The authors highlight that maximal functional-based resection under awake conditions can be safely performed with a low rate of intraoperative (3.5%) and early postoperative (7.9%) seizures, and with excellent long-term functional outcomes. Intraoperatively, the use of the lowest current threshold is mandatory to reduce the seizure occurrence intraoperatively and in the early postoperative period.
Authors:Colin J. Przybylowski, Xiaochun Zhao, Jacob F. Baranoski, Leandro Borba Moreira, Sirin Gandhi, Kristina M. Chapple, Kaith K. Almefty, Nader Sanai, Andrew F. Ducruet, Felipe C. Albuquerque, Andrew S. Little, and Peter Nakaji
The authors compared surgical and clinical outcomes of meningioma patients who did and did not undergo preoperative embolization after controlling for specific tumor parameters and found that preoperative embolization did not lead to superior surgical outcomes but did lead to a greater chance of clinical improvement for symptomatic patients. Preoperative embolization of intracranial meningiomas is a controversial topic, and neurosurgeons must carefully weigh the risks and benefits of preoperative embolization prior to its use.
The authors found that riluzole attenuates temozolomide (TMZ)–induced O6-methylguanine DNA methyltransferase (MGMT) upregulation and enhances the antitumor effect of TMZ in MGMT-positive glioblastoma (GBM), and they believe that their study provides novel insights into a potentially promising novel therapeutic regimen for MGMT-positive GBM.
Authors:Cecilia L. Dalle Ore, Stephen T. Magill, Roberto Rodriguez Rubio, Maryam N. Shahin, Manish K. Aghi, Philip V. Theodosopoulos, Javier E. Villanueva-Meyer, Robert C. Kersten, Oluwatobi O. Idowu, M. Reza Vagefi, and Michael W. McDermott
The authors reviewed how their patients did after surgery to remove a bone and soft-tissue tumor that causes a patient’s eye to bulge out and impair vision. The authors calculated the amount of bone and tumor removed, the operative complications, and how the patients’ eye position improved after surgery. Finally, they described how much bone is safe to remove and how they use a team approach to rebuild the orbit with an oculoplastic surgeon.
Authors:Daisuke Yamashita, Joshua D. Bernstock, Galal Elsayed, Hirokazu Sadahiro, Ahmed Mohyeldin, Gustavo Chagoya, Adeel Ilyas, James Mooney, Dagoberto Estevez-Ordonez, Shinobu Yamaguchi, Victoria L. Flanary, James R. Hackney, Krishna P. Bhat, Harley I. Kornblum, Nicola Zamboni, Sung-Hak Kim, E. Antonio Chiocca, and Ichiro Nakano
The authors performed comprehensive metabolic analyses using high-grade glioma (HGG) tissues and glioblastoma patient–derived sphere culture models and identified tyrosine metabolism as a novel target in HGG. This study is important for understanding the role of the metabolome in spatial heterogeneity and the development of targeted therapeutics in HGG.
Authors:Yukitomo Ishi, Shigeru Yamaguchi, Kanako C. Hatanaka, Michinari Okamoto, Hiroaki Motegi, Hiroyuki Kobayashi, Shunsuke Terasaka, and Kiyohiro Houkin
The authors systematically reviewed databases of medical literature to identify studies of cauda equina syndrome and its incidence. This information is important for organizing healthcare services and especially out-of-hours imaging arrangements, as MRI is required for all patients with suspected cauda equina syndrome.
Authors:Janelle Cyprich, Dhiraj J. Pangal, Martin Rutkowski, Daniel A. Donoho, Mark Shiroishi, Chia-Shang Jason Liu, John D. Carmichael, and Gabriel Zada
The authors compared clinical characteristics and outcomes between patients undergoing pituitary adenoma (PA) resection at a safety-net hospital (SNH) and patients undergoing resection at a private hospital (PH), with all PA resections performed by the same attending neurosurgeon and all patients under the care of the same tertiary multidisciplinary team at a single institution. This single-surgeon design allowed a unique examination of the effects of sociodemographic variables on presentation and outcomes associated with receiving treatment at an SNH compared to a PH in patients undergoing endoscopic transsphenoidal PA resection.
Authors:Iyan Younus, Mina M. Gerges, Rafael Uribe-Cardenas, Peter F. Morgenstern, Mahmoud Eljalby, Abtin Tabaee, Jeffrey P. Greenfield, Ashutosh Kacker, Vijay K. Anand, and Theodore H. Schwartz
The authors analyzed the largest consecutive series of endoscopic skull base surgeries and demonstrated that contrary to popular belief, the surgical learning curve does not plateau but can continue for several years when complex endpoints are considered. These findings may have implications for clinical trial design, surgical education, governmental policy, and patient safety measures. Further study in other surgical subspecialties is warranted.
Authors:Lea M. Alhilali, Andrew S. Little, Kevin C. J. Yuen, Jae Lee, Timothy K. Ho, Saeed Fakhran, and William L. White
The authors compared residual pituitary adenoma detection using early postoperative (EPO) MRI (< 48 hours postsurgery) and late postoperative (LPO) MRI (3 months postsurgery) to the current standard of intraoperative assessment. The findings that EPO MRI can be more reliably interpreted than LPO MRI and has better sensitivity for residual tumor detection than both intraoperative assessment and LPO MRI challenge current guidelines recommending delay of the first postoperative imaging until 3 months postsurgery and instead indicate that pituitary surgeons should consider performing EPO MRI in addition to or instead of delayed imaging.
Authors:John W. Rutland, Joshua Loewenstern, Daniel Ranti, Nadejda M. Tsankova, Christopher P. Bellaire, Joshua B. Bederson, Bradley N. Delman, Raj K. Shrivastava, and Priti Balchandani
In this study, the authors apply high–spatial resolution 7-tesla (1-mm3 isotropic) diffusion-weighted imaging (DWI) to measure the microstructural properties of 13 pituitary adenomas. They correlate results from 7T MRI with objective measures of intraoperative tumor consistency ratings, as well as with histological analysis, in an attempt to examine ultra–high field DWI as a noninvasive predictor of pituitary adenoma firmness. 7T DWI may hold clinical value in the preoperative workup and surgical management of patients with pituitary macroadenomas.
Authors:Daniel C. Kreatsoulas, Varun S. Shah, Bradley A. Otto, Ricardo L. Carrau, Daniel M. Prevedello, and Douglas A. Hardesty
Spontaneous CSF leaks are difficult to manage and can lead to meningitis, and the incidence is increasing around the world, so the authors retrospectively reviewed their institution's standard management paradigm (using endonasal endoscopic repair, an alternative to traditional craniotomy) for these patients to determine the utility of a standardized algorithm for the measurement of opening pressure via lumbar puncture postoperatively to diagnosis and treat suspected idiopathic intracranial hypertension.
Authors:Charles Ashton, Suhn K. Rhie, John D. Carmichael, and Gabriel Zada
The expression level of voltage-gated potassium channel regulator KCNAB2 was modulated in rat pituitary tumor cells and found to correlate with growth hormone (GH) secretion. Separately, rat pituitary tumor cells were treated with quinidine and found to secrete less GH and prolactin with increasing doses of the drug. These results suggest a potentially novel actor in the GH secretion pathway and a new therapeutic candidate for the treatment of GH and prolactin overproduction.
Authors:Soo Heon Kim, Cheol Ryong Ku, Minkyun Na, Jihwan Yoo, Woohyun Kim, In-Ho Jung, Kyung Won Kim, Ju Hyung Moon, Daham Kim, Eun Jig Lee, Sun Ho Kim, and Eui Hyun Kim
For thyroid-stimulating hormone–secreting pituitary adenoma, which is the rarest form of pituitary adenomas, the authors demonstrated that the immediate postoperative level of thyroid-stimulating hormone is highly predictive for long-term endocrinological remission.
Authors:Iyan Younus, Mina Gerges, Theodore H. Schwartz, and Rohan Ramakrishna
This report assesses the impact of Medicaid insurance on outcomes after endoscopic transsphenoidal pituitary surgery. The authors found that larger maximum tumor diameter, longer postoperative length of stay, higher rate of complications, and long-term cranial neuropathy were associated with Medicaid insurance.
Authors:Adomas Bunevicius, Hideyuki Kano, Cheng-Chia Lee, Michal Krsek, Ahmed M. Nabeel, Amr El-Shehaby, Khaled Abdel Karim, Nuria Martinez-Moreno, David Mathieu, John Y. K. Lee, Inga Grills, Douglas Kondziolka, Roberto Martinez-Alvarez, Wael A. Reda, Roman Liscak, Yan-Hua Su, L. Dade Lunsford, Mary Lee Vance, and Jason P. Sheehan
For the first time the authors have demonstrated that the interval between resection and radiosurgery is important for outcomes of Cushing’s disease. The authors analyzed a sample of 255 patients with Cushing’s disease after pituitary adenoma resection, and found that early radiosurgery was associated with improved endocrine remission rate. Early (ideally within 3 months, but not later than 12 months) radiosurgery should be considered after noncurative resection of adrenocorticotropic hormone–producing pituitary adenoma in order to achieve control of hypercortisolemia and possibly prevent long-term consequences of persistent Cushing’s disease.
Authors:Khodayar Goshtasbi, Brandon M. Lehrich, Mehdi Abouzari, Arash Abiri, Jack Birkenbeuel, Ming-Ying Lan, Wei-Hsin Wang, Gilbert Cadena, Frank P. K. Hsu, and Edward C. Kuan
The authors used the National Cancer Database and data from more than 30,000 patients to provide one of the largest studies that compares endoscopic and nonendoscopic resection of pituitary adenoma. This study is important because it compares the 2 cohorts’ demographic and clinical presentations, surgical outcomes, temporal trends, and predictors of undergoing endoscopy. With the continuous trend toward the endoscopic approach, this study provides a better understanding of some of its differences from the traditional nonendoscopy methods.
Authors:Davis G. Taylor, Ajay Chatrath, Panagiotis Mastorakos, Gabriella Paisan, Ching-Jen Chen, Thomas J. Buell, and John A. Jane Jr.
To determine if subarachnoid space loss is associated with syrinx formation and if syrinx resolution is associated with the expansion of subarachnoid spaces after surgery, the authors performed a retrospective review of patients at their institution who underwent posterior fossa decompression for Chiari malformation type I (CM-I). The study results demonstrate that CM-I patients with a syrinx have significantly decreased patency of subarachnoid spaces compared with patients without a syrinx and that restoration of subarachnoid patency is associated with syrinx resolution.
Authors:Mohamed A. Labib, Evgenii Belykh, Claudio Cavallo, Xiaochun Zhao, Daniel M. Prevedello, Ricardo L. Carrau, Andrew S. Little, Mauro A. T. Ferreira, Mark C. Preul, A. Samy Youssef, and Peter Nakaji
The authors present a novel and potentially less morbid approach for mobilizing the eustachian tube in endoscopic endonasal approaches to the jugular foramen. This new approach will improve access to difficult tumors in the petroclival region while minimizing the potential risks of hearing loss and infection.
The authors established a simple, safe technique of minimized mastoidectomy for the presigmoid approach in skull base surgery. The new technique could make the approach safer and the operating time shorter. It could be a useful option for many neurosurgeons performing the approach.
Authors:Pedram Golnari, Pouya Nazari, Roxanna M. Garcia, Hannah Weiss, Ali Shaibani, Michael C. Hurley, Sameer A. Ansari, Matthew B. Potts, and Babak S. Jahromi
The authors showed current treatment of brain aneurysms and subarachnoid hemorrhage in the context of change over time, and determined if trends over the past 2 decades indicate a continued shift versus a maturation of practice with respect to volumes, outcomes, and complication rates. To the authors’ knowledge, this is the longest time period assessed using the National Inpatient Sample database, with revised methodology permitting uniform assessment of volume and outcome trends over the entire study period.
Authors:Jorge A. Roa, Mario Zanaty, Carlos Osorno-Cruz, Daizo Ishii, Girish Bathla, Santiago Ortega-Gutierrez, David M. Hasan, and Edgar A. Samaniego
In this study with 80 patients harboring 102 aneurysms, the authors compared different methods to quantify wall enhancement of unruptured intracranial aneurysms and determined the sensitivity and specificity of each method as a surrogate of aneurysm instability. They found that the aneurysm-to–pituitary stalk contrast ratio (CRstalk) using maximal signal intensity (SI) values is the best predictor of aneurysm instability. This study compared SI quantification between different MRI vendors. When using maximal CRstalk, the same ratios were obtained between different manufacturers and scanners with different magnet strengths (3T and 7T). This finding is pivotal in a prospective multicenter clinical study.
Authors:Christopher R. Pasarikovski, Julia Keith, Leodante da Costa, Joel Ramjist, Yuta Dobashi, Sandra E. Black, and Victor X. D. Yang
The authors evaluated the possible contribution of prolonged vessel wall exposure to thrombus in endothelial injury and investigated a new technique, endovascular optical coherence tomography (OCT), to see in real time the different degrees of injury caused by devices used for blood clot removal during stroke. OCT imaging was demonstrated to be feasible in this preclinical study and can adequately quantify vessel wall injury in real time with histological accuracy, which can help with future device development.
Authors:Enrico Giordan, Christopher S. Graffeo, Alejandro A. Rabinstein, Robert D. Brown Jr., Walter A. Rocca, Alanna M. Chamberlain, and Giuseppe Lanzino
In this study, the authors analyzed current age- and sex-specific aneurysmal subarachnoid hemorrhage (aSAH) incidence rates and 30-day case-fatality rates. The incidence of aSAH over 20 years in Olmsted County, Minnesota, was examined and compared to a previous analog study made in the same population. The results were also compared with regional trends in smoking habits. This study aims to show that both aSAH incidence and case-fatality rates have significantly decreased over time.
Authors:Brian M. Corliss, Rachel Freedman, Meghan M. Brennan, Jessica Smith, John D. Nerva, Neil S. Harris, Adam J. Polifka, Brian L. Hoh, and W. Christopher Fox
The authors studied how well two separate tests of platelet function predicted complications during neurosurgery. This study is important because one test was unable to predict complications, and probably should not be used in this way.
Authors:Yang Liu, Yihao Zheng, Adithya S. Reddy, Daniel Gebrezgiabhier, Evan Davis, Joshua Cockrum, Joseph J. Gemmete, Neeraj Chaudhary, Julius M. Griauzde, Aditya S. Pandey, Albert J. Shih, and Luis E. Savastano
This study evaluated current medical devices used for blood clot removal (thrombectomy) for ischemic stroke treat-ment inside a cerebral artery model and analyzed the mechanical forces at the device-clot and clot–arterial wall inter-faces. Clot behavior under device action was mainly affected by the clot's tensile strength, which was quantified for 16 emboli retrieved from 11 stroke patients. The findings shed light on the failure mechanisms of current throm-bectomy devices and the need for innovative alternative devices for clot removal.
Authors:Jorge A. Roa, Mario Zanaty, Daizo Ishii, Yongjun Lu, David K. Kung, Robert M. Starke, James C. Torner, Pascal M. Jabbour, Edgar A. Samaniego, and David M. Hasan
In this study, the authors used high-resolution vessel wall imaging (HR-VWI) to investigate the effect of daily use of aspirin (ASA) for ≥ 6 months on gadolinium wall enhancement of 96 unruptured intracranial aneurysms (UIAs). HR-VWI showed a significant decrease (average 78%) of wall enhancement in patients taking ASA, an important finding that provides evidence for the therapeutic role of ASA in patients with UIAs and the potential role of HR-VWI as a noninvasive method to assess aneurysmal wall inflammation and instability.
Authors:Satoshi Kuroda, Naoki Nakayama, Shusuke Yamamoto, Daina Kashiwazaki, Haruto Uchino, Hisayasu Saito, Emiko Hori, Naoki Akioka, Naoya Kuwayama, and Kiyohiro Houkin
The authors evaluated late (5–20 year) outcomes of moyamoya patients after superficial temporal artery–middle cerebral artery (STA-MCA) anastomosis and indirect bypass (encephalo-duro-myo-arterio-pericranial synangiosis [EDMAPS]). The results indicate that STA-MCA combined with EDMAPS may prevent further cerebrovascular events for longer than 10 years in moyamoya patients by providing surgical collateral vessels to both the MCA and ACA territories. However, regular follow-up should be planned for longer than 10 years postsurgery to identify disease progression and prevent late cerebrovascular events.
The authors evaluated the hemorrhage risk and outcome of brainstem cavernous malformations (CMs). This study improved the understanding of the natural history of brainstem CMs, because the outcome of untreated brainstem CMs was unclear. These results are meaningful for helping patients and physicians choose a suitable treatment option.
The authors performed a retrospective study to examine the effects of hospital case volume and comprehensive stroke center (CSC) capabilities on patient outcomes of clipping or coiling for subarachnoid hemorrhage (SAH) due to a ruptured aneurysm in 27,490 SAH patients who underwent clipping or coiling in 621 institutions. Higher case volume was significantly associated with lower in-hospital mortality in both clipped and coiled patients, with better functional outcome in patients treated with coiling, and hospital CSC capabilities were significantly associated with lower in-hospital mortality with clipping, but not coiling, treatment.
Authors:Jun C. Takahashi, Takeshi Funaki, Kiyohiro Houkin, Satoshi Kuroda, Miki Fujimura, Yasutake Tomata, and Susumu Miyamoto
The authors conducted a subgroup analysis of a randomized controlled trial on hemorrhagic moyamoya disease, focusing on baseline hemodynamic severity assessed with SPECT. In the subgroup with hemodynamic failure, direct bypass significantly suppressed hemorrhagic events, although the effect modification by hemodynamic severity was not significant. In the nonsurgical cohort, the presence of hemodynamic failure was an independent risk factor for subsequent hemorrhagic stroke. This is the first study to reveal the significance of preoperative hemodynamic severity for the surgical indication in hemorrhagic moyamoya disease.
Authors:Michael Eibach, Sae-Yeon Won, Markus Bruder, Fee Keil, Eva Herrmann, Joachim Berkefeld, Volker Seifert, and Juergen Konczalla
The authors developed a new score, the modified Subarachnoid Hemorrhage Early Brain Edema Score (SEBES 6c), to measure cerebral edema on CT after subarachnoid hemorrhage (SAH). This study is important because the new score can predict the outcome after SAH. Furthermore, SEBES 6c predicts outcome independent of vasospasms, a significant complication after SAH.
Authors:Yuming Jiao, Fuxin Lin, Jun Wu, Hao Li, Weilun Fu, Ran Huo, Yong Cao, Shuo Wang, and Jizong Zhao
The authors studied the plasticity of the language cortex and language-related fibers in patients with brain arteriovenous malformations located in the inferior parietal lobe using pre- and postoperative functional MRI and diffusion tensor imaging. They provide evidence for the functional reorganization by recruiting the right hemispheric homologous region of Broca’s and Wernicke’s areas, right arcuate fascicle, and left inferior frontooccipital fascicle following resection of brain arteriovenous malformations in the inferior parietal lobe.
Authors:Adam A. Dmytriw, Anish Kapadia, Alejandro Enriquez-Marulanda, Carmen Parra-Fariñas, Anna Luisa Kühn, Patrick J. Nicholson, Muhammad Waqas, Leonardo Renieri, Caterina Michelozzi, Paul M. Foreman, Kevin Phan, I-Hsiao Yang, Vincent M. Tutino, Christopher S. Ogilvy, Ivan Radovanovic, Mark R. Harrigan, Adnan H. Siddiqui, Elad I. Levy, Nicola Limbucci, Christophe Cognard, Timo Krings, Vitor Mendes Pereira, Ajith J. Thomas, Thomas R. Marotta, and Christoph J. Griessenauer
This study assessed whether patients suffer spinal stroke when arteries to the upper spine were blocked while treating posterior circulation brain aneurysms. Aneurysm treatment using flow diversion with coverage of anterior spinal artery or posterior spinal artery/lateral spinal artery was not associated with higher rates of occlusion of these branches or any instances of cord infarction.
Authors:Yasser B. Abulhasan, Johanna Ortiz Jimenez, Jeanne Teitelbaum, Gabrielle Simoneau, and Mark R. Angle
In this retrospective cohort study, the authors analyzed outcomes of patients treated for vasospasm and identified risk factors associated with the development of refractory vasospasm. They showed that milrinone is safe at high doses when given intravenously (IV) or intraarterially (IA). Significant benefit was found with increasing IV and additional IA doses of milrinone, with favorable modified Rankin Scale scores, even when vasospasm was not reversed on imaging after rescue therapy. These findings shed light on the beneficial effect of milrinone, likely through multiple pathways.
There has never been a report on the nationwide incidence rate and recent trends in subarachnoid hemorrhage (SAH) in Japan. This study aimed to clarify the estimated nationwide SAH incidence rate and recent trend in SAH incidence and reasons for any changes in this trend. The estimated nationwide SAH incidence rate in Japan was higher than in other countries and has recently declined. An improving lifestyle may have contributed to the declining rate of SAH incidence in Japan.
The authors investigated whether administration of zinc inhibits the growth of intracranial aneurysms (IAs) in a rat model. The results indicate that zinc administration may be a potent and useful therapy to prevent the enlargement and subsequent rupture of IAs. This study is important because the development of effective noninvasive medical therapies that reduce the risk of aneurysm growth and rupture is one of the most important challenges currently facing neurosurgeons.
The bridging veins between the brain and the dura on the inner surface of the sphenoid wing can restrict brain retraction during clipping surgery for internal carotid artery–posterior communicating artery and basilar apex aneurysms. The authors report a technique in which the bridging veins are displaced posteriorly without venous injury, which enables widening the surgical corridor around the lateral retrocarotid space and is helpful for decreasing the risk of venous complications.
Authors of this study aimed to standardize skull density ratio (SDR), which shows different values for each manufacturer even for the same subject, and to enable accurate predictions of focal temperature during focused ultrasound surgery. The difference in SDR between manufacturers was smaller by developing a frequency filter, and the correlation with focal temperature was stronger. Therefore, the SDR after applying the frequency filter may more accurately predict the maximum temperature during treatment.
The authors used a new QST classification system to evaluate the outcomes among different tumor types of primary craniopharyngiomas resected via a transcranial or endonasal approach, in an attempt to provide more convincing evidence for selecting the optimal approach for a specific case.
The prevalence, imaging features, and optimal treatment of carotid webs (CWs) in the Japanese population remain unclear. The prevalence of CWs, which is more frequent in younger and female patients with fewer atherosclerosis risk factors, is similar to those reported from non-Asian populations. Extensive cross-sectional and prospective observational studies are warranted to elucidate the overall prevalence and natural history of CWs.
The authors present a prospective trial evaluating intraoperative imaging and clinical outcomes for high-dose, delayed imaging of second window indocyanine green (SWIG) in 51 brain metastases. Near-infrared fluorescence was detected in all cases, allowing dose-dependent, transdural localization of intracranial metastases. The absence of residual fluorescence in the postresection cavity better predicted improved progression-free survival compared to postoperative MRI. The study demonstrates potential clinical benefits of SWIG in surgery for patients with brain metastases.
The authors retrospectively identified stroke patients to develop a simple clinical risk index to help identify which stroke patients warrant transfer or further diagnostic imaging. Three clinical variables were identified that accurately predicted which patients had salvageable penumbra in a range of clinical scenarios and treatment cutoffs and would benefit from transfer. These hypothesis-generating findings warrant additional prospective study to determine whether this risk index can help mitigate health costs and determine patient eligibility for treatment requiring transfer to another hospital with capabilities for diagnostic CT and MR perfusion imaging.
This study compared middle meningeal artery (MMA) embolization with conventional therapy for chronic subdural hematomas (cSDHs) using a propensity-adjusted analysis. Both surgery and conservative therapy were predictors of treatment failure when compared with MMA embolization. The study suggests that MMA embolization for cSDHs is associated with a lower risk of treatment failure compared with conventional therapy. MMA embolization may be effective in the treatment of both primary cSDHs and cases that recur after surgery.
A possible prolonged survival after resection for primary central nervous system lymphoma (PCNSL) lesions in selected patients has been suggested, but selection criteria for surgery, especially for solitary lesions, have never been established. In this study, the authors identified a specific subgroup of patients with solitary PCNSL who gained significant survival benefit from resection compared with undergoing only a diagnostic biopsy. The authors' results suggest that the option for resection of single lesions should be included in the clinical decision-making process.
In patients with drug-resistant dominant temporal lobe epilepsy (TLE), the authors evaluated early and late naming outcomes after temporal lobe resection according to the resection status of the basal temporal language area (BTLA) identified by cortical stimulation during stereoelectroencephalography (SEEG). In patients with BTLA resection, naming scores within 1 year postoperatively were significantly worse than preoperative scores and tended to remain lower in the longer term despite some recovery. This finding emphasizes the relevance of SEEG language mapping to the prediction of postoperative naming outcome in TLE surgery.
The history of neurosurgery at Baylor College of Medicine is a reflection of the evolution of neurosurgery as a field as well as the development of the Texas Medical Center, the nation's largest medical center. This article describes how neurosurgery at Baylor has evolved from an informal coalition of pioneering private practice neurosurgeons to one of the largest and most academically and clinically productive programs in the nation.
The article is a history of neurosurgery at the University of Nebraska Medical Center in Omaha, Nebraska. The article highlights the important and innovative contributions to the field of neurosurgery by University of Nebraska Medical Center faculty.
The purpose of this study was to establish real-time and quantitative monitoring of vagus nerve function throughout microsurgery for jugular foramen tumors. The amplitude preservation ratio of the novel continuous monitoring significantly correlated with postoperative dysphagia and/or hoarseness. This monitoring is essential to avoid permanent vagus nerve palsy when sufficient resection of jugular foramen tumors is achieved.
The authors simplified the anterior and posterior combined (APC) transpetrosal approach by minimizing petrosectomy, and the clinical outcomes of this approach for large petroclival meningiomas were evaluated. The minimal APC transpetrosal approach allows adequate accessibility with safe surgical maneuverability to perform radical resection of large petroclival meningiomas while avoiding major neurovascular complications.
In this study the authors demonstrated that Schwann cells transplanted into a novel collagen conduit enhance nerve recovery in a rat sciatic nerve injury model with a critical length gap. The objective was to build translational data in nerve grafting and lay foundational work for a clinical trial. The ability to use such a conduit loaded with human Schwann cells may provide patients with an alternative to autograft harvesting, reducing surgical time and morbidity, and improve neurological outcomes.
The authors investigated the striatal dopamine transporter (DAT) availability and motor impairment in patients with Parkinson's disease (PD) before and 1 year after deep brain stimulation (DBS) of the subthalamic nucleus. While DAT availability was stable after DBS and DAT availability before surgery did not predict the clinical outcome, an increase in DAT availability was correlated with individual improvement in UPDRS III scores. Further studies should evaluate whether PD subtype–specific DAT availability before DBS can predict successful DBS.
The goal of this study was to examine the role of intraoperative neuromonitoring (IONM) during resection of benign peripheral nerve sheath tumors in achieving gross-total resection and reducing postoperative neurological complications. Formal IONM was associated with a reduced likelihood of gross-total resection and had no association with neurological complications. Understanding the benefits and consequences of using IONM will help surgeons choose when to selectively utilize IONM during these operations.
The authors derived and internally validated a new screening model for blunt cerebrovascular injury (BCVI) using a nomogram that allows clinicians to quantify BCVI risk. They evaluated 258,935 patients who experienced blunt injury from the Japan Trauma Data Bank (January 2009–December 2018). Patients were randomly divided into training (n = 129,468) and validation (n = 129,467) cohorts. A new screening model that comprised 13 significant risk factors for BCVI was derived. In the validation cohort, the model had an area under the receiver operating characteristic curve of 0.83 (95% CI 0.81–0.86).
This is a large, single-institution study evaluating the safety of deep brain stimulation (DBS) in patients 75 years old or older. Although older patients had longer, more difficult recoveries after surgery, the complication and reoperation rates were similar to those in the younger group. Use of DBS to treat elderly patients is safe, and advanced age should not preclude patients from receiving DBS.
The authors studied the rhinopharyngeal flap to understand its blood supply and clinical value. They found that robust blood supply from ascending pharyngeal arteries and the flap may help prevent oral contamination/infection of the surgical site. This study adds significant knowledge about a new nasal flap that can be used during skull base surgery as an adjunct to other vascularized flaps.