glioma-related epilepsy for the benefit of patients with diffuse high-grade gliomas.
In patients with obsessive-compulsive disorder (OCD), the authors evaluated the relation of the neuroanatomical location of cingulotomy treatment to symptomatic improvement to determine whether the lesion placement sites during treatment are related to responder status. Using an anatomical registration matrix, the authors found that cingulotomy lesions that were placed more superiorly and posteriorly within Brodmann area 32 conferred a higher likelihood of response, a finding that is important because the precise underlying neuroanatomical basis for the beneficial effects of this treatment in OCD patients has thus far been poorly understood.