Authors:Haruto Uchino, Shusuke Yamamoto, Daina Kashiwazaki, Naoki Akioka, Naoya Kuwayama, Kyo Noguchi, and Satoshi Kuroda
This study used MRA to evaluate the quantitative changes in the calibers of donor arteries associated with combined direct and indirect bypass procedures in adults and children with moyamoya disease. The study is important because caliber changes in the donor arteries can be easily measured by MRA and could be used as indicators of direct and indirect bypass development.
Authors:Ephraim W. Church, Rabia Qaiser, Teresa E. Bell-Stephens, Mark G. Bigder, Eric K. Chow, Summer S. Han, Yasser Y. El-Sayed, and Gary K. Steinberg
In this clinical study, the authors review their large series of patients with moyamoya disease who underwent cerebral revascularization and later became pregnant, and they examine risk of neurological events and obstetric complications in pre-bypass and post-bypass pregnancies in this rarely studied group of patients. Their data indicate that post-bypass pregnancy is accompanied by a low rate of complication.
This study is the first in the literature to demonstrate the significance of hemodynamic analysis of the recipient parasylvian cortical arteries in predicting the occurrence of postoperative cerebral hyperperfusion during superficial temporal artery–middle cerebral artery bypass surgeries for adult patients with moyamoya disease.
To investigate whether the timing of exposure to hyperoxemia after aneurysmal subarachnoid hemorrhage (aSAH) onset may alter the effects of oxygen therapy, the authors compared partial pressures of arterial oxygen in 4 aSAH patient groups, patients with favorable versus poor outcomes and patients with versus without delayed cerebral ischemia (DCI). Hyperoxemia during the first 24 hours after arrival at the hospital was associated with poor neurosurgical outcome and DCI, a finding that contributes useful information for determining the necessity and appropriateness of oxygen therapy in aSAH patients.
Authors:Kathryn Wagner, Aditya Srivatsan, Alina Mohanty, Visish M. Srinivasan, Yasir Saleem, Jacob Cherian, Robert F. James, Stephen Chen, Jan-Karl Burkhardt, Jeremiah Johnson, and Peter Kan
The authors present the first analysis of the cognitive outcomes of patients following flow diversion therapy for unruptured intracranial aneurysms. Their results better inform the risk-benefit analysis of treating unruptured intracranial aneurysms.
Authors:Kubilay Aydin, Christian Paul Stracke, Mehmet Barburoglu, Elif Yamac, Mynzhylky Berdikhojayev, Serra Sencer, and René Chapot
Endovascular treatment of wide-necked intracranial bifurcation aneurysms remains a challenge for endovascular surgeons. T-stent–assisted coiling is a relatively new endovascular treatment for these lesions. It differs from other double-stenting techniques in that there are no overlapping or intersecting stent segments. The authors investigated the long-term angiographic and clinical outcomes of patients with wide-necked complex intracranial bifurcation aneurysms treated with T-stent–assisted coiling. This work is important because, until now, the long-term results of T-stenting have not been reported.
Authors:Julius Dengler, Daniel Rüfenacht, Bernhard Meyer, Veit Rohde, Matthias Endres, Pavlina Lenga, Konstantin Uttinger, Viktoria Rücker, Maria Wostrack, Adisa Kursumovic, Bujung Hong, Dorothee Mielke, Nils Ole Schmidt, Jan-Karl Burkhardt, Philippe Bijlenga, Edoardo Boccardi, Christophe Cognard, Peter U. Heuschmann, Peter Vajkoczy, and On behalf of the Giant Intracranial Aneurysm Study Group
This is an international, interdisciplinary prospective and retrospective observational study on giant intracranial aneurysms (GIAs) aiming to describe the natural history as well as case fatalities after endovascular or surgical management. The finding that conservative GIA management led to substantially worse outcomes compared with endovascular or surgical management may have significant impact on how clinicians, of whom a relevant proportion currently prefers a wait-and-see strategy, may view nonconservative options.
Authors:Sandrine Morel, Agnieszka Karol, Vanessa Graf, Graziano Pelli, Henning Richter, Esther Sutter, Vincent Braunersreuther, Juhana Frösen, Philippe Bijlenga, Brenda R. Kwak, and Katja M. Nuss
The work addresses temporal changes in aneurysms depending on sex. The understanding of these progressive changes would impact risk assessment and provide insights into different clinical strategies for men and women.
Authors:Murat Ulutas, Kadir Çinar, Ihsan Dogan, Mehmet Secer, Semra Isik, and Kaya Aksoy
The authors report the clinical and surgical results of a series of 54 consecutive patients (involving 60 total intracranial aneurysms) who underwent surgery for the first time using a microsurgical lateral transorbital approach (LTOA). The authors present their surgical experience and the technical nuances and key points of each surgical procedure. They also discuss its feasibility and practicality relevant to neurovascular surgical principles. This study is important as the first use of an LTOA for anterior circulation cerebral aneurysm surgery in a case-based series. LTOA includes the advantages of both the pterional-transsylvian and keyhole approaches (i.e., minimally invasive procedures).
Authors:Kosuke Kumagai, Arata Tomiyama, Satoru Takeuchi, Naoki Otani, Masanori Fujita, Kazuya Fujii, Kojiro Wada, and Kentaro Mori
This study elucidates the pathophysiological mechanisms of not only early brain injury (EBI) but also delayed brain injury (DBI) after subarachnoid hemorrhage (SAH). The SAH + unilateral common carotid artery occlusion model that simulates EBI with early cerebral hypoperfusion demonstrated aggravation of reactive astrogliosis, cerebral vasospasm, and DBI without high mortality.
Authors:R. Loch Macdonald, Daniel Hänggi, Poul Strange, Hans Jakob Steiger, J Mocco, Michael Miller, Stephan A. Mayer, Brian L. Hoh, Herbert J. Faleck, Nima Etminan, Michael N. Diringer, Andrew P. Carlson, Francois Aldrich, and the NEWTON Investigators
The authors injected nimodipine into the heads of patients with ruptured brain aneurysms and determined what the concentrations of the drug were in their heads and in their blood. The results show that the higher concentrations of drug in the head that can be achieved by this method, compared to giving the drug as pills, does not appear to make patients recover any better.
Authors:Miyuki Fukuda, Shunichi Fukuda, Joji Ando, Kimiko Yamamoto, Naohiro Yonemoto, Takashi Suzuki, Youko Niwa, Takayuki Inoue, Noriko Satoh-Asahara, Koji Hasegawa, Akira Shimatsu, and Tetsuya Tsukahara
Chronic inflammation is closely involved in cerebral aneurysm formation. Using an animal model of experimentally induced cerebral aneurysms, the authors found that P2X4 purinoceptor, which is associated with flow-sensitive mechanisms that regulate vascular remodeling, is involved in cerebral aneurysm formation and growth, initiating the inflammation. There are no effective therapeutic drugs for cerebral aneurysms. The P2X4 inhibitor paroxetine may be a potential clinical remedy for cerebral aneurysms, given that it may weaken aneurysm growth and that it has been used safely in humans as an antidepressant.
Authors:Mirja M. Wirtz, Philipp Hendrix, Oded Goren, Lisa A. Beckett, Heather R. Dicristina, Clemens M. Schirmer, Shamsher Dalal, Gregory Weiner, Paul M. Foreman, Ramin Zand, and Christoph J. Griessenauer
The authors assessed predictors of functional outcome 90 days after mechanical thrombectomy for large-vessel acute ischemic stroke. The study found that a National Institutes of Health Stroke Scale (NIHSS) score of 10 or less at 24 hours from thrombectomy was the best predictor, even after using different absolute NIHSS cutoffs or delta NIHSS score from before the procedure to 24 hours after the procedure.
Authors:Yasuhiro Aida, Tomoya Kamide, Hiroshi Ishii, Yasuko Kitao, Naoyuki Uchiyama, Mitsutoshi Nakada, and Osamu Hori
This study is the first to report the difference in plasma soluble receptor for advanced glycation end products (sRAGE) levels in a subset of patients with subarachnoid hemorrhage (SAH). The results show that the plasma sRAGE levels could be used as a potential biomarker for the prediction of symptomatic vasospasm after SAH.
Authors:Robert C. Rennert, Martin P. Powers, Jeffrey A. Steinberg, Takanori Fukushima, John D. Day, Alexander A. Khalessi, and Michael L. Levy
Posterolateral approaches to the skull base require a comprehensive understanding of the vertebral artery (VA). The authors histologically assessed the VA-dural junction using cadaveric specimens to determine whether separation of these structures is safe during posterolateral skull base approaches. In all specimens, dural connective tissue was contiguous with VA adventitia, with no clear histological plane identified. These findings support the authors’ practice of leaving a dural cuff on the VA when dissecting the VA-dural interface.
Authors:Daniel G. Eichberg, Ashish H. Shah, Long Di, Alexa M. Semonche, George Jimsheleishvili, Evan M. Luther, Christopher A. Sarkiss, Allan D. Levi, Sakir H. Gultekin, Ricardo J. Komotar, and Michael E. Ivan
Stimulated Raman histology is a new technology that delivers accurate intraoperative pathological diagnosis and saves an average of 30.5 minutes compared to traditional frozen sectioning; it can be successfully implemented in neurosurgical operating rooms to shorten operative times.
The authors used clinical factors and biomarkers reported to be associated with prognosis in clival chordoma to established a nomogram, which performed well for predicting progression-free survival and risk stratification. Degree of resection as well as E-cadherin, Ki-67, and VEGFA expression levels were independent prognostic factors of PFS. This nomogram could facilitate prognostic evaluation and patient follow-up.
Authors:Assaf Berger, Gali Tzarfati, Matias Costa, Marga Serafimova, Akiva Korn, Irina Vendrov, Tali Alfasi, Dana Krill, Daniel Aviram, Shlomit Ben Moshe, Alon Kashanian, Zvi Ram, and Rachel Grossman
This study is the first to assess the various aspects of stroke in a patient cohort that underwent resection of low-grade gliomas (LGGs). Intraoperative strokes were found to be more common in recurrent tumors and especially LGGs in insular locations. These strokes negatively affect patient activity and performance status mainly during the first 3 postoperative months, with gradual functional improvement over 1 year. Several intraoperative parameters could indicate the impending development of an infarct.
Authors:Erin S. Murphy, Shireen Parsai, Hideyuki Kano, Jason P. Sheehan, Roberto Martinez-Alvarez, Nuria Martinez-Moreno, Douglas Kondziolka, Gabriela Simonova, Roman Liscak, David Mathieu, Cheng-Chia Lee, Huai-Che Yang, John Y. Lee, Brendan J. McShane, Fang Fang, Daniel M. Trifiletti, Mayur Sharma, and Gene H. Barnett
In this study, the authors retrospectively evaluated the outcomes of patients treated with Gamma Knife radiosurgery for upfront unresectable, residual, or recurrent pilocytic astrocytoma. This study is important since there is no standard of care treatment for these patients.
Authors:Jonathan Shapey, Guotai Wang, Reuben Dorent, Alexis Dimitriadis, Wenqi Li, Ian Paddick, Neil Kitchen, Sotirios Bisdas, Shakeel R. Saeed, Sebastien Ourselin, Robert Bradford, and Tom Vercauteren
Because current techniques for accurate tumor delineation and measurement are labor intensive and dedicated clinical software is not readily available, the authors developed the first fully automated method using artificial intelligence to detect subtle growth in MR images of vestibular schwannoma (a type of brain tumor). This work could significantly improve clinical workflow and assist in the management of patients with VS.
The relationship between sellar and suprasellar tumors and disturbance of visual function was examined using preoperative MRI. The authors first focused on the sagittal bending of the optic nerve at the entrance from the intracranial to the optic canal. This study is important for preoperative neuroophthalmological assessment, MRI assessment, surgical indications, and surgical strategies in sellar and suprasellar lesions.
Authors:Vincenzo Levi, Giovanna Zorzi, Giuseppe Messina, Luigi Romito, Irene Tramacere, Ivano Dones, Nardo Nardocci, and Angelo Franzini
This is the first paper comparing the results of deep brain stimulation and pallidotomy for the treatment of status dystonicus in a single-center case series. The two treatments seem to be equally effective and not mutually exclusive. Other important factors should be considered in the treatment algorithms for status dystonicus, such as etiology and evolution of the underlying dystonia and clinical conditions at the moment of onset.
Authors:Johanna Philipson, Patric Blomstedt, Marwan Hariz, and Marjan Jahanshahi
The authors studied the cognitive status of patients with essential tremor before and after they underwent deep brain stimulation (DBS) targeting the caudal zona incerta (cZi) to treat motor symptoms. The study is important to increase understanding of the potential side effects of DBS, and to the authors’ knowledge the association of cZi-targeted DBS with cognitive changes has not been previously evaluated.
This study revealed the efficacy of unilateral pallidotomy for cervical dystonia using an objective evaluation (the Toronto Western Spasmodic Torticollis Rating Scale [TWSTRS] score). Unilateral pallidotomy provided a mean improvement of 47.9% in total TWSTRS score at the 6-month follow-up, suggesting that unilateral pallidotomy is an acceptable treatment option for asymmetrical cervical dystonia.
Authors:Thomas Datzmann, Thomas Kapapa, Angelika Scheuerle, Oscar McCook, Tamara Merz, Sarah Unmuth, Andrea Hoffmann, René Mathieu, Simon Mayer, Uwe Max Mauer, Stefan Röhrer, Deniz Yilmazer-Hanke, Peter Möller, Benedikt Lukas Nussbaum, Enrico Calzia, Michael Gröger, Clair Hartmann, Peter Radermacher, and Martin Wepler
This study describes a clinically relevant, long-term porcine model of acute subdural hematoma–induced brain injury with all human intensive care standards. Maintenance of cerebral perfusion pressure was associated with largely unaffected neurological outcomes despite macroscopic and histological damage. Different intensive care diagnostics (e.g., brain injury biomarkers), therapy strategies and approaches (e.g., blood pressure and/or oxygen levels), and effects of combined trauma (e.g., brain injury and hemorrhage) can be studied in detail using this model.
Authors:Dong Wang, Chuang Gao, Xin Xu, Tao Chen, Ye Tian, Huijie Wei, Shu Zhang, Wei Quan, Yi Wang, Shuyuan Yue, Zengguang Wang, Ping Lei, Craig Anderson, Jingfei Dong, Jianning Zhang, and Rongcai Jiang
The authors investigated the use of dexamethasone (DXM) to enhance the effectiveness of atorvastatin (ATO) as a conservative treatment for chronic subdural hematoma (CSDH), because ATO treatment alone is not effective in some patients and the ATO therapeutic window of 8 weeks or more may increase risks of drug-related complications and patient noncompliance. The results demonstrated that ATO combined with low-dose DXM is more effective than ATO alone in reducing hematoma and improving neurological function in patients with CSDH.
Authors:Ariana S. Barkley, Laura J. Spece, Lia M. Barros, Robert H. Bonow, Ali Ravanpay, Richard Ellenbogen, Phearum Huoy, Try Thy, Seang Sothea, Sopheak Pak, James LoGerfo, and Abhijit V. Lele
The Lancet Commission's report “Global Surgery 2030” incorporated essential surgical services into universal healthcare. The global prevalence of traumatic brain injury (TBI), especially in the low- and middle-income country (LMIC) setting, has reinforced the importance of neurosurgical capacity-development initiatives. The authors undertook the first mixed-methods evaluation for neurosurgical TBI capacity development in an LMIC setting and also demonstrate the first application of the Neurocritical Care checklist in an LMIC setting.
Authors:Jayme Augusto Bertelli, Sushil Nehete, Elisa Cristiana Winkelmann Duarte, Neehar Patel, and Marcos Flávio Ghizoni
The authors developed a new technique for wrist extension restoration in radial nerve paralysis. They describe their anatomical cadaveric findings and report the results of their nerve transfer technique in 5 patients followed for at least 24 months postoperatively. Although some anatomical studies pertaining to nerve transfer surgery for radial nerve reconstruction have been published, the course and disposition of the pronator teres motor branches and histomorphometric analysis have been lacking until now.
Authors:Ignazio G. Vetrano, Francesco Acerbi, Jacopo Falco, Grazia Devigili, Sara Rinaldo, Giuseppe Messina, Francesco Prada, Antonio D’Ammando, and Vittoria Nazzi
The authors think that the use of intraoperative fluorescein is a feasible, safe, and helpful intraoperative adjunct to better identify and distinguish peripheral nerve sheath tumors from intact functional nerves. Intravenous fluorescein administration provided excellent visualization—in particular for huge and diffuse neurofibromas—allowing surgeons to increase the extent of resection without neurological deficits.
Authors:Anne E. Carolus, Jens Möller, Martin R. Hofmann, Johannes A. P. van de Nes, Hubert Welp, Kirsten Schmieder, and Christopher Brenke
Optical coherence tomography (OCT) is the first in vivo imaging technique that is able to resolve a nerve’s structures down to the level of myelinated axons. In this paper the technical aspects of OCT were investigated, in which the authors compare the image results to some histological sections of peripheral nerves, and evaluate which structures can be visualized by OCT, a pioneering development. By providing this additional information about the nerve’s microstructures, OCT can be used as a new device in surgical contexts as well as in processing nerve specimens after surgery.
Authors:Nasser Mohammed, Yi-Chieh Hung, Thomas J. Eluvathingal Muttikkal, Roy C. Bliley, Zhiyuan Xu, and Jason P. Sheehan
The motor root of the trigeminal nerve runs close to the sensory root and receives considerable radiation during Gamma Knife radiosurgery (GKRS) for trigeminal neuralgia (TN). The study objective was to evaluate the changes in the muscles of mastication before and after upfront GKRS in patients with idiopathic TN by using MRI. A subset of patients with TN with significant pain on chewing have pre-GKRS disuse atrophy of the muscles of mastication. A reversal of the atrophy occurs in a majority of the patients following GKRS. New-onset motor neuropathy post-GKRS was rare. The study reveals some interesting changes that occur in the muscles of mastication in trigeminal neuralgia.
Authors:John W. Rutland, Satish Govindaraj, Corey M. Gill, Michael Shohet, Alfred M. C. Iloreta Jr., Joshua B. Bederson, Raj K. Shrivastava, and Bradley N. Delman
In the present study the authors performed semiautomated segmentation of pooled CSF leak volumes by using high-resolution MRI sequences acquired approximately 45 minutes apart during the scan session. Subtraction between early and late segmentation volumes yielded accumulated CSF leak volumes, which were compared between high- and low-flow leak rates and correlated with postoperative outcomes such as leak recurrence.
Authors:Adham M. Khalafallah, Adrian E. Jimenez, Rafael J. Tamargo, Timothy Witham, Judy Huang, Henry Brem, and Debraj Mukherjee
The authors found that neurosurgeons with Master of Science (MS) degrees are more likely to pursue academic careers relative to their non-MS counterparts; thus, this study establishes a novel factor associated with academic career choice in neurosurgery. The findings may be used to help predict trainees’ future potential in academic neurosurgery and to help improve mentoring for neurosurgical trainees and students.
Authors:D. Ryan Ormond, Mohab Abozeid, Shekar Kurpad, and Stephen J. Haines
In this study the authors investigated the academic productivity of past Van Wagenen Fellows as an assessment of the value of the fellowship and its fellows in promoting academic neurosurgery. The results are evidence of the continuing value of the fellowship to organized neurosurgery.
Authors:Jarod L. Roland, Syed Hassan A. Akbari, Afshin Salehi, and Matthew D. Smyth
The authors reviewed their early clinical experience performing corpus callosotomy with laser interstitial thermal therapy and found it to be a well-tolerated procedure with outcomes comparable to those attained with open approaches.
The objective of this study was to evaluate the feasibility of an endoscopic transorbital approach to the insular region. The authors' cadaveric study demonstrated that the insula was safely accessed and removed without violation of major blood vessels via an endoscopic transorbital approach. In a clinical case, the endoscopic transorbital approach was successfully performed for a high-grade glioma (grade III) in the right insula. This study suggests that the transorbital route may serve as a potential alternative to the classic transcranial approach to access tumors located in the insula.
This historical vignette provides an overview of the establishment and subsequent development of the Department of Neurosurgery at Yonsei University College of Medicine. It describes the pioneering foresight, indomitable enthusiasm, and awe-inspiring efforts of its illustrious predecessors that led to the establishment of this state-of-the-art department.
The authors have developed and validated an ex vivo human brain test bed to gain further understanding of the mechanics of embolization and of embolus removal with stent retrievers and suction catheters. The test bed allowed high-definition and radiation-free visualization of 184 thrombectomy passes for 105 cases of large vessel occlusion in real cerebrovascular anatomy and flow conditions. This test bed enables high-fidelity analysis of artery-embolus-device interaction and can facilitate the development of future thrombectomy devices and stroke research.
Complications of nontraumatic, primary intracerebral hemorrhage (ICH) can serve as useful prognostic factors of early mortality and morbidity. In this study, the authors aimed to explore the incidence and cost of care associated with the major complications of ICH. In this analysis, hydrocephalus resulted in the greatest mortality rate and cost of care. Healthcare costs associated with complications of ICH are considerable. Further research needs to be conducted to identify the critical time of intervention to minimize the development of, and the consequent cost to treat, ICH complications.
The goal of this study was to evaluate the efficacy of levetiracetam (LEV) combined with perampanel (PER) therapy for intraoperative seizure treatment during awake surgery. The authors showed that LEV combined with PER therapy is significantly associated with a lower risk of intraoperative seizures, compared with LEV therapy alone, in patients with glioma during awake brain mapping. These findings will help neurosurgeons conduct safe and reliable awake surgeries and reduce the rate of intraoperative intractable seizures during such procedures.
This study describes and evaluates two distinct methods for stereotactic laser corpus callosotomy (SLCC) in the treatment of epilepsy. The authors retrospectively reviewed 15 cases, analyzing outcomes and elucidating insights from each case. They also provide a review of the current literature regarding this procedure and the outcomes. The authors believe this to be the largest series of SLCC procedures to date.
Investigators assessed the role of stereotactic radiosurgery (SRS) for schwannomas of the oculomotor nerves. SRS was found to provide tumor control and symptom improvement in the majority of cases with minimal risks. This multicenter study is the largest case series in the literature.
The objective of this paper was to explore quantitatively the utility and adherence to guideline-based therapy in patients with severe traumatic brain injury accessing care at a tertiary referral center in a resource-restricted setting in Tanzania. The authors found that critical care monitoring and interventions were significantly underutilized; less than half of the patients were urgently intubated or received any locally available neurology-specific intracranial pressure–lowering therapy.
The object of this study was to evaluate the utility of proton density–weighted MRI and tractography of the intersecting dentato-rubro-thalamic tract for direct "intersectional" targeting of the ventral intermediate nucleus for treating patients with essential tremor (ET). This method was feasible for deep brain stimulation lead placement in patients with ET. These advanced targeting techniques can supplement awake intraoperative testing or be used independently in asleep cases to improve surgical efficiency and confidence.
This article assesses the long-term predictive capability of the SAFIRE grading scale using the Barrow Ruptured Aneurysm Trial (BRAT) patient population by comparing patient outcomes at the 1- and 6-year follow-ups. The SAFIRE grading scale is a simple bedside assessment that predicts the prognostic outcome of aSAH patients at 2 months. Furthermore, this study finds that the grading scale may also be used as a predictor of long-term outcomes in these patients.
The objective of this study was to evaluate the efficacy of different surgical approaches to treated meralgia paresthetica. Among injection, decompression, and neurectomy approaches, neurectomy provided the highest rate of pain relief and lowest rate of reoperation. Conversely, injection provided the lowest rate of pain relief and highest rate of reoperation. These findings will help inform management selection and expectations to treat meralgia paresthesia.
The authors prospectively confirmed the efficacy of unilateral pallidothalamic tractotomy (PTT) for akinetic-rigid Parkinson's disease (AR-PD) in 10 patients. The total Movement Disorder Society–Unified Parkinson's Disease Rating Scale Part III score significantly improved from 45 ± 4.6 at baseline to 32.9 ± 4.8 at 12 months postoperatively. However, no significant change was found in the levodopa equivalent daily dose. Unilateral PTT improved contralateral side rigidity and bradykinesia, dyskinesia, and dystonia in patients with AR-PD.
The authors detailed the composition of the sagittal stratum (SS), an important region of the human brain white matter. Layer-by-layer fiber dissection from the superolateral aspect to the ventricular cavity was performed in 20 cadaveric human hemispheres to systematize the general organization of the SS and provide important updates to data on the composition of the SS outer layer in relation to earlier definitions. The presented data may influence how neurosurgeons plan operative approaches to the brain and how neuroscientists model neurophysiological networks.
The objective of this study was to demonstrate that entering the ventricle during glioblastoma resection did not increase complications such as tumor spread or dissemination. Therefore, there should be no indication to avoid entering the ventricle to obtain an extensive resection. The key finding is that extent of resection is critical for glioblastoma outcome, and if this means removing tumor and entering the ventricle, that is well tolerated without complications. This important observation should change the way in which surgeons deal with tumors that abut the ventricle and require extensive resection to enhance outcome.
The authors analyzed prognostic factors associated with unfavorable seizure outcome following epilepsy surgery in temporal lobe epilepsy (TLE). In particular, the evidence of hippocampal gliosis (HG) as a predictor for unfavorable seizure outcome is an underrepresented aspect, which supports the suggestion that HG is a distinct entity in patients with TLE.
The purpose of this study was to observe whether cell-free DNA (cfDNA), the main framework of neutrophil extracellular traps, is involved in fibrinolysis resistance. It was found that cfDNA damaged the tPA fibrinolysis of intraventricular hemorrhage (IVH), while the degradation of cfDNA promoted the fibrinolysis of IVH. This study provides a new target for fibrinolytic therapy for IVH that might have practical implications.
The authors report the largest case series of basal ganglia cavernous malformations in the literature, analyzing the clinical course of these surgically managed lesions. They also performed a systematic review of the literature, revealing a total of 90 additional surgically treated cases. Nearly a quarter of patients will experience a temporary neurological decline in the immediate perioperative period with a permanent morbidity rate of around 10%. They also identified clinical factors associated with the risk of developing perioperative deficits.
The authors explored the architecture of the fronto-caudate tract (FCT) through the fiber microdissection technique. The FCT was consistently identified in the medial layer of the corona radiata, connecting the head and anterior part of the body of the caudate nucleus with Brodmann areas 8, 9, 10, and 11. These novel findings lend support to the tract's putative functional significance in motor and behavioral processes and inform surgical practice in the fields of functional and oncological neurosurgery.
The purpose of this prospective study was to determine whether cerebral hyperperfusion following carotid endarterectomy (CEA) leads to the development of cerebral microbleeds (CMBs) and if postoperative cognitive decline is related to these developed CMBs. Cerebral hyperperfusion was associated with an increase in CMBs, and increased CMBs were associated with cognitive decline after surgery. CMBs as toxic substances may leak through the blood-brain barrier that is disrupted by cerebral hyperperfusion and injure neural tissue, resulting in cognitive decline.
Authors of the present study investigated the association between ABO blood type and postoperative chronic subdural hematoma (CSDH) recurrence. Blood type A was found to be a significant independent predictor of the recurrence of CSDH. Therefore, patients with blood type A should be carefully followed up. Moreover, a new treatment strategy may be needed for them.
Easy to perform, flat-panel CT (FPCT) equipped in a modern angiography machine is widely used. The authors evaluated the role of FPCT to predict patients' outcomes after endovascular recanalization treatment. FPCT was predictive of patients' functional outcome and cerebral edema, which was comparable to MR images. This study shows the significance of FPCT in predicting patient outcome. FPCT could be useful in determining a management plan after endovascular treatment.
The authors investigated a new method to noninvasively visualize eloquent fibers and their localization on the brainstem level. By combining neurophysiological data derived from navigated transcranial magnetic stimulation with diffusion tensor imaging (DTI), the authors were able to determine tract alteration and conductivity. This innovative protocol allows for an objective evaluation of tract location and functionality and is thus less operator dependent and prone to interobserver variability than conventional DTI.
The authors examined the treatment outcomes of vagus nerve stimulator–associated surgical site infection (VNS-SSI). The incidence of VNS-SSI was 1.5%. The majority (14/16) of the patients with VNS-SSI eventually required removal of the hardware. Mild swallowing difficulties and hoarseness occurred in 2 patients after compete lead removal, but not in any patients after partial lead removal. The study confirmed that the incidence of VNS-SSI is low. Snipping the electrode close to the vagus nerve, as opposed to complete removal, is a prudent alternative to decrease the risk of dysphagia.