Rajeev D. Sen, Isaac Josh Abecassis, Jason Barber, Michael R. Levitt, Louis J. Kim, Richard G. Ellenbogen, and Laligam N. Sekhar
The authors compare the outcomes of patients who underwent concurrent emergent decompression and brain arteriovenous malformation (bAVM) resection with those of patients who underwent delayed bAVM resection. They report no significant difference in hospital or intensive care unit lengths of stay (LOSs), rates of complete obliteration, medical complications, and long-term outcomes. Concurrent decompression and resection of a ruptured bAVM can be performed on low-grade lesions without compromising LOS or long-term functional outcome; however, the surgeon may encounter a more challenging surgical environment.
Hyeong Jin Lee, Jai Ho Choi, Kwan Sung Lee, Bum Soo Kim, and Yong Sam Shin
The authors analyzed risk factors for the rupture of vertebral artery dissecting aneurysms and showed that fusiform shape, irregular surface, posterior inferior cerebellar artery involvement, and the stagnation sign were significantly associated with the rupture. When these potential risk factors are observed, more aggressive treatment rather than follow-up or medical therapy may be considered.
The objective of this study was to investigate the hemodynamic factors related to aneurysm initiation using angiographic images taken before and after aneurysm formation in patients with cerebral aneurysms. The results suggest that aneurysm formation may be initiated in a region where large tensile forces are acting on the vessel wall and total pressure loss is also large. These findings may be utilized to assess the potential risk of aneurysm initiation in brain screening in the future.
Alon Orlev, James Feghali, Gil Kimchi, Moran Salomon, Shani Berkowitz, Liat Oxman, Idan Levitan, Nachshon Knoller, Eitan Auriel, Judy Huang, Rafael J. Tamargo, and Sagi Harnof
This study identified key risk factors for recurrent neurological events in patients with symptomatic cerebral cavernous malformations (CCMs). Four risk factors were found on multivariable analysis: bleeding at presentation, large size > 12 mm, eloquent location, and duration ≤ 1 year since last event. All factors were assigned 1 point, except duration from last event which was assigned 2 points. The acronym, BLED2, summarizes this scoring system and predicts prospective neurological events in symptomatic CCM patients.
Justin R. Mascitelli, J Mocco, Trevor Hardigan, Benjamin K. Hendricks, James S. Yoon, Kurt A. Yaeger, Christopher P. Kellner, Reade A. De Leacy, Johanna T. Fifi, Joshua B. Bederson, Felipe C. Albuquerque, Andrew F. Ducruet, Lee A. Birnbaum, Jean Louis R. Caron, Pavel Rodriguez, and Michael T. Lawton
The authors' objective was to compare clinical and angiographic outcomes between endovascular therapy (EVT) and microsurgery (MS) for unruptured wide-neck aneurysms (WNAs). Although there was no difference in the primary clinical outcome, secondary clinical outcomes favored EVT and secondary angiographic outcomes favored MS. There are very few published studies that compare EVT and MS for unruptured WNAs, and this study helps fill that literature gap.
Ching-Jen Chen, Nisha Dabhi, M. Harrison Snyder, Natasha Ironside, Isaac Josh Abecassis, Ryan T. Kellogg, Min S. Park, and Dale Ding
Researchers reviewed the medical literature for the endovascular treatment of brain aneurysms with a relatively new class of devices called intrasaccular flow disruption (IFD) device. IFD devices were found to be a very safe treatment for appropriately selected brain aneurysms with low complication rates. However, aneurysm cure at 1-year follow-up is achieved in only half of patients treated with an IFD device, and the probability of aneurysm cure does not increase much after 1 year.
The authors analyzed in-hospital and prognostic differences between patients with aneurysmal subarachnoid hemorrhage (aSAH) treated with surgical clipping and those treated wtih endovascular coiling. The endovascular coiling group showed advantages in discharge and 90-day outcomes, in-hospital complications, and the number of in-hospital risk factors. In-hospital complications such as DCI and pneumonia may have a long-lasting impact on the prognosis of aSAH patients. This study provides new evidence for in-hospital treatment of aSAH patients in the future.
Fabio A. Frisoli, Visish M. Srinivasan, Joshua S. Catapano, Robert F. Rudy, Candice L. Nguyen, Soren Jonzzon, Clayton Korson, Katherine Karahalios, and Michael T. Lawton
The authors analyzed the outcomes of microsurgical management of vertebrobasilar dissecting aneurysms, a complex pathology that often requires revascularization. The authors found that favorable outcomes are achievable, especially when the patient's presenting neurological grade is not poor. This study balances the growing endovascular literature with a large series of microsurgically treated patients.
In this study, the authors have demonstrated that repeated systemic administration of mesenchymal stem cells over 3 weeks resulted in greater functional improvement compared to single administration and/or vehicle infusion. Besides, the administration of mesenchymal stem cells is associated with the promotion of interhemispheric connectivity through corpus callosum in the chronic phase of cerebral infarction. This study adds a possible therapeutic option for chronic stroke with mesenchymal stem cell therapy.
Zhikai Hou, Long Yan, Zhe Zhang, Jing Jing, Jinhao Lyu, Ferdinand K. Hui, Weilun Fu, Ying Yu, Rongrong Cui, Min Wan, Jia Song, Yongjun Wang, Zhongrong Miao, Xin Lou, and Ning Ma
Researchers evaluated the role of high-resolution magnetic resonance vessel wall imaging (MR-VWI) for endovascular recanalization of nonacute intracranial artery occlusion (ICAO). Successful recanalization of nonacute ICAO was associated with occlusion with residual lumen and shorter occlusion length on high-resolution MR-VWI. These results indicated that high-resolution MR-VWI can display the characteristics of occluded arterial segments and guide endovascular recanalization of nonacute ICAO.
The objective of this study was to find the efficacy of intraoperative electrocorticography in determining the extent of resection to obtain a better seizure outcome without memory deterioration in patients with temporal lobe epilepsy. This study confirmed that visual assessment of intraoperative electrocorticography alone could not determine the extent of resection. Hence, to concretely elucidate the epilepsy network, inclusion of computational features such as high-frequency oscillation and phase-amplitude coupling should be incorporated.
Brian Y. Hwang, Alexander Eremiev, Adhith Palla, David Mampre, Serban Negoita, Yohannes K. Tsehay, Min Jae Kim, Christopher Coogan, Joon Y. Kang, and William S. Anderson
The authors investigated whether intraoperative physiological parameters affect ablation volume during magnetic resonance-guided laser interstitial thermal therapy (MRgLiTT) for mesial temporal lobe epilepsy (mTLE). Total ablation energy and end-tidal carbon dioxide (ETCO2) level, but not blood pressure, may affect ablation volume. Specifically, mild hypocapnia of ETCO2 of 33 mm Hg or less was associated with increased ablation volume. This is one of the first studies to report an association between modifiable intraoperative physiological parameters and ablation volume. Intraoperative adjustment of ETCO2 may have therapeutic implications during MRgLiTT for mTLE.
Juan S. Bottan, Ana Suller Marti, Jorge G. Burneo, Andrew G. Parrent, Keith W. MacDougall, Richard S. McLachlan, Seyed Mirsattari, David C. Diosy, and David A. Steven
The authors' goal was to analyze the role of resective surgery in patients older than 60 years and to assess outcomes and safety. Older patients who underwent epilepsy surgery appeared to have equal or better outcomes at 1 year than younger patients. Although the morbidity rate appeared to be slightly higher in the older population, it remained acceptable. This study provides further evidence that older patients are suitable candidates for surgery despite controversies derived from their longer duration of epilepsy and perceived higher surgical risk.
Karina A. González Otárula, Yee-Leng Tan, Jeffery A. Hall, Edward F. Chang, José A. Correa, François Dubeau, Viviane Sziklas, Jean-Paul Soucy, Marie-Christine Guiot, Robert C. Knowlton, and Eliane Kobayashi
The authors aimed to report postsurgical seizure outcomes of patients with temporal lobe epilepsy with normal or subtle, nonspecific MRI findings and to identify prognostic factors of postsurgical seizure control. They found that 44% of patients had Engel class I outcome, and favorable factors included focal nonmotor aware seizures and unilateral or no spikes on interictal scalp EEG. This study shows that favorable outcomes can be achieved and that some presurgical characteristics can support postsurgical seizure control.
Nicholas C. Sinclair, Hugh J. McDermott, Wee-Lih Lee, San San Xu, Nicola Acevedo, Angus Begg, Thushara Perera, Wesley Thevathasan, and Kristian J. Bulluss
Because the need to undergo awake neurosurgery may be a barrier to patients receiving deep brain stimulation (DBS), the authors investigated the impact of general anesthesia (GA) on neural activity recorded from electrodes implanted in the subthalamic nucleus for Parkinson's disease to determine whether real-time feedback on lead positioning may be sufficient during GA. Evoked resonant neural activity (ERNA) was largely preserved under GA, coinciding with the location of chronic DBS, whereas spontaneous beta and high-frequency oscillations were abolished. These findings support the use of ERNA to help guide subthalamic nucleus electrode implantation, including during GA.
Francesco Sammartino, Fang-Cheng Yeh, and Vibhor Krishna
An accurate lesion characterization is crucial to optimize focused ultrasound (FUS) treatment parameters and ultimately improve clinical outcomes. This study found that intraoperative restricted diffusion imaging (RDI) accurately identified the volume and location of FUS lesions. Lesions adjacent to the ventral border of the VIM were significantly associated with tremor improvement; in contrast, lesion extension into the inferolateral white matter was associated with ataxia. These data support the acquisition of intraoperative RDI to characterize FUS lesions.
The authors investigated the degree of neuronal terminal survival in Parkinson's disease patients after subthalamic nucleus deep brain stimulation (STN-DBS) using [11C]CFT PET. Dopamine transporter availability was significantly increased in the anteroventral part of the striatum in Parkinson's disease patients 1 year after STN-DBS. Importantly, a significant correlation was observed with this increase in dopamine transporter availability and motor recovery under STN-DBS. This result elucidated the partly in vivo mechanism of STN-DBS on dopaminergic neurons in patients with Parkinson's disease.
Georgi Minchev, Ayguel Wurzer, Wolfgang Ptacek, Gernot Kronreif, Alexander Micko, Christian Dorfer, and Stefan Wolfsberger
Researchers developed a novel, miniature, highly accurate guidance device that can be seamlessly integrated into an existing operating room setup for stereotactic neurosurgical procedures. The system was optimized in 150 cases of stereotactic brain biopsy, and stereoelectroncephalography electrode and catheter placements. According to the obtained clinical data, the robot can significantly improve procedural accuracy without significantly adding instrument positioning time. Future applications will further increase the versatility of the device.
Wendell Gibby, Steve Cvetko, Andrew Gibby, Conrad Gibby, Kiel Sorensen, Edward G. Andrews, Joseph Maroon, and Ryan Parr
The authors tested augmented reality (AR) accuracy for deep brain targets. Combined processes of presurgical planning, automatic registration with image-visible optical codes, and surgeon-directed holographic acquisition of simulated deep brain targets yielded a mean 2.3° angle of error and 3.62-mm radial error at 85.41-mm depth. Slight improvements in AR precision will equal or exceed current stereotactic standards. AR guidance may revolutionize neurosurgery with low-cost, high-accuracy cranial targeting and a nominal operating room footprint.
Yuyao Zhou, Zehao Zhao, Jie Zhang, N. U. Farrukh Hameed, Fengping Zhu, Rui Feng, Xiaoluo Zhang, Junfeng Lu, and Jinsong Wu
Researchers provided a modified intraoperative mapping strategy to explore the distribution pattern of speech-related negative motor responses (NMRs). The speech-specific NMR was mainly located in the ventral part of the ventral precentral gyrus (vPrCG), whereas the nonspeech-specific NMR was mainly located in the dorsal part of the vPrCG. These findings not only provide insight into the motor control of speech production but also will facilitate surgical planning and intraoperative brain mapping.
Although the parietooccipital fissure divides the temporal, occipital, and parietal lobes, where 40% of gliomas are located with the temporal lobe as the most common location, little is known about the clinical significance of this fissure to gliomas. The authors investigated the correlation between the parietooccipital fissure and medial posterior temporal gliomas and found that the fissure strongly affects glioma invasion patterns. This study highlights the importance of the parietooccipital fissure in determining the invasion pattern of posterior medial temporal gliomas and understanding their complex anatomical architecture.
Ron Gadot, A. Basit Khan, Rajan Patel, Eric Goethe, Arya Shetty, Caroline C. Hadley, James C. Bayley V, Akdes S. Harmanci, Tiemo J. Klisch, Daniel Yoshor, Sameer A. Sheth, and Akash J. Patel
The authors aimed to identify independent predictors of seizure outcome after supratentorial meningioma resection in patients with history of preoperative seizures. They found that postresection ischemia, tumor recurrence, high WHO grade, and higher MIB-1 index independently predicted worse seizure outcome in their cohort. These results are valuable in identifying factors driving epileptogenicity in meningioma, as well as in counseling patients on the likelihood of seizure freedom after surgical intervention.
Jeffrey A. Zuccato, Ozer Algan, Vimoj J. Nair, Tyler Gunter, Chad A. Glenn, Ian F. Dunn, Kar-Ming Fung, David B. Shultz, Gelareh Zadeh, Normand Laperriere, and Derek S. Tsang
The objective of our study was to determine whether adjuvant radiotherapy improves outcomes in adults with intracranial ependymoma. Gross- (GTR) or near-total resection (NTR) and adjuvant radiotherapy were associated with improved progression-free survival. Maximum safe resection, ideally GTR or NTR, should be obtained when possible, while the merits of adjuvant radiotherapy should be discussed with all patients with intracranial ependymoma.
Jihwan Yoo, Seon-Jin Yoon, Kyung Hwan Kim, In-Ho Jung, Seung Hoon Lim, Woohyun Kim, Hong In Yoon, Se Hoon Kim, Kyoung Su Sung, Tae Hoon Roh, Ju Hyung Moon, Hun Ho Park, Eui Hyun Kim, Chang-Ok Suh, Seok-Gu Kang, and Jong Hee Chang
The authors sought to elucidate the effects of supratotal resection (SupTR) on patterns of recurrence in patients with glioblastoma (GBM). SupTR in GBM patients resulted in a relatively low rate of local recurrence and a higher rate of distant recurrence, which may provide clinical evidence of remaining GBM origin cells that are potential therapeutic targets. Additional clinical aspects, including extent of resection and radiotherapy range, have important implications for developing more effective treatment of GBM.
Dennis London, Dev N. Patel, Bernadine Donahue, Ralph E. Navarro, Jason Gurewitz, Joshua S. Silverman, Erik Sulman, Kenneth Bernstein, Amy Palermo, John G. Golfinos, Joshua K. Sabari, Elaine Shum, Vamsidhar Velcheti, Abraham Chachoua, and Douglas Kondziolka
Researchers studied patients with previously treated non-small cell lung cancer brain metastases to determine the likelihood of recurrence while off systemic therapy. New brain metastases occurred after a median of 16 months and were associated with mutations in the RAS pathway and with stopping therapy early due to adverse effects. Patients who complete systemic therapy may have a significant amount of time without new brain metastases.
Shoji Yomo, Takehiro Yako, Kazuo Kitazawa, and Kazuhiro Oguchi
The authors investigated whether staged stereotactic radiosurgery (S-SRS) alone or postoperative cavity SRS (C-SRS) has better outcomes for patients with midsize-to-large brain metastases (BMs). There was no significant difference in overall survival or neurological mortality between the two groups, but local control failure was more common in the S-SRS group, whereas the development of leptomeningeal disease was more common in the C-SRS group. The S-SRS-alone strategy for midsize-to-large BMs can be considered an effective and minimally invasive alternative.
The goal of this study was to compare outcomes between combined tyrosine kinase inhibitor (TKI) and stereotactic radiosurgery (SRS) versus TKI therapy alone in non-small cell lung cancer (NSCLC) patients with brain metastases (BMs) and epidermal growth factor receptor (EGFR) mutations. The addition of SRS to TKI therapy resulted in improvement of intracranial tumor control but not in overall survival. This study is the first entity that proves the superior intracranial tumor control of concomitant SRS and TKI therapy and provides a probable alternative treatment strategy for NSCLC patients with BMs and EGFR mutations.
Carolina Gesteira Benjamin, Jason Gurewitz, Ami Kavi, Kenneth Bernstein, Joshua Silverman, Monica Mureb, Bernadine Donahue, and Douglas Kondziolka
The authors examined survival outcomes and dosimetry to critical structures in patients treated with Gamma Knife radiosurgery for ≥ 25 brain metastases (BMs) in a single session or cumulatively over their disease course. The results showed that in selected patients with a large number of cumulative BMs, multiple courses of stereotactic radiosurgery (SRS) are feasible and safe, with survival rates that compared favorably to those in larger contemporary cohorts, while avoiding whole-brain radiotherapy in most patients. The findings support SRS as standard practice in selected patients with larger numbers of BMs.
Eric Suero Molina, Sönke J. Hellwig, Anna Walke, Astrid Jeibmann, Herbert Stepp, and Walter Stummer
Tumor fluorescence has greatly improved the ability of neurosurgeons to resect gliomas, a type of brain tumor. Previously, a certain neurosurgical microscope was necessary for the visualization of fluorescence. Researchers developed a new, easy-to-use device based on a unique combination of light-emitting diodes and special loupe glasses, and tested these in a study on tumor tissue. In their study they confirm equivalent performance compared to the microscope for finding tumor, whereas the overall brightness of fluorescence was superior to the microscope. The new device is an important additional tool for improving glioma surgery.
Thomas Sauvigny, Henrik Giese, Julius Höhne, Karl Michael Schebesch, Christian Henker, Andreas Strauss, Kerim Beseoglu, Niklas von Spreckelsen, Jürgen A. Hampl, Jan Walter, Christian Ewald, Aleksandrs Krigers, Ondra Petr, Vicki M. Butenschoen, Sandro M. Krieg, Christina Wolfert, Khaled Gaber, Klaus Christian Mende, Thomas Bruckner, Oliver Sakowitz, Dirk Lindner, Jan Regelsberger, and Dorothee Mielke
The authors aimed to generate reliable data on surgery-related complications and neurological outcomes after cranioplasty by establishing a prospectively conducted, multicenter registry. This analysis of 502 patients from 16 participating centers revealed that preoperatively increased score on the modified Rankin Scale, higher American Society of Anesthesiologists Physical Status Classification System score, and traumatic brain injury as the underlying diagnosis were independent predictors of surgical revision. These new findings provide evidence-based surgical standards for cranioplasty.
The authors report a novel approach using Gamma Knife Icon technology to fractionate daily treatment, even over 6 weeks, to patients with primary brain tumors that progressed after prior surgery and radiation and were located adjacent to critical dose-limiting organs at risk. The authors took advantage of radiosurgical dosimetric characteristics, and the principles of radiation oncology, to essentially escalate the intratumoral dose, maximally spare the surrounding normal tissues, and achieve preliminary but encouraging results.
TO THE EDITOR: With immense interest, we read the analytical article published in the Journal of Neurosurgery by Johnson et al.,1 which brought forth some important points on the representation of women in various subspecialties by virtue of their participation as oral/poster presenters at the premiere neurosurgery conferences (Johnson GW, Almgren-Bell A, Skidmore A, et al. Representation of female neurosurgeons as abstract authors at neurological surgery conferences. J Neurosurg. Published online February 25, 2022. doi:10.3171/2022.1.JNS212096). The article, which highlighted the deficits in the academic opportunities given to women neurosurgeons despite a logarithmic
Researchers explored molecular characteristics of incidental lower-grade gliomas (iLGGs) to improve their management. Symptomatic LGGs showed more malignant characteristics than iLGGs in the perspective of genomic and transcriptomic landscapes. The new insights regarding molecular characteristics of iLGGs indicated that the immediate management of iLGGs could result in a better prognosis than the “wait-and-see” strategy.
It was with great sadness that we wrote this obituary for Robert George Grossman (Fig. 1), a true legend in the field of neurosurgery, who is often regarded as one the godfathers of the specialty. Dr. Grossman was born on January 24, 1933, in the Bronx, New York, during a time when the United States was experiencing the Great Depression. His parents were Dr. Ferenc Grossman and Vivian Eisenberg Grossman, both immigrants to the United States. Dr. Grossman’s father was born in Hungary and was a family practice doctor. His mother was born in Lithuania and
The landmark study of the Lancet Commission on Global Surgery was instrumental in identifying the disparity of access to surgery across the world. It estimated that 5 billion people lacked access to safe and affordable surgical and anesthesia care, with low- and middle-income countries (LMICs) bearing the brunt of this unmet need.1 Within the surgical disciplines, neurosurgery remains a significant contributor to the global deficit in surgical care. Annually, about 22.6 million patients suffer from neurological disorders or injuries requiring neurosurgical care, with 5 million of them lacking access to the expertise of a neurosurgeon.2
Scientific publication is among the most important endeavors to improve neurosurgical understanding and patient care. As exemplified by the “seminal” carotid endarterectomy studies1,2 in which approximately 95% of patients were White, equity and diversity have often been de-emphasized in neurosurgical scientific publication. In the wake of recent racially motivated violence and COVID-19–related healthcare disparities, we are now beginning to understand the value of diversity. Indeed, there has been increased interest in scientific publishing with diversity, equity, and inclusion (DEI) in mind. As a result, there has been an influx of publications that specifically focus
The authors tested conventional predictors of meningioma recurrence as well as a novel molecular-based location paradigm. Brain invasion did not increase the risk of recurrence in otherwise WHO grade I meningioma. Adjuvant radiosurgery to subtotally resected WHO grade I meningiomas did not prolong the time to recurrence. Location categorized by distinct molecular signatures predicted recurrence in a univariate but not a multivariate model. The role of location in predicting recurrence has yet to be defined.
The study used historical data to appraise the specialist neurosurgical workforce and training capacity in Africa and projected the workforce capacity by 2030. Africa, especially sub-Saharan Africa, currently has a significant deficit in neurosurgical workforce and training and will be unable to meet global targets by 2030 at current growth trends. Scaling up neurosurgical training would help to meet this target, and requires concerted collaborative efforts from continental, regional, and national agencies, and international organizations.
The authors investigated the predictive value of cerebral small vessel disease (CSVD) for symptomatic in-stent restenosis (SISR) in patients with severe intracranial atherosclerotic stenosis (ICAS) who underwent intracranial stenting. Of the CSVD subtypes, deep white matter hyperintensities (DWMHs) are associated with SISR. The DWMH Fazekas scale grade is considered a predictor for SISR. Intensive surveillance in severe ICAS patients with concurrent CSVD may be necessary to prevent recurrent stroke after intracranial stenting.
Authors of this study aimed to identify radiological factors associated with intracranial hypertension following traumatic brain injury (TBI). The main finding was that patients with a Rotterdam CT score ≤ 2 and no sulcal effacement were unlikely to develop intracranial hypertension. Based on this study, patient selection criteria for intracranial pressure monitoring may be refined using radiological information following severe TBI.
The authors investigated motor recovery after hypoglossal-to-facial nerve anastomosis in patients with facial nerve palsy. They conducted a systematic review of the literature and performed a patient-level analysis. Surgery was quite effective in restoring at least part of facial nerve functionality, with almost half the patients experiencing improvement by 3 or more points on the House-Brackmann scale. In this analysis, a shorter window from injury to anastomosis was associated with superior outcomes.
These researchers used quantitative digital subtraction angiography to explore the hemorrhagic quantitative hemodynamic indicators of the arteriovenous malformation (AVM) nidus. A higher stasis index and slower transnidal relative velocity in the nidus were independent hemorrhagic indicators and were revealed as stable predictors of future hemorrhage using a prospective data set. This study revealed that the core mechanisms underlying AVM rupture could be intravascular blood stasis and occlusive hyperemia of the nidus and provided usable indicators for future AVM rupture prediction models.
The authors aimed to evaluate the efficacy of radiofrequency thermocoagulation (RFTC) for seizure control using stereo-EEG (SEEG), routinely performed after localization of the epileptogenic zone, in patients with MRI-negative epilepsy. The key finding was that 25.8% of patients remained seizure free at 1-year follow-up without the need for subsequent surgical intervention and 45.2% have > 50% reduction in seizure frequency. This suggests that RFTC can be performed routinely and safely in patients with focal epilepsy guided by SEEG. The technique's adverse effects are minimal and, even if the patient does not remain seizure free, the reduction in seizure frequency would be a positive prognostic factor for subsequent resection.
Researchers investigated the prognostic relevance of various biomarkers of primary cancer for clinical outcomes after stereotactic radiosurgery (SRS) in patients with metastatic brain tumors from lung adenocarcinoma. Thyroid transcription factor 1 and napsin A were significant prognostic factors for local control and overall survival, respectively. These findings provide evidence that pathological biomarkers of primary lung cancer should be considered to establish better models for predicting clinical outcomes after SRS in patients with lung adenocarcinoma.
The objective of this study was to evaluate the possibility of single antiplatelet therapy (SAPT) discontinuation after stent-assisted coil embolization. The authors observed safe SAPT discontinuation in patients without ischemic complications and with stable intraaneurysmal signals on MRA for 2 years. Although SAPT discontinuation is not attempted in most institutions, lifelong SAPT may not be necessary in certain cases. These results may provide useful information about temporary or permanent SAPT discontinuation in the future.
The authors compared clinical courses of patients with Parkinson disease undergoing subthalamic nucleus (STN) deep brain stimulation (DBS) surgery through either awake or asleep targeting and correlated outcomes with estimates of structural and functional connectivity. Compared to awake STN DBS, asleep procedures achieved similarly optimal targeting based on clinical outcomes, electrode placement, and connectivity estimates with shorter duration of surgery. These results add to literature demonstrating similar clinical efficacy between awake and asleep DBS.
Epilepsy specialists shared their initial experience with a novel automated technique that enhances the ability of PET scanning to detect the seizure onset zone in patients with medically refractory epilepsy. This new software-based technique improved the ability of PET to detect the seizure onset zone above the standard methods of visual analysis. Application of this technique may eventually improve the chance for seizure freedom following epilepsy surgery.
Collagen alpha-2(I) chain (COL1A2) is an essential component of extracellular matrix. Based on the authors' previous proteomics analysis showing a high value of COL1A2 in the blood of patients with glioblastoma (GBM), this study revealed the functions and underlying mechanism of COL1A2 in GBM. COL1A2 inhibition significantly suppressed GBM proliferation via inducing G1 arrest caused by Akt dephosphorylation both in vitro and in vivo. COL1A2 could be a promising biomarker and a new therapeutic target against GBM.
The authors' objective was to determine whether Broca's aphasia is associated with resections of anatomically defined Broca's area (Brodmann's areas 44/45). They found that Broca's aphasia is not associated with resections of Broca's area. Instead, transient Broca's aphasia is associated with resection of the ventral rolandic cortex and supramarginal gyrus, and also the underlying white matter tracts. These findings have significant implications for understanding the risks to language that are associated with surgery in eloquent brain areas.
In this issue of the Journal of Neurosurgery, Mulligan et al. review the historical growth of women neurosurgeons in the US and use univariate linear regression and Holt-Winter forecasting to calculate a timeline of 156 years to achieve gender parity with the US physician workforce, and 246 years to achieve parity with the US population.1 The authors should be commended for this reckoning of gender balance in US neurosurgery and their rigorous quantification of the path to gender equity. Their results may seem shocking, but even a cursory glance at the web pages of
Examining the life of the late Dr. Ernesto Bustamante Zuleta (1922—2021), the authors provide a biographical lens through which to envisage the development of modern Colombian neurosurgery. Dr. Bustamante's legacy in the larger history of Colombian neurosurgery bridges the preexisting systematist and anatomoclinical approaches in the discipline with the incorporation of new medical technologies and interdisciplinary collaborations. Dr. Bustamante's celebrated educational leadership bears witness to the enduring impact a cordial neurosurgeon can have on future generations.
The purpose of this pilot study was to test the safety and feasibility of capturing and recording task-specific brain activities using an already approved and commercially available intravascular device to treat brain aneurysms, the Woven EndoBridge Aneurysm Embolization System. This case series provides a proof of concept of the safety and feasibility of recording task-specific brain activities and successfully decoupling these electroencephalography activities from the noise signal generated by arterial pulsation. This study could pave the way for future studies to test the safety and efficacy of using intraarterial devices for deep brain stimulation and as brain interface devices.
Researchers examined the 5-year clinical outcomes of patients with medically refractory essential tremor (ET) who had previously undergone MRI-guided focused ultrasound (MRgFUS) thalamotomy in a randomized, blinded, sham-controlled trial. Improvement in tremor control was measured at 73.1% from baseline with only mild or moderate side effects and no delayed complications. Unilateral MRgFUS thalamotomy demonstrates sustained and significant tremor improvement with an overall improvement in the quality of life of patients with medically refractory ET.
The authors apply a novel forecasting method to find the most accurate projection of when gender parity in the field of neurosurgery may be achieved. This study found that female neurosurgeons would not reach the same proportion as male neurosurgeons until the year 2177 when compared to the overall physician workforce and, alarmingly, until 2267 compared to the entire US. population. The authors discuss strategies to disrupt and accelerate this current projected rate of growth.
Seven bypass simulation scenarios were developed with artificial head models for microvascular bypass training. Scenarios included 1) temporal craniotomy for superficial temporal artery (STA)—2013;middle cerebral artery bypass, 2) pterional craniotomy for STA-M2 bypass, 3) bifrontal craniotomy for A3-A3 bypass, 4) far lateral craniotomy for posterior inferior cerebellar artery (PICA)—PICA bypass or 5) PICA reanastomosis, 6) orbitozygomatic craniotomy for posterior cerebral artery bypass, and 7) extended retrosigmoid craniotomy for occipital artery—anterior inferior cerebellar artery bypass. Seven neurosurgeons confirmed that these anatomical models can be used for training and microsurgical courses.
The authors evaluated the implementation of a standardized shunt infection prevention bundle in 621 consecutive shunt surgeries performed in an adult patient population without the use of antibiotic-impregnated shunt catheters. This standardized bundle significantly reduced the rate of shunt infections from 5.8% to 0%, a reduction that was sustained over many years. The use of 2% chlorhexidine gluconate in 70% isopropyl alcohol for preoperative antisepsis may have played a significant role in the effectiveness of this procedure.
Stereotactic radiosurgical capsulotomy (SRS-C) is an effective neurosurgical option for patients with treatment-resistant obsessive-compulsive disorder (TROCD). Unlike other procedures such as deep brain stimulation and radiofrequency ablation, the cost-effectiveness of SRS-C for TROCD has not been investigated. The authors herein report the first cost-effectiveness analysis of SRS-C for TROCD.
Using a decision analytic model, the authors compared the cost-effectiveness of SRS-C to treatment as usual (TAU) for TROCD. Treatment response and complication rates were derived from a review of relevant clinical trials. Published algorithms were used to convert Yale-Brown Obsessive Compulsive Scale scores into utility scores reflecting improvements in quality of life. Costs were approached from the healthcare sector perspective and were drawn from Medicare reimbursement rates and available healthcare economics data. A Monte Carlo simulation and probabilistic sensitivity analysis were performed to estimate the incremental cost-effectiveness ratio.
One hundred fifty-eight TROCD patients across 9 studies who had undergone SRS-C and had at least 36 months of follow-up were included in the model. Compared to TAU, SRS-C was more cost-effective, with an estimated incremental cost-effectiveness ratio of $28,960 per quality-adjusted life year (QALY) gained. Within the 3-year time horizon, net QALYs gained were greater in the SRS-C group than the TAU group by 0.27 (95% CI 0.2698–0.2702, p < 0.0001). At willingness-to-pay thresholds of $50,000 and $100,000 per QALY, the Monte Carlo simulation revealed that SRS-C was more cost-effective than TAU in 83% and 100% of iterations, respectively.
Compared to TAU, SRS-C for TROCD is more cost-effective under a range of possible cost and effectiveness values.
Researchers characterized equity among the international women neurosurgery community to better depict perceptions of their neurosurgical careers. The respondents represented 54 countries in 6 continents. Despite perceived barriers to support from their departments and colleagues regarding family situations, person situations, and career advancement, women neurosurgeons were satisfied with their career choice. This article characterizes the experiences and perceptions of global women in neurosurgery, so neurosurgeons can understand common challenges and aim to address them.
A chronological summary of the development of the neurosurgical specialty in Colombia was conducted in view of significant persons, events, and associations. The Colombian tradition of neurosurgery combines innovative and pioneering individuals who left their homeland, only to return with and implement best practices from the wider world. The insights gleaned in this historical survey demonstrate that both national and international collaboration have the power to provide collective efficacy and timely advancements to emerging medical systems.