Alexander C. Whiting, Tsinsue Chen, Kyle I. Swanson, Corey T. Walker, Jakub Godzik, Joshua S. Catapano, and Kris A. Smith
This study represents the largest series of patients who have undergone subtemporal selective amygdalohippocampectomy for mesial temporal lobe epilepsy (MTLE) and analyzes seizure and neuropsychological outcomes. This approach is a minimally invasive technique that appears to be safe and effective for the treatment of MTLE.
Olivia Foesleitner, Benjamin Sigl, Victor Schmidbauer, Karl-Heinz Nenning, Ekaterina Pataraia, Lisa Bartha-Doering, Christoph Baumgartner, Susanne Pirker, Doris Moser, Michelle Schwarz, Johannes A. Hainfellner, Thomas Czech, Christian Dorfer, Georg Langs, Daniela Prayer, Silvia Bonelli, and Gregor Kasprian
The authors investigated pathology- and surgery-triggered language organization in drug-resistant temporal lobe epilepsy using functional-MRI (fMRI) activation along with network analysis, diffusion tensor imaging, and neuropsychological measures. This study contributes novel insights into language network remodeling, evaluates fMRI network analysis as a complementary tool, and suggests specific biomarkers for language function outcomes. These insights are highly relevant for all physicians caring for patients who are candidates for epilepsy surgery.
Juan Delgado-Fernández, Maria Ángeles García-Pallero, Rafael Manzanares-Soler, Pilar Martín-Plasencia, Guillermo Blasco, Natalia Frade-Porto, Marta Navas-García, Paloma Pulido, Rafael G. Sola, and Cristina V. Torres
The authors attempted to determine if tractography is useful for establishing language hemispheric dominance in patients with epilepsy. The key finding in this study was that the fractional anisotropy of the arcuate fasciculus is higher in dominant hemispheres. Diffusion tensor imaging and tractography of fiber bundles could be useful to avoid the Wada test in these patients in the future.
M. Benjamin Larkin, John P. McGinnis, Rita I. Snyder, Eric A. Storch, Wayne K. Goodman, Ashwin Viswanathan, and Sameer A. Sheth
The authors provide a unique literature review article focused on treatment-resistant posttraumatic stress disorder, which highlights the current understanding of neuronal circuit dysfunction in this disorder, and offers a new potential deep brain stimulation target for posttraumatic stress disorder. The authors also discuss the current federal Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative and developments toward the use of neural stimulators and therapeutic systems for the treatment of neuropsychiatric illnesses.
Andrew J. Gogos, Jacob S. Young, Ramin A. Morshed, Lauro N. Avalos, Roger S. Noss, Javier E. Villanueva-Meyer, Shawn L. Hervey-Jumper, and Mitchel S. Berger
The authors reviewed their use of multiple techniques to map and monitor patients' motor function during glioma surgery. They demonstrated that their method of triple motor mapping was very safe and effective and improved outcomes when compared with their previous technique of cortical and subcortical bipolar stimulation. The authors highlight the different role of each mapping and monitoring modality and demonstrate that the combined use of all three techniques is responsible for the results obtained.
Victor E. Staartjes, Morgan Broggi, Costanza Maria Zattra, Flavio Vasella, Julia Velz, Silvia Schiavolin, Carlo Serra, Jiri Bartek Jr., Alexander Fletcher-Sandersjöö, Petter Förander, Darius Kalasauskas, Mirjam Renovanz, Florian Ringel, Konstantin R. Brawanski, Johannes Kerschbaumer, Christian F. Freyschlag, Asgeir S. Jakola, Kristin Sjåvik, Ole Solheim, Bawarjan Schatlo, Alexandra Sachkova, Hans Christoph Bock, Abdelhalim Hussein, Veit Rohde, Marike L. D. Broekman, Claudine O. Nogarede, Cynthia M. C. Lemmens, Julius M. Kernbach, Georg Neuloh, Oliver Bozinov, Niklaus Krayenbühl, Johannes Sarnthein, Paolo Ferroli, Luca Regli, Martin N. Stienen, and FEBNS
New functional impairment occurs in some patients after intracranial tumor surgery; neurosurgeons demonstrably tend to overestimate their patients' postoperative functional status and underestimate the incidence of functional impairment. Accurate preoperative prediction of new postoperative functional impairment thus remains extremely difficult, even for experienced neurosurgeons. The authors developed and externally validated a machine learning model for predicting functional impairment after intracranial tumor surgery. They incorporated this model into a free web-based clinical prediction tool, allowing for preoperative and objective prediction of individualized patient-specific risk of impairment.
Russell R. Lonser, Asad S. Akhter, Mirosław Zabek, J. Bradley Elder, and Krystof S. Bankiewicz
The authors review the convective properties of viral vectors, associated technology, and clinical applications. Emerging translational and clinical findings, using direct convective delivery and image monitoring, demonstrate that targeted gene therapy can be used to successfully treat neurodegenerative, metabolic, and enzyme deficiency disorders.
Dorothee Cäcilia Spille, Katharina Hess, Eike Bormann, Cristina Sauerland, Caroline Brokinkel, Nils Warneke, Christian Mawrin, Werner Paulus, Walter Stummer, and Benjamin Brokinkel
The authors investigated the prognostic value of tumor remnants on postoperative MRI for the development of recurrence. The study provides clinical and histological analyses of almost 1000 patients with meningioma, and 3D tumor volumetry on postoperative MRI in more than 400 cases. This study raises the question of whether intraoperative assessment of the extent of resection remains the gold standard in meningioma surgery, and underlines the importance of tumor remnants on initial postoperative MRI after meningioma surgery for the estimation of prognosis and planning of adjuvant treatment.
The authors investigated the therapeutic potential of CD146-targeted gene therapy using folate-conjugated chitosan nanoparticles in a mouse glioma model. Successful inhibition of CD146 expression by small-interfering RNA (siRNA) delivery eradicates mouse brain tumors. CD146 is demonstrated as a therapeutic target for malignant glioma, and siRNA delivery using folate-conjugated nanoparticle shows promise in the advancement of brain tumor treatment.
Joseph Georges, Xiaodong Qi, Xiaowei Liu, Yu Zhou, Eric C. Woolf, Amber Valeri, Zein Al-Atrache, Evgenii Belykh, Burt G. Feuerstein, Mark Preul, Adrienne C. Scheck, Mark Reiser, Trent Anderson, Jonas Gopez, Denah Appelt, Steven Yocom, Jennifer Eschbacher, Hao Yan, and Peter Nakaji
The authors developed a straightforward technique that may provide rapid and definitive intraoperative diagnosis of CNS lymphoma.
Adomas Bunevicius, Karen Lavezzo, Leah Shabo, Jesse McClure, and Jason P. Sheehan
This longitudinal study explored quality-of-life (QOL) trajectories and predictors of brain metastasis patients treated with stereotactic radiosurgery (SRS). QOL was typically preserved in brain metastasis patients treated with SRS. Higher recursive partitioning analysis class, upfront whole-brain radiation therapy, and a greater number of lesions predicted QOL deterioration. Worse pre-SRS QOL was associated with shorter survival after SRS when adjusting for clinical and demographic variables. Monitoring of QOL should be considered in brain metastases patients treated with SRS.
Martin J. Rutkowski, Ki-Eun Chang, Tyler Cardinal, Robin Du, Ali R. Tafreshi, Daniel A. Donoho, Andrew Brunswick, Alexander Micko, Chia-Shang J. Liu, Mark S. Shiroishi, John D. Carmichael, and Gabriel Zada
The authors established a universally applicable, standardized, and easy-to-implement consistency grading scale for pituitary adenomas. They additionally demonstrated correlations between tumor consistency and invasion, size, sex, endocrinopathy, and functionality. This study, combined with future studies using preoperative MRI to accurately predict tumor consistency, will allow the surgeon to tailor the exposure and resection strategy on a patient-by-patient basis.
Kihwan Hwang, Yong Hwy Kim, Jung Hee Kim, Jung Hyun Lee, Hee Kyung Yang, Jeong-Min Hwang, Chae-Yong Kim, and Jung Ho Han
This study showed that asymptomatic nonfunctioning pituitary adenomas with optic nerve compression demonstrated more indolent behavior than expected. Nevertheless, this finding does not guarantee that these tumors would be managed with the "wait-and-see" policy. Although benign in nature, these tumors need individualized treatment and lifelong radiological and endocrinological follow-up. These findings, although analyzed in rare cases, add to the literature, and this kind of effort has not previously been attempted.
Shane Shahrestani, Alexander M. Ballatori, Xiao T. Chen, Andy Ton, Ben A. Strickland, Andrew Brunswick, and Gabriel Zada
The authors evaluated the effects of modifiable and nonmodifiable risk factors on complications in patients undergoing pituitary surgery. The presence of both modifiable and nonmodifiable risk factors negatively affected outcomes in patients receiving pituitary surgery. The identification of preoperative risk factors facilitates the management and selection of patients undergoing pituitary surgery.
Rupa G. Juthani, Anne S. Reiner, Ankur R. Patel, Aimee Cowan, Marie Roguski, Katherine S. Panageas, Eliza B. Geer, Sasan Karimi, Marc A. Cohen, and Viviane Tabar
The authors tested if using intraoperative MRI can help make pituitary surgery safer and more complete. They found that intraoperative MRI does help surgeons to remove tumors more completely and more safely.
Alberto Di Somma, Cristobal Langdon, Matteo de Notaris, Luis Reyes, Santiago Ortiz-Perez, Isam Alobid, and Joaquim Enseñat
The authors shed light on the technical aspects of a simultaneous endoscopic endonasal and transorbital approach for a Meckel's cave schwannoma. By means of multidisciplinary teamwork, and taking advantage of the endoscopic skull base technique, complete tumor removal was accomplished with a satisfactory outcome and a good cosmetic result. This brief contribution exemplifies the translation into a real surgical scenario of recent anatomical studies regarding the novel endoscopic transorbital avenue and its integration with the endoscopic endonasal pathway. Therefore, it paves the way for future applications of multiportal endoscopic surgery to skull base pathologies.
Xiaochun Zhao, Ali Tayebi Meybodi, Mohamed A. Labib, Sirin Gandhi, Evgenii Belykh, Komal Naeem, Mark C. Preul, Peter Nakaji, and Michael T. Lawton
The accessible region of the paraclinoid carotid artery via a contralateral interoptic trajectory was quantitatively measured. The resulting algorithm can be used to predict whether a paraclinoid aneurysm can be accessed via a contralateral interoptic trajectory. Such data offer more clinical information for decision-making.
Yiping Li, Jason Kim, Dustin Simpson, Beverly Aagaard-Kienitz, David Niemann, Ignatius N. Esene, and Azam Ahmed
Oftentimes when patients have temporary neurological deficits after endovascular surgery, nothing is identified on imaging studies to explain the cause. The authors imaged the blood-brain barrier (BBB) of patients who had undergone endovascular therapy for unruptured intracranial aneurysms and found that BBB disruptions are better predictors of transient deficits than traditional imaging of stroke. This study suggests that BBB imaging provides value in identifying and assessing patients who may be at risk for or who are experiencing neurological deficits after surgery.
Heidi J. Nurmonen, Terhi Huttunen, Jukka Huttunen, Arttu Kurtelius, Satu Kotikoski, Antti Junkkari, Timo Koivisto, Mikael von und zu Fraunberg, Olli-Pekka Kämäräinen, Maarit Lång, Helena Isoniemi, Juha E. Jääskeläinen, and Antti E. Lindgren
The authors set out to determine whether the autosomal dominant polycystic kidney disease (ADPKD), a well-known risk factor for intracranial aneurysms, affects the phenotype and outcome of aneurysmal subarachnoid hemorrhage (aSAH). ADPKD patients, who had aSAH at a median age of 43 years, fared similarly to their age-, sex-, and year-of-admission–matched controls; however, during the median follow-up of 11 years, the risk of second aSAH from a de novo aneurysm was increased.
Youngseok Kwak, Wonsoo Son, Yong-Sun Kim, Jaechan Park, and Dong-Hun Kang
The authors evaluated the sensitivity and accuracy of MRA compared with DSA for identifying irregularly shaped unruptured intracranial aneurysms, which have a risk of rupture even if small in size. Important findings were that aneurysm shape determination with MRA is unreliable, particularly with anterior cerebral artery locations, < 3-mm diameter, and 1.5T rather than 3T MRA detection. These results indicate that DSA is needed for decision making in aneurysm treatment, because MRA findings alone are not sufficient to determine the shape of small unruptured intracranial aneurysms.
Ephraim W. Church, Mark G. Bigder, Eric S. Sussman, Santosh E. Gummidipundi, Summer S. Han, Jeremy J. Heit, Huy M. Do, Robert L. Dodd, Michael P. Marks, and Gary K. Steinberg
The authors present their experience with the microsurgical and endovascular treatment of posterior circulation fusiform aneurysms at Stanford Medical Center over the last 2 decades; they examine outcomes and related factors using regression analysis. This study is important because it summarizes and analyzes advances and outcomes in endovascular and microsurgical treatments of a very challenging class of cerebrovascular lesions, based on one of the largest experiences available.
Constantin Tuleasca, Iulia Peciu-Florianu, Henri-Arthur Leroy, Maximilien Vermandel, Mohamed Faouzi, and Nicolas Reyns
The authors investigated the role of biologically effective dose (BED) on obliteration and complication appearance in a series of patients with unruptured arteriovenous malformations (AVMs) treated by upfront radiosurgery. They found that the strongest predictor of obliteration was BED and proposed a radiosurgical obliteration score. Beam-on time was illustrated as significant for both obliteration and complication appearance. This is the first time that BED has been used and confirmed as the strongest predictor for obliteration after radiosurgery for AVMs.
Dag Ferner Netteland, Magnus Mejlænder-Evjensvold, Nils O. Skaga, Else Charlotte Sandset, Mads Aarhus, and Eirik Helseth
In this study, the authors describe the effects of cerebral venous thrombosis on patient outcome in the setting of traumatic brain injury by characterizing the complication rate and added mortality from cerebral venous thrombosis. The study is important because the question of whether cerebral venous thrombosis affects outcome in traumatic brain injury patients is unanswered, and this knowledge is important to be able to diagnose and treat the condition appropriately.
Ross C. Puffer, Luz M. Cumba Garcia, Benjamin T. Himes, Mi-Yeon Jung, Frederic B. Meyer, David O. Okonkwo, and Ian F. Parney
The authors identified and isolated extracellular vesicles (EVs) from plasma in patients with traumatic brain injury (TBI). The study confirmed that the EVs contained glial fibrillary acidic protein (GFAP) and were therefore brain specific. miRNA signatures were then isolated from the EVs and identified statistically significant up- and downregulated miRNAs in TBI patients. This pilot study demonstrates that brain-specific EVs can be isolated from peripheral blood draws in trauma patients, and that these EVs may contain novel biomarkers that could prove useful in the diagnosis and prognosis of TBI.
Michael C. Jin, Bina Kakusa, Seul Ku, Silvia D. Vaca, Linda W. Xu, Juliet Nalwanga, Joel Kiryabwire, Hussein Ssenyonjo, John Mukasa, Michael Muhumuza, Anthony T. Fuller, Michael M. Haglund, and Gerald A. Grant
This study explored short- and long-term traumatic brain injury (TBI) outcomes in Uganda in a prospective cohort of 1274 patients admitted to the neurosurgical ward at Mulago National Referral Hospital; factors associated with inpatient mortality, postdischarge mortality, and postdischarge TBI-associated neurological sequelae were assessed. There is a paucity of studies examining long-term outcomes of TBI patients in lower- and middle-income countries; thus, the authors hope this study contributes to understanding optimal post-TBI care in low-resourced health systems.
Daniel García-Pérez, Irene Panero-Pérez, Carla Eiriz Fernández, Luis Miguel Moreno-Gomez, Olga Esteban-Sinovas, Blanca Navarro-Main, Pedro A. Gómez López, Ana M. Castaño-León, and Alfonso Lagares
The aim of this study was to determine whether CT densitometric analysis in patients with isolated acute subdural hematoma (ASDH) was a reliable outcome predictor. The authors demonstrated that the magnitude of side-to-side differences between the lesioned and nonlesioned hemispheres was a key prognostic factor. This study is important because there is a lack of specific and reliable prognostic models for patients with ASDH. This method shows potential to be used in routine practice.
Ayguel Wurzer, Georgi Minchev, Claudia Cervera-Martinez, Alexander Micko, Gernot Kronreif, and Stefan Wolfsberger
The authors invented a novel patient reference tracker for electromagnetic navigation. This study proves that because of its endonasal position, the tracker is noninvasive but highly stable throughout surgical procedures. Hence, it may, in the future, revolutionize noninvasive patient positioning, continuous instrument navigation, and repositioning during a procedure.
Anujan Poologaindran, Stephen R. Lowe, and Michael E. Sughrue
The authors explore the finer clinical and scientific points salient to neurosurgery gleaned from the study of the Human Connectome Project. This study provides a starting point to begin incorporating connectomics into supratentorial neurosurgery.
Christopher Miller, Paige Lundy, and Sarah Woodrow
The authors surveyed program directors from Accreditation Council of Graduate Medical Education–approved residency programs about international electives. The survey was designed to better understand the current landscape of international electives as well as the perceived benefits of and barriers to international training. During a time of increased awareness of the neurosurgical needs of low- and middle-income countries, this paper provides valuable new information and discussion to improve global neurosurgery at the resident level.
Scott L. Zuckerman, Natalie Limoges, Aaron M. Yengo-Kahn, Christopher S. Graffeo, Lola B. Chambless, Rohan Chitale, J Mocco, and Susan Durham
As traditional metrics are shown to be poor predictors of residency performance, more rigorous interviews are needed. Through surveys to neurosurgery residency applicants, the authors found that applicants rated several of the most frequently asked questions to be less useful, indicating a potential disconnect between what applicants and faculty find important. Knowledge assessments and manual dexterity tests were rated as stressful topics with low utility.
Christine Park, Rasheedat T. Zakare-Fagbamila, Wes Dickson, Alessandra N. Garcia, and Oren N. Gottfried
The authors looked into the factors that affect the overall hospital rating (OHR) measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Many items in the HCAHPS are not under the control of the neurosurgeons but nevertheless affect the OHR. Neurosurgeons should consider improving other measures of performance, such as teamwork, in order to achieve greater patient satisfaction.
Robert J. Dambrino IV, Scott L. Zuckerman, Bradley S. Guidry, Henry J. Domenico, Reid C. Thompson, Mitchell B. Galloway, James W. Pichert, and William O. Cooper
The authors evaluated unsolicited physician complaints (UPCs) associated with neurosurgeons, other surgeons, and nonsurgeon physicians. Important findings were that neurosurgeons are at higher risk for UPCs than other surgeons and nonsurgeon physicians, and among neurosurgeons, spine surgeons and younger surgeons are at increased risk to receive more complaints. These findings may help the entire neurosurgical field to identify, aggregate, and address complaints in ways designed to improve the overall quality of care delivered.
By analyzing a series of patients with tumors located in the nondominant perirolandic area who underwent operations with brain-mapping techniques, the authors identified clinical and imaging variables associated with asleep versus awake motor mapping in order to generate a score. The clinical validity of this score was validated in a prospective series.
The objective of this study was to investigate the real-time kinetics of protoporphyrin IX in low-grade glioma (LGG) based on hyperspectral fluorescence-based measurements and identify factors that predict fluorescence. Maximum fluorescence was measured within a 7- to 8-hour time frame. Gadolinium enhancement, Ki-67/MIB-1 index, 18F-fluoroethyl-l-tyrosine (18F-FET) PET uptake ratio, and apparent diffusion coefficient–based tumor cellularity differed significantly between fluorescing and nonfluorescing tissue. Logistic regression demonstrated 18F-FET PET uptake and Ki-67/MIB-1 index as independently related to fluorescence. These findings have implications for the timing and case selection of 5-aminolevulinic acid administration in LGG.
The authors assessed the association among promising neurosurgeon-scientists of being awarded Neurosurgery Research and Education Foundation (NREF) in-training and early career funding with subsequently receiving National Institutes of Health (NIH) funding. The study results indicate that a significant portion of awardees of NREF grants went on to obtain NIH funding, which resulted in a large multiplicative impact of NREF in-training and early career funding.
The authors report a large series of patients with arteriovenous malformations that were treated with preoperative stereotactic radiosurgery as a surgical adjunct. They discuss the utility of multimodal therapy and presurgical stereotactic radiosurgery. Despite the majority of lesions being Spetzler-Martin grade III-V arteriovenous malformations, high rates of arteriovenous malformation obliteration and optimal outcomes were obtained in their series.
The authors sought to investigate use of the retrosigmoid transhorizontal (RSTH) approach to dissect the horizontal fissure and to gain better access for resection of lateral pontine cavernous malformation. This approach had a shorter operative time than the transpetrosal presigmoid retrolabyrinthine technique. Also, the RSTH approach provided a direct and safer route to the lesion via the infratrigeminal safe entry zone. The RSTH route should be considered an alternative technique for selected patients with pontine cavernous malformation.
The authors report the largest subarachnoid hemorrhage (SAH) patient cohort treated with intrathecal (IT) nicardipine (n = 422) for cerebral vasospasm. IT nicardipine led to a rapid and lasting improvement in arterial transcranial Doppler velocities. In a propensity score-based comparison with the SAH International Trialists database, treatment with IT nicardipine was associated with reduced delayed cerebral ischemia and improved functional outcomes. These encouraging data will assist in planning a randomized controlled clinical trial treating SAH-related vasospasm.
This retrospective cohort study included 28 patients who underwent stereotactic laser amygdalohippocampotomy (SLAH) for mesial temporal lobe epilepsy (MTLE) at a single institution. Seizure freedom at 1 year after surgery was associated with greater extent of ablation of the parahippocampal gyrus, including the parahippocampal cortex and angular bundle. The parahippocampal gyrus is an epileptogenic structure that warrants attention in the surgical treatment of MTLE, especially for newer minimally invasive techniques like SLAH.
This cadaveric study enhances the understanding of the failure modes of thrombectomy in stroke and provides new knowledge for the development of next-generation devices and techniques. The artery/device/clot interactions were analyzed in more than 100 recanalization attempts with aspiration catheters and stent retrievers by transmural visualization, revealing intraluminal clot fragmentation and iatrogenic embolization, weak device/clot integration with persistent occlusion, residual occlusion in small branching and perforating arteries, arterial collapse, and arterial traction with avulsion.
Supramarginal resection (SMR)—resection beyond T1-weighted post-contrast enhancement but within the boundaries of FLAIR-hyperintense signal—may have a beneficial influence on the overall survival (OS) of patients diagnosed with IDH-wild-type glioblastoma who undergo gross-total resection of the contrast-enhanced tumor. The results show that increased SMR was associated with significantly beneficial OS, regardless of age or any other factor. A minimum SMR of 20% was associated with beneficial OS, with no significant influence seen with SMR greater than 60%.
The objective of this retrospective cohort study was to determine the associations of driver mutation status and targeted therapy with survival of patients with non-small cell lung cancer after resection of brain metastasis. Patients with EGFR mutation who received targeted tyrosine kinase inhibitor therapy had significantly improved survival compared with patients with wild-type tumor. This study highlights the heterogeneity of lung cancer and the need for precision therapy to determine prognosis and treatment.
The authors provided an overview of FDA efforts to facilitate the initiation of early feasibility clinical studies using novel neurological and physical medicine devices. The FDA uses several approaches to work with innovators and developers to initiate these early feasibility clinical studies in the US. The approaches outlined in this article will help ensure that high-quality, safe, and effective neurological devices reach US patients in a timely manner.
The authors examined the reliability of language assessments commonly used for brain mapping by administering five language tasks 1 day prior to surgery and again during the surgery after cessation of anesthesia. Accuracy on several tasks, including picture naming, declined nonspecifically in the operating room, while text reading remained stable. Thus, patients who experience significant declines in one modality may benefit from testing in another to facilitate accurate mapping.
Over the past decade, neurosurgery residency continued to attract an increasing number of applicants. In this study, the authors analyzed the factors contributing to a successful residency match from the applicants’ and program directors’ perspectives. In recent years, while ranking programs, applicants have placed greater importance on well-being values as opposed to strictly academic factors. Letters of recommendation were listed as the top criteria by program directors for both interview invitation and ranking selection.
The researchers present a series of 142 cases of intracranial dural arteriovenous fistula (DAVF) treated with transvenous embolization (TVE). TVE provided an effective occlusion rate (90%). Procedure-related mortality (1.5%) was associated with extension of thrombosis (EoT). Other minor permanent complications included cochleovestibular syndrome and oculomotor nerve damage. Anticoagulation therapy after TVE significantly reduced the occurrence of EoT. TVE remains a valid option for DAVF located on a sinus that does not participate in normal venous drainage.
The authors compared surgical epilepsy populations at their institution before and after the implementation of stereoelectroencephalography (SEEG) and responsive neurostimulation. They found that the post-SEEG patients were increasingly complex but had similar rates of seizure freedom when operated on. This indicates that as the technological capability of the field grows, the patient population will evolve with it. This is important for surgeons to recognize as they counsel patients and compare outcomes using data from varying epochs.
Published outcomes for patients with resected brain metastases treated with radiosurgery are largely based on a carefully preselected population of patients who complete timely radiation. In this study the researchers evaluated outcomes of all patients referred for postoperative radiosurgery and found that intervals to radiation > 4 weeks resulted in increased recurrence and that delays in radiosurgery were often caused by logistics and management of systemic disease or of comorbidities. These findings elucidate real-world outcomes of adjuvant radiosurgery and identify potential strategies for improving disease control with timely radiosurgical treatment.
Hypothalamic cavernous malformations (HCMs) are rare; therefore, published literature regarding the surgical indications, risks, and outcomes is limited. This study reports the largest surgical series of HCMs and provides a corresponding literature review. The authors found that gross-total resection of HCMs can be safely achieved with improved functional status and reduced recurrent hemorrhage rates. They conclude that microsurgery remains a viable option for symptomatic HCMs in experienced hands.
The authors describe their experience with the Kempe incision in traumatic brain injury and stroke patients for craniotomy and decompressive craniectomy. Decompression size and clinical results are compared with a group undergoing the more traditional reverse question mark incision. The authors report comparable outcomes, with a trend toward larger decompression with the Kempe incision. This incision can also be easily converted to bilateral or bifrontal. The Kempe incision appears to be a valuable and versatile alternative in emergency neurological surgery.