Authors:Sepideh Amin-Hanjani, Nicholas C. Bambakidis, Fred G. Barker II, Bob S Carter, Kevin M. Cockroft, Rose Du, Justin F. Fraser, Mark G. Hamilton, Judy Huang, John A. Jane Jr., Randy L. Jensen, Michael G. Kaplitt, Anthony M. Kaufmann, Julie G. Pilitsis, Howard A. Riina, Michael Schulder, Michael A. Vogelbaum, Lynda J. S. Yang and Gabriel Zada
Authors:Roman Rodionov, Aidan O’Keeffe, Mark Nowell, Michele Rizzi, Vejay N. Vakharia, Victoria Wykes, Sofia H. Eriksson, Anna Miserocchi, Andrew W. McEvoy, Sebastien Ourselin and John S. Duncan
The authors developed and applied a quality assurance process for stereoelectroencephalography electrode implantation. This is important to monitor, assess, and compare the accuracy of various implantation techniques, including beyond the field of epilepsy surgery.
Authors:Michael Kogan, David J. Caldwell, Shahin Hakimian, Kurt E. Weaver, Andrew L. Ko and Jeffery G. Ojemann
The authors investigated a novel approach to seizure detection, which may be used as guidance for therapeutic resection in the future. Such detection methods may lead to better epileptogenic focus detection and eventual seizure freedom rates, as well as improve our basic understanding of the physiological role of various frequency bands recorded from human subjects.
Authors:Michal M. Andelman-Gur, Tomer Gazit, Fani Andelman, Svetlana Kipervasser, Uri Kramer, Miri Y. Neufeld, Itzhak Fried and Firas Fahoum
Studying the precise anatomical regions in which electrical brain stimulation evoked experiential phenomena, the authors found that complex visual hallucinations could be elicited over widespread cortical regions spanning all lobes of the right hemisphere but only rarely over the left occipital lobe. These results offer some insights into lateralized differences in functional connectivity that may be used for presurgical functional mapping of the designated surgical area in patients with epilepsy.
Authors:Whitney E. Parker, Elizabeth K. Weidman, J. Levi Chazen, Sumit N. Niogi, Rafael Uribe-Cardenas, Michael G. Kaplitt and Caitlin E. Hoffman
This study establishes and tests the feasibility of a novel, noninvasive surgical approach to treat mesial temporal lobe epilepsy (MTLE). This theoretical modeling study provides the necessary groundwork for future clinical trials applying this novel neurosurgical technique to patients with refractory MTLE and surgical contraindications, multiple prior surgeries, or other factors favoring noninvasive treatment.
Authors:Anthony T. Lee, John F. Burke, Pranathi Chunduru, Annette M. Molinaro, Robert Knowlton and Edward F. Chang
Given the poor enrollment of recent randomized controlled trials (RCTs) in epilepsy surgery, the authors argue for the need to adopt study designs incorporating historical cohorts. As a benchmark for future non-RCTs, they determined the historical seizure-freedom outcome for anterior temporal lobectomy (ATL) from level I data (RCTs). Seizure-freedom rates from RCTs for adults who underwent ATL were approximately 70%—nearly identical to overall rates found in level II prospective cohort studies. Rates have remained consistent over time. Future investigations of temporal lobe epilepsy surgery should consider a historical seizure-freedom rate of 70% for ATL in designing non-RCTs.
Authors:Georg Widhalm, Jonathan Olson, Jonathan Weller, Jaime Bravo, Seunggu J. Han, Joanna Phillips, Shawn L. Hervey-Jumper, Susan M. Chang, David W. Roberts and Mitchel S. Berger
The authors analyzed the use of a spectroscopic probe for improved tumor visualization in patients whose lesions were suspected to be low-grade gliomas based on preoperative MRI. The probe is important to improve the surgical outcome of patients with brain tumors.
Authors:Ankush Chandra, Jacob S. Young, Cecilia Dalle Ore, Fara Dayani, Darryl Lau, Harsh Wadhwa, Jonathan W. Rick, Alan T. Nguyen, Michael W. McDermott, Mitchel S. Berger and Manish K. Aghi
In this study, the authors determined the economic burden of disease of glioblastoma (GBM) categorized by insurance type and found that Medicaid patients had the highest cost of GBM resection. This study is important because it identifies factors that are predictors of higher costs of resection, which if modified can reduce the economic burden of GBM on patients and caregivers.
Authors:Ilkka Haapala, Markus Karjalainen, Anton Kontunen, Antti Vehkaoja, Kristiina Nordfors, Hannu Haapasalo, Joonas Haapasalo, Niku Oksala and Antti Roine
There is a need for intraoperative tissue identification technology in neurosurgery. The authors developed a method based on differential mobility spectrometry (DMS) analysis of diathermy smoke and tested it to discriminate brain tumors and control samples ex vivo. To their knowledge, this is the first demonstration of DMS analysis in brain tumor identification. Such a system could potentially become an affordable, user-friendly, and near–real-time instrument for intraoperative brain tumor tissue identification.
Authors:Giovanni Raffa, Thomas Picht, Antonino Scibilia, Judith Rösler, Johannes Rein, Alfredo Conti, Giuseppe Ricciardo, Salvatore Massimiliano Cardali, Peter Vajkoczy and Antonino Germanò
The occurrence of postoperative motor deficits after surgery for meningiomas located in the rolandic region is usually underestimated by neurosurgeons but it accounts for up to 24.7%. This is the first published study to evaluate the role of navigated transcranial magnetic stimulation for preoperative planning, surgical strategy definition, and prediction of arachnoidal cleavage and motor outcome in patients operated on for meningiomas located in the rolandic region.
Authors:Bin Tang, ShenHao Xie, GuanLin Huang, ZhiGang Wang, Le Yang, XuanYong Yang, Shan Xu, ErMing Zeng and Tao Hong
This study was focused on the clinical features and operative technique of transinfundibular craniopharyngioma. Identification of this type of tumor preoperatively is essential for planning the appropriate surgical approach and degree of excision.
Authors:Min Ho Lee, Kyung Hwan Kim, Kyung Rae Cho, Jung Won Choi, Doo-Sik Kong, Ho Jun Seol, Do-Hyun Nam and Jung-Il Lee
Recently, fractionated radiosurgery or hypofractionated stereotactic radiotherapy has been attempted for large brain metastases and has demonstrated acceptable efficacy. The authors have found that tumors can change during fractionated radiosurgery, which will be an important parameter in increasing the effectiveness of the treatment.
The authors developed a new procedure for safe endonasal extradural posterior clinoidectomy and performed it in 44 patients with parasellar and retrosellar tumors. This is the first large clinical series of endonasal extradural posterior clinoidectomy in which the clinical outcomes of this approach were evaluated.
Authors:Assaf Berger, Uri Hochberg, Alexander Zegerman, Rotem Tellem and Ido Strauss
Cancer patients suffering from intractable pain were treated by ablative neurosurgical procedures (e.g., cordotomy, cingulotomy) aimed to disconnect pain pathways in the spinal cord or the brain. Clinical results and algorithm to patients’ selection are presented. These procedures are underused and still have an important place in the treatment of severe cancer-related pain. This is one of the largest modern series describing this treatment approach, and will guide adoption of these procedures in other medical centers.
Authors:Umeshkumar Athiraman, Diane Aum, Ananth K. Vellimana, Joshua W. Osbun, Rajat Dhar, Rene Tempelhoff and Gregory J. Zipfel
The authors looked into the effects of anesthetics on secondary brain injury after aneurysmal subarachnoid hemorrhage (SAH). The results suggest that inhalational anesthetics (especially desflurane) represent a novel therapeutic approach toward minimizing secondary brain injury following SAH.
Authors:Benjamin K. Hendricks, James S. Yoon, Kurt Yaeger, Christopher P. Kellner, J Mocco, Reade A. De Leacy, Andrew F. Ducruet, Michael T. Lawton and Justin R. Mascitelli
The authors performed a systematic review of recent literature for the definition of wide-necked aneurysms (WNAs). The most prevalent definition of a WNA was a neck diameter of ≥ 4 mm or a dome-to-neck ratio of < 2. Whether this definition is the most appropriate definition is a topic of discussion and future research. The use of a standard definition would be beneficial when comparing various WNA studies.
The authors identified frequency and risk factors for complications of embolization for dural arteriovenous fistulas in a large retrospective multicenter registry. These risk factors should be kept in mind when planning treatment of these lesions.
Authors:Mariangela Piano, Luca Valvassori, Emilio Lozupone, Guglielmo Pero, Luca Quilici, Edoardo Boccardi and the FRED Italian Registry Group
This paper reports on the Italian multicenter experience using the flow re-direction endoluminal device (FRED) in the treatment of cerebral aneurysms, evaluating both short- and long-term safety and efficacy of this device. This experience represents one of the largest case series available with long-term follow-up.
Authors:Tae-Jin Song, Seung-Hun Oh and Jinkwon Kim
The authors conducted a study of data from a large nationwide Korean database to investigate whether statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes. Focusing on the proportion of days covered by statin therapy after treatment, they found that consistent statin therapy was significantly associated with better prognosis after aneurysm treatment. These results support further evaluation in clinical trials.
Authors:Marcelo Magaldi Ribeiro de Oliveira, Taise Mosso Ramos, Carlos Eduardo Ferrarez, Carla Jorge Machado, Pollyana Helena Vieira Costa, Daniel L. Alvarenga, Carolina K. Soares, Luiza M. Mainart, Pedro Aguilar-Salinas, Sebastião Gusmão, Eric Sauvageau, Ricardo A. Hanel and Giuseppe Lanzino
This paper reviews Percival Bailey’s contributions to our understanding of hypothalamic physiology and craniopharyngioma pathology. It was written with the intention of crediting Bailey for his pioneering definition of craniopharyngiomas as tumors with a true intra-hypothalamic position.
Authors:Benjamin A. Plog, Nanhong Lou, Clifford A. Pierre, Alex Cove, H. Mark Kenney, Emi Hitomi, Hongyi Kang, Jeffrey J. Iliff, Douglas M. Zeppenfeld, Maiken Nedergaard and G. Edward Vates
The authors evaluated the impact of craniectomy on glymphatic function in a murine model. This work is important as it shows that a craniectomy alone is sufficient to impair glymphatic flow through decreased penetrating arterial pulsatility, and this is associated with increased neuroinflammation, as well as cognitive and motor deficits.
Authors:Andreas Knoll, Andrej Pal’a, Maria-Teresa Pedro, Ute Bäzner, Max Schneider, Ralph W. König, Christian Rainer Wirtz, Sarah Friedrich, Markus Pauly and Gregor Antoniadis
The authors performed postoperative neurosonography in patients undergoing decompression of intraneural ganglion cysts of the common peripheral nerve (CPN) and found that favorable clinical outcome was highly correlated with an intraneural hypoechogenic ring-shaped structure on the medial side of the CPN identified during a follow-up postoperative ultrasound scan. This study is important because the results indicate the potential benefit of ultrasound scanning as a prognostic tool following decompression procedures for intraneural ganglion cysts of the CPN.
Authors:Alexander Micko, Arthur Hosmann, Aygül Wurzer, Svenja Maschke, Wolfgang Marik, Engelbert Knosp and Stefan Wolfsberger
The authors developed an advanced image guidance protocol dedicated to sinunasal surgery that extracts information from multiple modalities into one single image and includes fine sinunasal structures and arteries. In improving intraoperative orientation, this was found to reduce the rate of complications in a series of patients with pituitary adenomas undergoing resection via a transnasal transsphenoidal endoscopic approach.
Authors:Christian Scheller, Stefan Rampp, Marcos Tatagiba, Alireza Gharabaghi, Kristofer F. Ramina, Oliver Ganslandt, Barbara Bischoff, Cordula Matthies, Thomas Westermaier, Maria Teresa Pedro, Veit Rohde, Kajetan von Eckardstein and Christian Strauss
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.
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.
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.
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.
The authors conducted a multicenter retrospective review studying how stereotactic radiosurgery (SRS), when used as the primary surgical intervention in patients with typical trigeminal neuralgia, affects pain outcomes and medication usage based on the time course between diagnosis and radiosurgery. They found that patients managed with SRS within 4 years of diagnosis experienced a shorter interval to pain relief with low risk and that SRS yielded significant decreases in adjunct medication utilization..
The authors investigated the fine architecture of the fibrous network and fatty matrix in the jugular foramen. The resulting presentation of these anatomical details may aid neurosurgeons in planning surgical approaches to the region and increase understanding of how tumors in this area grow.
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.
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.
The authors provide a detailed endoscopic description of the normal anatomy of the posterior third ventricle and its physiological variations, as observed during neuroendoscopic procedures. They also compare the normal anatomy with the alterations due to chronic hydrocephalus. This study is important because the authors provide for the first time a thorough fully endoscopic description of the anatomy of the normal and hydrocephalic third ventricle. This is of the utmost importance for neurosurgeons who want to begin ventricular endoscopy.
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.
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.
The authors sought to determine clinical and imaging characteristics that may be useful in preoperative assessment of neurosurgical patients who may benefit from awake craniotomies. Important findings were that preoperative physical status was the most decisive factor in predicting whether patients can tolerate an awake craniotomy without complications, whereas older age and history of psychiatric treatment were not necessarily associated with adverse events. This study is important because it demonstrates that careful preoperative patient selection is the key to success for awake surgery.
The authors evaluated the largest sample of patients with familial chordoma with and without T gene duplications and compared them to white patients with sporadic chordoma in the United States general population reported to the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Several features including young age at diagnosis, skull base presentation, or multiple primary chordomas were related to a positive family history and would suggest the opportunity for screening at-risk family members by MRI for early detection of chordoma.
This study represents the second largest series of non-missile penetrating head injuries published to date. A detailed statistical analysis of the data was conducted and revealed risk factors for vascular and infectious complications. The results were used to recommend management strategies for these injuries, which have not been previously defined.
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.
Stereotactic radiosurgery for central neurocytoma has been considered as an alternative to surgery or radiotherapy almost always in instances of residual or recurrent tumors following prior treatment or in patients with an inoperable condition. In this study, Gamma Knife radiosurgery proved to be safe and effective in newly diagnosed cases without previous surgical treatment. With adequate selection criteria, Gamma Knife radiosurgery deserves to be a primary treatment modality for central neurocytoma.
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.
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.