Journal of Neurosurgery
Volume 134: Issue 5 (May 2021): Pages 1355-1684

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Open access
Ellen L. Air, Katie O. Orrico, Deborah L. Benzil, Alan M. Scarrow, James R. Bean, Catherine A. Mazzola, Linda M. Liau, James T. Rutka, and Karin M. Muraszko
Free access
Andrew L. A. Garton, Connor J. Kinslow, Ali I. Rae, Amol Mehta, Susan C. Pannullo, Rajiv S. Magge, Rohan Ramakrishna, Guy M. McKhann, Michael B. Sisti, Jeffrey N. Bruce, Peter Canoll, Simon K. Cheng, Adam M. Sonabend, and Tony J. C. Wang

In Brief

The authors' study uses one of the largest sets of patients with oligodendroglioma, extracted from the National Cancer Database, to perform a side-by-side analysis of the correlates and survival benefit of extent of resection in patients with these tumors. This result is important as it corroborates national guidelines and reassures the field of neurooncology that, despite the reclassification of oligodendrogliomas, our treatment techniques remain valid.

Free access
Ayesha Sunil Mirchandani, Ahmad Beyh, José Pedro Lavrador, Henrietta Howells, Flavio Dell’Acqua, and Francesco Vergani

In Brief

The authors applied spherical deconvolution tractography to investigate the presence of microstructural changes of the corticospinal tract (CST) in IDH1 glioma patients compared to healthy volunteers. They then correlated the microstructural changes observed in the CST to the presence of an altered excitability of the motor cortex, as measured by transcranial magnetic stimulation (TMS). This is the first time that a neurophysiological measurement has been used to investigate the meaning of white matter changes in the CST. The combination of advanced tractography and TMS can detect preclinical changes affecting the motor system in patients with low-grade gliomas.

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Samiya Abi Jaoude, Matthieu Peyre, Vincent Degos, Stéphane Goutagny, Béatrice Parfait, and Michel Kalamarides

In Brief

The authors assessed risk factors for rapid growth in neurofibromatosis type 2 (NF2)–associated intracranial meningiomas and validated the recently published Asan Intracranial Meningioma Scoring System score. They found that the scoring system provides a good estimate of the overall risk of rapid tumor growth in these meningiomas. One of the challenges of managing multiple meningiomas in NF2 patients is to choose which tumor to treat, allowing best benefit/risk balance. Thus, estimating which meningiomas are most likely to grow rapidly is of great interest.

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Jacob S. Young, Andrew K. Chan, Jennifer A. Viner, Sujatha Sankaran, Alvin Y. Chan, Sarah Imershein, Aldea Meary-Miller, Philip V. Theodosopoulos, Line Jacques, Manish K. Aghi, Edward F. Chang, Shawn L. Hervey-Jumper, Tracy Ward, Liz Gibson, Mariann M. Ward, Peter Sanftner, Stacy Wong, Dominic Amara, Stephen T. Magill, Joseph A. Osorio, Brinda Venkatesh, Ralph Gonzales, Catherine Lau, Christy Boscardin, Michael Wang, Kim Berry, Laurie McCullagh, Mary Reid, Kayla Reels, Sara Nedkov, Mitchel S. Berger, and Michael W. McDermott

In Brief

The authors developed a "Safe Transitions Pathway" (STP) for postoperative recovery after elective craniotomies so that selected neurosurgical patients were able to bypass the ICU. STP patients had shorter lengths of stay and no serious adverse events or complications. Patients and nursing staff did not report adverse recovery experiences, and direct costs were lower for the hospital. This report will be useful for other institutions interested in creating a recovery pathway that maximizes patient safety and resources to deliver efficient and effective care.

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Moran Amit, Diana Bell, Patrick J. Hunt, Ehab Hanna, Shirley Y. Su, Michael Kupferman, Mohamed Aashiq, Hideaki Takahashi, Paul W. Gidley, Marc-Elie Nader, Franco DeMonte, and Shaan M. Raza

In Brief

Although numerous publications have reported surgical techniques, relatively few have reported disease-related outcomes in the management of cancers of the anterolateral skull base and infratemporal fossa (ITF). To help shed light on the surgical and management challenges unique to carcinomas involving the ITF, the authors performed a retrospective review of their institutional experience. They demonstrated that resection for anterolateral skull base carcinomas in selected patients whose tumors are considered resectable can help to achieve long-term outcomes similar to those reported for carcinomas at other anatomical sites.

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Dilys M. Parry, Mary L. McMaster, Norbert J. Liebsch, Nicholas J. Patronas, Martha M. Quezado, Deborah Zametkin, Xiaohong R. Yang, and Alisa M. Goldstein

In Brief

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.

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Ina Bährend, Max R. Muench, Heike Schneider, Rabih Moshourab, Felix R. Dreyer, Peter Vajkoczy, Thomas Picht, and Katharina Faust

In Brief

The authors compared a noninvasive method of language localization in the human brain to the current gold standard, which involves electrical stimulation of the cortex during awake surgery. The development of reliable noninvasive methods of language localization can reduce risks during awake surgery and can increase our understanding of how language functions.

Open access
Daniel Lewis, Carmine A. Donofrio, Claire O’Leary, Ka-loh Li, Xiaoping Zhu, Ricky Williams, Ibrahim Djoukhadar, Erjon Agushi, Cathal J. Hannan, Emma Stapleton, Simon K. Lloyd, Simon R. Freeman, Andrea Wadeson, Scott A. Rutherford, Charlotte Hammerbeck-Ward, D. Gareth Evans, Alan Jackson, Omar N. Pathmanaban, Federico Roncaroli, Andrew T. King, and David J. Coope

In Brief

Through a combined tumor tissue analysis and MRI study of tumor vascularity, the researchers sought to compare differences in the tumoral microenvironment between sporadic and NF2-related vestibular schwannomas (VSs). They demonstrate that despite the considerable variation in clinical behavior between these tumors, in terms of their underlying inflammatory and microvascular characteristics, they are strikingly similar. These findings suggest that in both sporadic and NF2-related VSs, inflammation may be a relevant therapeutic target.

Free access
Gregory Neil Bowden, Jong Oh Kim, Andrew Faramand, Kevin Fallon, John Flickinger, and L. Dade Lunsford

In Brief

As use of radiosurgery for extensive brain metastases expands rapidly, it is critical to understand the dosing characteristics. The authors calculated the dose to the whole brain and hippocampal structures after Gamma Knife stereotactic radiosurgery (GKSRS) for extensive brain metastases. Patients treated for ≥ 15 brain metastases had a mean brain dose of 2.58 Gy; only 0.9% of the brain received a 12-Gy dose. There was no correlation between the number of metastases and the mean dose to the brain. GKSRS provides a relatively low dose of radiation to the brain, supporting continued escalation of treating multiple metastases with SRS.

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Nida Fatima, Victoria Y. Ding, Summer S. Han, Steven D. Chang, and Antonio Meola

In Brief

This article highlights the predictors of visual outcomes in patients with cavernous sinus meningioma and further signifies the importance of pretreatment visual functional assessment in these patients.

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Diana A. Julie, Stefanie P. Lazow, Daniel B. Vanderbilt, Shoshana Taube, Menachem Z. Yondorf, Albert Sabbas, Susan Pannullo, Theodore H. Schwartz, and A. Gabriella Wernicke

In Brief

For patients with resected brain metastases, the authors compared clinical outcomes (local disease control, distant brain disease control, and survival) for treatment with radioactive cesium-131 brachytherapy seeds and postoperative radiosurgery. The authors showed improved local control of disease with brachytherapy. This potentially provides an alternative or possibly superior treatment choice for these patients.

Free access
Lai-fung Li, Chung-ping Yu, Anderson Chun-on Tsang, Benedict Beng-teck Taw, and Wai-man Lui
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Chiman Jeon, Kyung Rae Cho, Jung Won Choi, Doo-Sik Kong, Ho Jun Seol, Do-Hyun Nam, and Jung-Il Lee

In Brief

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.

Free access
James Feghali, Yangyiran Xie, Yuxi Chen, Sean Li, and Judy Huang

In Brief

In this study, the authors evaluated the performance of previously published prediction scores for improvement after surgery in adult Chiari malformation type I. They found that these scores had a poor predictive ability and suffered from several limitations. Their critical analysis allowed them to identify gaps and suggestions for the development of future prediction algorithms that may serve to improve the decision-making process (surgery vs observation) in adult Chiari malformation type I.

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Doo-Sik Kong, Yong Hwy Kim, and Chang-Ki Hong

In Brief

The authors evaluated surgical outcomes of using the endoscopic transorbital approach (eTOA) with a superior eyelid incision as a minimally invasive technique for treatment of spheno-orbital meningiomas (SOMs). These tumors have high levels of infiltrative growth and complexity involving multiple structures at initial presentation and cannot be completely removed with conventional transcranial surgery, which can also result in serious cosmetic issues such as bony depression. An important finding was that eTOA for SOM had clinical outcomes comparable to those for transcranial surgery but without major postsurgical cosmetic defects.

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Kenichi Oyama, Kentaro Watanabe, Shunya Hanakita, Pierre-Olivier Champagne, Thibault Passeri, Eduard H. Voormolen, Anne Laure Bernat, Nicolas Penet, Takanori Fukushima, and Sébastien Froelich

In Brief

The authors describe the surgical technique obtained by enlarging the anteromedial triangle. It is significant because it can provide a useful corridor to the nasal cavity and sinuses.

Free access
Taiichi Saito, Yoshihiro Muragaki, Manabu Tamura, Takashi Maruyama, Masayuki Nitta, Shunsuke Tsuzuki, Atsushi Fukui, and Takakazu Kawamata

In Brief

Identification of the motor area during awake craniotomy is essential for preservation of motor function when resecting glioma within or close to the motor area or pyramidal tract. The authors believe that their study makes a significant contribution to the literature because its results show that identification of the motor area can be difficult when a supratentorial glioma is localized to the precentral gyrus.

Free access
Nikolaos Mouchtouris, Fadi Al Saiegh, Breanna Valcarcel, Carrie E. Andrews, Evan Fitchett, David Nauheim, David Moskal, Nabeel Herial, Pascal Jabbour, Stavropoula I. Tjoumakaris, Ashwini D. Sharan, Robert H. Rosenwasser, and M. Reid Gooch

In Brief

The authors sought to understand the common reasons for readmission in patients who have undergone mechanical thrombectomy and identify the predictors that led to readmission. Infection was the most common cause of 30-day readmission, followed by cardiac and cerebrovascular diagnoses and hypertension, and hospital length of stay and postprocedural hemorrhage were strong predictors of 30-day readmission in stroke patients who underwent mechanical thrombectomy. This study is a preliminary effort to better understand the nuances of stroke care and reduce preventable causes of readmission.

Free access
Moinay Kim, Wonhyoung Park, Yeongu Chung, Si Un Lee, Jung Cheol Park, Do Hoon Kwon, Jae Sung Ahn, and Seungjoo Lee

In Brief

The objective of this study was to reveal relevant factors that may impact postoperative outcome and to establish a scoring system to predict the functional outcome of moyamoya disease. This is the first study to address a preoperative scoring system for moyamoya disease, using various parameters to predict postoperative outcome in relatively large internal and external cohorts, and to have confirmed its clinical value.

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Hanjin Cui, Ali Yang, Huajun Zhou, Yang Wang, Jiekun Luo, Jun Zhou, Tao Liu, Pengfei Li, Jing Zhou, En Hu, Zehui He, Wang Hu, and Tao Tang

In Brief

A microRNA (miRNA) array was used to identify candidate miRNAs, and then Western blotting, quantitative real-time polymerase chain reaction, and miRNA antagomir intervention were used to verify the results of the miRNA array. The authors found that thrombin reduces hypoxia inducible factor–1α degradation and initiates angiogenesis by increasing miR-24, which targets prolyl hydroxylase domain 1 after intracerebral hemorrhage (ICH). The findings revealed a new mechanism for how thrombin, a unique post-ICH angiogenic promotor, initiates the process of angiogenesis after ICH, which will help to improve the understanding of cerebral recovery after hemorrhagic injury and develop novel therapeutic strategies.

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Michael Veldeman, Walid Albanna, Miriam Weiss, Catharina Conzen, Tobias Philip Schmidt, Henna Schulze-Steinen, Martin Wiesmann, Hans Clusmann, and Gerrit Alexander Schubert

In Brief

This study illustrates the usefulness of invasive neuromonitoring (INM) in patients who cannot be examined due to their poor-grade subarachnoid hemorrhage (SAH). In patients who underwent INM, delayed cerebral ischemia events were detected earlier and therefore treated faster than events in a group of patients treated before the introduction of INM, resulting in a better outcome. To the authors' knowledge, this is the largest SAH cohort in which INM has been examined. The authors believe the results of this trial can upgrade existing evidence and recommendations concerning the use of brain tissue oxygen monitoring and cerebral microdialysis in SAH patients.

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Tomohide Hayashi, Seiji Yamamoto, Takeru Hamashima, Hisashi Mori, Masakiyo Sasahara, and Satoshi Kuroda

In Brief

In this study the authors first clarified the underlying mechanism of spontaneous angiogenesis after indirect bypass surgery for moyamoya disease. The findings strongly suggest that platelet-derived growth factor receptor–α signal may play an important role in developing spontaneous angiogenesis between the temporal muscle and neocortex after encephalomyosynangiosis in moyamoya disease.

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Kenji Shimada, Tadashi Yamaguchi, Takeshi Miyamoto, Shu Sogabe, Masaaki Korai, Toshiyuki Okazaki, Yasuhisa Kanematsu, Junichiro Satomi, Shinji Nagahiro, and Yasushi Takagi

In Brief

The authors found that intraarterial indocyanine green (ICG) videoangiography was more useful than intravenous ICG videoangiography in surgery for cerebral arteriovenous malformations. It was especially effective in the identification of the feeders, nidi, and drainers and in the assessment of the flow dynamics of the nidus. Use of Flow 800 made it simpler and easier to evaluate these findings.

Open access
E. François Aldrich, Randall Higashida, Abdel Hmissi, Elizabeth J. Le, R. Loch Macdonald, Angelina Marr, Stephan A. Mayer, Sébastien Roux, and Nicolas Bruder

In Brief

In this post hoc analysis, the authors identified patients at high risk for vasospasm-related morbidity and mortality, as well as poor long-term clinical outcome, based on the burden of subarachnoid hemorrhage shown on CT scans, using the data from the CONSCIOUS-2 and CONSCIOUS-3 studies. Future clinical trials may consider directing attention to the group of high-risk patients with thick, diffuse clots, given their high tendency for vasospasm-related morbidity and mortality.

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Christopher J. Stapleton, Ahmed E. Hussein, Mandana Behbahani, Ali Alaraj, Sepideh Amin-Hanjani, and Fady T. Charbel

In Brief

In this study, the authors compared long-term patency rates between autologous and cadaveric saphenous vein grafts (SVGs) in cerebral revascularization surgery. In the largest series to date, they demonstrated that patency rates of cadaveric SVGs are similar to those with autologous grafts and that cadaveric SVGs are a reasonable graft option for cerebral bypass procedures.

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Jie Cao, Hang Lin, Min Lin, Kaifu Ke, Yunfeng Zhang, Yong Zhang, Weihong Zheng, Xingyu Chen, Wei Wang, Meng Zhang, Jinggang Xuan, Ya Peng, and for the REDIRECT Trial Investigators

In Brief

The authors compared the RECO flow restoration device with the Solitaire flow restoration stent retriever in acute ischemic stroke caused by large vessel occlusion. The primary efficacy endpoint (modified thrombolysis in cerebral infarction reperfusion grade ≥ 2 within three passes) was similar in the two groups. No serious adverse device effects occurred. Rates of symptomatic intracerebral hemorrhage and serious adverse effects were similar in the groups. There was no significant difference in the rates of functional independence or 90-day all-cause mortality or in procedure duration between the groups. The RECO stent retriever is effective and safe as a mechanical thrombectomy device.

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Troels H. Nielsen, Kumar Abhinav, Eric S. Sussman, Summer S. Han, Yingjie Weng, Teresa Bell-Stephens, CNRN, Jeremy J. Heit, and Gary K. Steinberg

In Brief

The authors individualized moyamoya disease treatment (direct vs indirect bypass) based on preoperative and intraoperative patient factors to determine the ideal modality. They found that a direct bypass provides superior increase in blood flow to the brain with a comparable low risk of complications. These findings will guide other neurosurgeons in their choice of treatment.

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Nicholas von Guionneau, Karim A. Sarhane, Gerald Brandacher, Shehan Hettiaratchy, Allan J. Belzberg, and Sami Tuffaha

In Brief

The supercharged end-to-side (SETS) nerve transfer is a surgical technique with great potential to improve functional outcomes after peripheral nerve injuries. However, its widespread use by peripheral nerve surgeons is hindered by a complicated and poorly understood biology. This review gives a structured approach for surgeons and scientists to evaluate the current applications and limitations of the SETS transfer. It also highlights opportunities for further investigation into the underlying mechanisms.

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Fu-Lin He, Shuai Qiu, Jian-Long Zou, Fan-Bin Gu, Zhi Yao, Zhe-Hui Tu, Yuan-Yuan Wang, Xiao-Lin Liu, Li-Hua Zhou, and Qing-Tang Zhu

In Brief

The authors found that the application of chondroitin sulfate proteoglycan (CSPG) coverage to the nerve stump helps to block irregular axon regeneration in terminal neuroma, and it is beneficial to relieve neuroma-related pain symptoms after sciatic nerve transection in Sprague Dawley rats. The results indicate that covering the proximal nerve stump with CSPGs may be a new and promising strategy to prevent traumatic painful neuroma formation in a clinical setting.

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Zachary A. Abecassis, Amit B. Ayer, Jessica W. Templer, Ketan Yerneni, Nikhil K. Murthy, and Matthew C. Tate

In Brief

This study assessed the clinical risk of intraoperative seizures and afterdischarges in the setting of awake mapping. This work is important as it provides clinical insight to a known complication within awake mapping.

Free access
Kenji Fukutome, Yoshihiro Kuga, Hideyuki Ohnishi, Hidehiro Hirabayashi, and Hiroyuki Nakase

In Brief

The authors examined which factors have an impact on the clinical outcome of MRI-guided focused ultrasound (MRgFUS) thalamotomy for essential tremor. MRgFUS is a novel and useful treatment for essential tremor; however, the factors affecting treatment outcome are unknown. This report is useful for the future study of target patients and the prediction of clinical outcome.

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Nikolas R. Monteferrante, Brian G. Wilhelmi, Margaret Lambert, and Francisco A. Ponce

In Brief

In this study, the authors evaluated changes in weight following deep brain stimulation surgery. Changes in weight can be alarming or distressing to patients. Understanding the associations with such changes following deep brain stimulation surgery can help clinicians inform patients and mitigate such changes.

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Hirokazu Takami, Nikki Khoshnood, and Mark Bernstein

In Brief

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.

Free access
Nathan Todnem, Khoi D. Nguyen, Vamsi Reddy, Dayton Grogan, Taylor Waitt, and Cargill H. Alleyne Jr.

In Brief

The authors created an inexpensive brain model that was easy to produce and therefore easy to replicate for the purpose of ventricular catheter placement training. This model may be useful for neurosurgery resident training, especially in institutions with limited resources.

Free access
Jon Pérez-Bárcena, Catalina Crespí, Guillem Frontera, Juan Antonio Llompart-Pou, Osman Salazar, Victor Goliney, Javier Ibáñez, M. Ross Bullock, and Juan Pablo de Rivero Vaccari

In Brief

The authors' group has previously shown that the innate immune response after traumatic brain injury is regulated in part by the inflammasome. In this study they expand clinical knowledge about the inflammasome in a group of patients with severe traumatic brain injury. The authors believe that the study of the temporal profile of fluid biomarkers could be useful to plan therapeutic interventions in the future.

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Omer Doron, Ofer Barnea, Nino Stocchetti, Tal Or, Erez Nossek, and Guy Rosenthal

In Brief

In this study the authors studied intracranial elastance in a cardiac-gated manner in a swine model of brain edema. Measuring elastance in this way may improve the ability to predict which brain-injured patients may be at risk for sudden untoward deterioration due to brain swelling.

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Bradley M. Harrington, Armin Gretschel, Carl Lombard, Russell R. Lonser, and Adriaan J. Vlok

In Brief

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.

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Jennifer T. Cone, Elizabeth R. Benjamin, Daniel B. Alfson, and Demetrios Demetriades

In Brief

Obesity is frequently a significant problem in trauma patients but may also have a protective effect, the "obesity paradox," likely attributable to obesity-related attenuation of the inflammatory response and influences on posttraumatic physiology. The authors investigated the influence of obesity on the outcomes of patients with severe blunt traumatic brain injury (TBI), in whom outcome is often influenced by physiological variables. The findings that obesity is not protective for mortality after severe blunt TBI and that complication rates are increased in both obese and underweight patients will be useful in guiding future investigations.

Free access
Andrew L. A. Garton, Connor J. Kinslow, and Tony J. C. Wang
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Long Wang, Lujun Jing, Huaiyu Sun, and Xiang’en Shi
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Sergio García-García, Diego Culebras, and Ramón Torné
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Nícollas Nunes Rabelo, Mateus Gonçalves de Sena Barbosa, Matheus Pereira Silva Lemos, Sérgio Brasil, and Gustavo Frigieri
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In Brief

The authors assessed the utility of endovascular thrombectomy in patients with acute stroke with large vessel occlusion and low Alberta Stroke Program Early CT Scores at presentation. The results show thrombectomy to be cost-effective in the long term (lifetime horizon), considering the poor outcomes and significant disability associated with nonreperfusion. Better patient selection would increase the cost-effectiveness of thrombectomy even further.

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In Brief

Enhanced Recovery After Surgery (ERAS) has led to a paradigm shift in perioperative care. However, the evidence for ERAS in cranial surgery remains limited. The authors systematically reviewed the published evidence on cranial ERAS and provide a synthesis of evidence-based, multimodal, pre-, intra-, and postoperative interventions that may improve recovery after cranial surgery.

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In Brief

Researchers presented the largest series to date evaluating prognostic factors and visual outcomes of adult patients with craniopharyngioma after extended endoscopic endonasal surgery with visual evoked potential (VEP) monitoring. Tight adhesion and larger tumor volume were adverse factors for postoperative visual outcomes. Intraoperative VEP proved to be reliable for predicting postoperative visual function changes and can serve as a real-time warning to guide surgeons to avoid postoperative visual deterioration.

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In Brief

Researchers conducted a retrospective analysis of 316 patients with ruptured brain arteriovenous malformations (bAVMs) to compare the safety and efficacy of acute targeted embolization of angiographic weak points in ruptured bAVMs versus delayed treatment. Targeting these weak points resulted in a significantly lower rerupture rate with similar mortality and complication rates. These findings suggest a protective effect of upfront targeted embolization that should be followed with serial angiography and possible delayed definitive treatments.

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In Brief

The authors sought to characterize invasion rates, clinical outcomes, and disease recurrence and progression patterns in patients with silent corticotroph adenoma (SCA). Although overall rates of progression and recurrence do not statistically differ in patients with SCAs compared to those with nonfunctional adenomas (NFAs), SCA patients have significantly lower progression-free survival. SCAs exhibit a more aggressive clinical course than NFAs and should have a low threshold for adjuvant radiosurgery.

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In Brief

The authors aimed to assess the efficacy of preoperative chlorhexidine gluconate (CHG) showering on surgical site infection (SSI) following cranial surgery. In an analysis of 3126 cranial surgeries, implementation of a preoperative CHG showering protocol was not associated with decreased SSI. These findings do not support the use of preoperative CHG showering prior to cranial surgery and suggest that alternative preventative measures for SSI should be investigated.

Open access

In Brief

Researchers evaluated the implantation accuracy of oblique stereo-electroencephalography (SEEG) trajectories and the detection of epilepsy-related SEEG activity in insular epilepsy. The authors found that the oblique approach is safe and efficient, covering the complete functional organization of the insula with few electrodes. There was no decrease in accuracy due to the longer trajectory of insular SEEG, and there was no difference between frame-based and robot-assisted implantations.

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In Brief

A subset of patients with pituitary apoplexy (PA) may benefit from conservative management in lieu of surgery. In this study, the authors report the clinical, radiological, and ophthalmological outcomes of patients with PA who underwent intended conservative management versus early transsphenoidal surgery. The results suggest that excellent clinical and ophthalmological outcomes are possible for patients with PA and that the majority of patients with PA can be managed in a conservative manner.

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In Brief

The authors studied the outcomes among patients who had undergone three or more Gamma Knife radiosurgery (GKRS) procedures for trigeminal neuralgia (TN). Adverse outcomes and times to pain recurrence were comparable following the third treatment and the first two treatments, and adverse effects from all treatments predominantly involved trigeminal sensory dysfunction. This study supports the utility of a third GKRS treatment for selected patients with TN, provides benchmarks for patient counseling, and defines areas for future study.

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In Brief

Researchers demonstrated in the laboratory that a simple, inexpensive face mask attached to suction could effectively reduce aerosol formation during endoscopic endonasal approaches, which could reduce the surgeon's and staff exposure to COVID-19 and other respiratory viruses.

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In Brief

Hemifacial spasm is a debilitating neuromuscular disorder with limited treatment options. Here the authors have described and examined the clinical efficacy of awake CT-guided radiofrequency ablation of the facial nerve to treat hemifacial spasm. Their data indicated that this approach is a precise and minimally invasive procedure that can provide effective and sustained relief for patients with hemifacial spasm, with minimal side effects.

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In Brief

To develop an isolated neuropathic pain model in domestic swine, the authors created a common peroneal nerve injury that caused mechanical allodynia and leg-guarding behavior and induced demyelination of the nerve. Because of the genetic and anatomical similarities between humans and swine, this model, to the authors′ knowledge the first of its kind, will help move experimental neuropathic pain treatments developed in rodents toward clinical implementation in humans with chronic pain.

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In Brief

Despite proven efficacy in the management of selected brain aneurysms, flow-diverter stents (FDSs) are not generally used in patients with acutely ruptured aneurysms, since full aneurysm angiographic exclusion is delayed and dual-antiplatelet therapy is required. In this study, the authors found that FDSs can be safely used to manage acutely ruptured small uncoilable aneurysms in conjunction with early ventriculostomy and a strong proven antiplatelet effect. This strategy prevented aneurysm rebleeding and avoided serious procedural thromboembolic complications, with high long-term occlusion rates.

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In Brief

After demonstrating that noninvasive low intensity focused ultrasound directed at the L5 dorsal root ganglion (DRG) reduces allodynia for days in rodents, the authors advanced this treatment toward clinical use in humans by adapting the probe to treat a DRG 5 cm below the skin's surface in domestic swine. Allodynia was reduced for 5 days and pain guarding for up to 1 month after a one-time noninvasive treatment.

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In Brief

In the current study, the authors sought to define optimal blood pressure targets based on the prevalence of brain tissue hypoxia and metabolic distress in patients after hematoma evacuation. These parameters were derived from invasive multimodal neuromonitoring data in the perihematomal area. The results are hypothesis generating and challenge the current guideline recommendations.

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In Brief

The lateral posterior choroidal artery should be a major consideration in the microsurgical management of lateral ventricular tumors. In this study, the authors aimed to delineate the anatomy of the lateral posterior choroidal artery by using surgical microdissections. They investigated the trajectory, segments, variations, and relationship of these arteries to adjacent neurovascular structures as well as the overall implications in surgical approaches. An enhanced understanding of lateral posterior choroidal artery microanatomical features is of great value when choosing the optimal surgical approach for lateral ventricular lesions.