Journal of Neurosurgery
Volume 136: Issue 1 (Jan 2022)

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Tito Vivas-Buitrago, Ricardo A. Domingo, Shashwat Tripathi, Gaetano De Biase, Desmond Brown, Oluwaseun O. Akinduro, Andres Ramos-Fresnedo, David S. Sabsevitz, Bernard R. Bendok, Wendy Sherman, Ian F. Parney, Mark E. Jentoft, Erik H. Middlebrooks, Fredric B. Meyer, Kaisorn L. Chaichana, and Alfredo Quinones-Hinojosa

In Brief

Supramarginal resection (SMR)—resection beyond T1-weighted post-contrast enhancement but within the boundaries of FLAIR-hyperintense signal—may have a beneficial influence on the overall survival (OS) of patients diagnosed with IDH-wild-type glioblastoma who undergo gross-total resection of the contrast-enhanced tumor. The results show that increased SMR was associated with significantly beneficial OS, regardless of age or any other factor. A minimum SMR of 20% was associated with beneficial OS, with no significant influence seen with SMR greater than 60%.

Open access
Sadahiro Kaneko, Eric Suero Molina, Peter Sporns, Stephanie Schipmann, David Black, and Walter Stummer

In Brief

The objective of this study was to investigate the real-time kinetics of protoporphyrin IX in low-grade glioma (LGG) based on hyperspectral fluorescence-based measurements and identify factors that predict fluorescence. Maximum fluorescence was measured within a 7- to 8-hour time frame. Gadolinium enhancement, Ki-67/MIB-1 index, 18F-fluoroethyl-l-tyrosine (18F-FET) PET uptake ratio, and apparent diffusion coefficient–based tumor cellularity differed significantly between fluorescing and nonfluorescing tissue. Logistic regression demonstrated 18F-FET PET uptake and Ki-67/MIB-1 index as independently related to fluorescence. These findings have implications for the timing and case selection of 5-aminolevulinic acid administration in LGG.

Open access
Marco Rossi, Guglielmo Puglisi, Marco Conti Nibali, Luca Viganò, Tommaso Sciortino, Lorenzo Gay, Antonella Leonetti, Paola Zito, Marco Riva, and Lorenzo Bello

In Brief

By analyzing a series of patients with tumors located in the nondominant perirolandic area who underwent operations with brain-mapping techniques, the authors identified clinical and imaging variables associated with asleep versus awake motor mapping in order to generate a score. The clinical validity of this score was validated in a prospective series.

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Desmond A. Brown, Anshit Goyal, Kent R. Richter, Jack M. Haglin, Benjamin T. Himes, Victor M. Lu, Kendall Snyder, Joshua Hughes, Paul A. Decker, Michael Opoku-Darko, Michael J. Link, Terry C. Burns, and Ian F. Parney
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Alvin Y. Chan, Elliot H. Choi, Michael Y. Oh, Sumeet Vadera, Jefferson W. Chen, Kiarash Golshani, William C. Wilson, and Frank P. K. Hsu
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Domenique M. J. Müller, Pierre A. Robe, Hilko Ardon, Frederik Barkhof, Lorenzo Bello, Mitchel S. Berger, Wim Bouwknegt, Wimar A. Van den Brink, Marco Conti Nibali, Roelant S. Eijgelaar, Julia Furtner, Seunggu J. Han, Shawn L. Hervey-Jumper, Albert J. S. Idema, Barbara Kiesel, Alfred Kloet, Emmanuel Mandonnet, Jan C. De Munck, Marco Rossi, Tommaso Sciortino, W. Peter Vandertop, Martin Visser, Michiel Wagemakers, Georg Widhalm, Marnix G. Witte, Aeilko H. Zwinderman, and Philip C. De Witt Hamer

In Brief

The authors used resection probability maps to quantify and compare glioblastoma surgery decisions from each of 12 neurosurgical teams with those of the other teams. The neurosurgical teams were found to generally agree on which glioblastoma-infiltrated brain regions to biopsy and which to resect, and the few observed differences indicated surgical controversies. The benchmark probability maps of glioblastoma surgery decisions will serve quality-of-care discussions and may steepen the learning curve of neurosurgical education.

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Pavan P. Shah, Jennifer L. Franke, Ravi Medikonda, Christopher M. Jackson, Siddhartha Srivastava, John Choi, Patrick M. Forde, Julie R. Brahmer, David S. Ettinger, Josephine L. Feliciano, Benjamin P. Levy, Kristen A. Marrone, Jarushka Naidoo, Kristin J. Redmond, Lawrence R. Kleinberg, and Michael Lim

In Brief

The objective of this retrospective cohort study was to determine the associations of driver mutation status and targeted therapy with survival of patients with non-small cell lung cancer after resection of brain metastasis. Patients with EGFR mutation who received targeted tyrosine kinase inhibitor therapy had significantly improved survival compared with patients with wild-type tumor. This study highlights the heterogeneity of lung cancer and the need for precision therapy to determine prognosis and treatment.

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Lianwang Li, Shengyu Fang, Guanzhang Li, Kenan Zhang, Ruoyu Huang, Yinyan Wang, Chuanbao Zhang, Yiming Li, Wei Zhang, Zhong Zhang, Qiang Jin, Dabiao Zhou, Xing Fan, and Tao Jiang

In Brief

Researchers investigated the epidemiological characteristics, associated risk factors, and prognostic value of glioma-related epilepsy in patients with diffuse high-grade gliomas diagnosed after implementation of the 2016 updated World Health Organization classification. The occurrence of preoperative and postoperative glioma-related epilepsy was associated with 3 and 4 clinical characteristics, respectively. Postoperative glioma-related epilepsy predicted longer overall survival time. The results provided new insights into the management of glioma-related epilepsy for the benefit of patients with diffuse high-grade gliomas.

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Kenichiro Asano, Seiko Hasegawa, Masashi Matsuzaka, and Hiroki Ohkuma

In Brief

This study aimed to determine the incidence of brain tumor–related epilepsy (BTE) associated with metastatic brain tumors and retrospectively investigate the risk factors. BTE was recorded in 24.6% of patients during the entire course of treatment. Logistic regression analysis identified young age, male sex, breast cancer, eloquent area, peritumoral edema, dissemination, and maximum tumor volume as significant risk factors. BTE was more common with tumor volumes greater than the cutoff value of 1.92 ml.

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Josh Neman, Meredith Franklin, Zachary Madaj, Krutika Deshpande, Timothy J. Triche Jr., Gal Sadlik, John D Carmichael, Eric Chang, Cheng Yu, Ben A Strickland, and Gabriel Zada

In Brief

The authors asked whether nonrandom distributions of brain metastasis vary according to primary cancer subtype and stereotactic radiosurgery coordinates utilized for treatment of brain metastasis. The authors concluded that nonuniform spatial distributions of metastasis to preferential brain regions vary according to primary cancer subtype. These cancer-specific brain topographic patterns may underlie the ability of tumor cells to adapt to regional neural microenvironments in order to facilitate colonization and establish metastasis.

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Meeki Lad, Radhika Gupta, Alex Raman, Neil Parikh, Raghav Gupta, Ankush Chandra, Ashok Para, Manish K. Aghi, and Justin Moore

In Brief

The authors used Medicare data from 2009 to 2018 to elucidate trends in intracranial neoplasm treatment and compare reimbursements for stereotactic radiosurgery (SRS) and open resection. The authors found that the increase in the number of SRS procedures outpaced the baseline expansion of Medicare enrollees, while the relative number of comparable craniotomies declined. The authors also found that Medicare reimbursed 2.9 times as much for open resection than SRS during the study period.

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Nasser Mohammed, Yi-Chieh Hung, Zhiyuan Xu, Tomas Chytka, Roman Liscak, Manjul Tripathi, David Arsanious, Christopher P. Cifarelli, Marco Perez Caceres, David Mathieu, Herwin Speckter, Gautam U. Mehta, Gregory P. Lekovic, and Jason P. Sheehan
Open access
Ofer Sadan, Hannah Waddel, Reneé Moore, Chen Feng, Yajun Mei, David Pearce, Jacqueline Kraft, Cederic Pimentel, Subin Mathew, Feras Akbik, Pouya Ameli, Alexis Taylor, Lisa Danyluk, Kathleen S. Martin, Krista Garner, Jennifer Kolenda, Amit Pujari, William Asbury, Blessing N. R. Jaja, R. Loch Macdonald, C. Michael Cawley, Daniel L. Barrow, and Owen Samuels

In Brief

The authors report the largest subarachnoid hemorrhage (SAH) patient cohort treated with intrathecal (IT) nicardipine (n = 422) for cerebral vasospasm. IT nicardipine led to a rapid and lasting improvement in arterial transcranial Doppler velocities. In a propensity score-based comparison with the SAH International Trialists database, treatment with IT nicardipine was associated with reduced delayed cerebral ischemia and improved functional outcomes. These encouraging data will assist in planning a randomized controlled clinical trial treating SAH-related vasospasm.

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Joshua S. Catapano, Fabio A. Frisoli, Candice L. Nguyen, Mohamed A. Labib, Tyler S. Cole, Jacob F. Baranoski, Helen Kim, Robert F. Spetzler, and Michael T. Lawton

In Brief

We analyzed the operability boundary for AVMs and characterized the AVM subsets with good or poor patient outcomes. Patients with supplemented Spetzler-Martin (Supp-SM) grade 7 AVMs had worse outcomes, making Supp-SM grade 6 an appropriate operability cutoff. Interestingly, patients with Supp-SM grade 7 AVMs characterized by young age and a small AVM nidus had favorable outcomes. These findings assist neurosurgeons in decision making for lesions at the operability boundary (Supp-SM grades 6 and 7 AVMs).

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Michael L. Martini, Sean N. Neifert, William H. Shuman, Emily K. Chapman, Alexander J. Schüpper, Eric K. Oermann, J Mocco, Michael Todd, James C. Torner, Andrew Molyneux, Stephan Mayer, Peter Le Roux, Mervyn D. I. Vergouwen, Gabriel J. E. Rinkel, George K. C. Wong, Peter Kirkpatrick, Audrey Quinn, Daniel Hänggi, Nima Etminan, Walter M. van den Bergh, Blessing N. R. Jaja, Michael Cusimano, Tom A. Schweizer, Jose I. Suarez, Hitoshi Fukuda, Sen Yamagata, Benjamin Lo, Airton Leonardo de Oliveira Manoel, Hieronymus D. Boogaarts, R. Loch Macdonald, and on behalf of the SAHIT Collaboration

In Brief

Researchers applied explainable machine learning techniques to identify factors associated with better outcomes after rescue therapy for postsubarachnoid hemorrhage vasospasm. Younger age and absence of delayed cerebral ischemia/infarction were linked to better rescue outcomes. A machine learning-based, propensity score-matched analysis showed that rescue was associated with higher odds of better 3-month outcome. These findings suggest that trials focusing on preventative or therapeutic interventions in patients with delayed cerebral ischemia/infarction may be most able to demonstrate improvements in outcomes.

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Sen Gao, Jeffrey Nelson, Shantel Weinsheimer, Ethan A. Winkler, Caleb Rutledge, Adib A. Abla, Nalin Gupta, Joseph T. Shieh, Daniel L. Cooke, Steven W. Hetts, Tarik Tihan, Christopher P. Hess, Nerissa Ko, Brian P. Walcott, Charles E. McCulloch, Michael T. Lawton, Hua Su, Ludmila Pawlikowska, and Helen Kim

In Brief

The study objectives were to screen mitogen-activated protein kinase (MAPK) pathway genes for somatic mutations in patients with sporadic brain arteriovenous malformation (BAVM) and to evaluate associations between somatic mutations and phenotypes of BAVM severity. The study replicated the high prevalence of somatic KRAS mutations in patients with BAVM and identified candidate somatic mutations in other MAPK pathway genes, but it did not find associations with phenotype. The study confirms the importance of KRAS mutations in patients with sporadic BAVM and provides additional MAPK pathway targets for investigation.

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Seppo Juvela

In Brief

In an almost lifelong prospective follow-up study of patients with unruptured intracranial aneurysms and with minimal treatment selection bias, the author compared the population, hypertension, age, size of aneurysm, earlier aneurysm rupture, site of aneurysm (PHASES) score with his own new one for predicting aneurysm rupture risk. Both scores predicted the long-term aneurysm rupture risk moderately well, with the new one, which also included smoking, being easier and slightly better in clinical practice. The findings suggest that decisions about the treatment of unruptured aneurysms in patients of working age can be made with an improved cost-effectiveness.

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Ali Tayebi Meybodi, Arjun Gadhiya, Leandro Borba Moreira, and Michael T. Lawton

In Brief

Bypass surgery has evolved into a complex art that incorporates a variety of donors, recipients, interpositional grafts, anastomoses, and suturing techniques. Given these contemporary advancements in bypass techniques, the existing nomenclature that joins abbreviations for donor and recipient arteries with a hyphen is simplistic and uninformative. The authors propose a new nomenclature system based on segmental anatomy and anastomotic details that uses alphanumeric shorthand to code bypasses simply, succinctly, and accurately and clarify technical details, thus encouraging greater descriptive precision.

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Richard Voldřich, David Netuka, František Charvát, and Vladimír Beneš

In Brief

Transarterial embolization using Onyx is the method of choice for the treatment of dural arteriovenous fistulas (DAVFs). The long-term stability of Onyx has been questioned, and digital subtraction angiography (DSA) has been dogmatically used in patient follow-up. The authors' cohort is one of the largest series with long-term follow-up and the only study in which DSA and MR angiography (MRA) findings are prospectively compared. The results confirm the long-term stability of Onyx and suggest that MRA may be a sufficient diagnostic method in patients with embolized DAVFs.

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Mark Bigder, Omar Choudhri, Mihir Gupta, Santosh Gummidipundi, Summer S. Han, Ephraim W. Church, Steven D. Chang, Richard P. Levy, Huy M. Do, Michael P. Marks, and Gary K. Steinberg

In Brief

The authors report a large series of patients with arteriovenous malformations that were treated with preoperative stereotactic radiosurgery as a surgical adjunct. They discuss the utility of multimodal therapy and presurgical stereotactic radiosurgery. Despite the majority of lesions being Spetzler-Martin grade III-V arteriovenous malformations, high rates of arteriovenous malformation obliteration and optimal outcomes were obtained in their series.

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Yang Liu, Daniel Gebrezgiabhier, Adithya S. Reddy, Evan Davis, Yihao Zheng, Jorge L. Arturo Larco, Albert J. Shih, Aditya S. Pandey, and Luis E. Savastano

In Brief

This cadaveric study enhances the understanding of the failure modes of thrombectomy in stroke and provides new knowledge for the development of next-generation devices and techniques. The artery/device/clot interactions were analyzed in more than 100 recanalization attempts with aspiration catheters and stent retrievers by transmural visualization, revealing intraluminal clot fragmentation and iatrogenic embolization, weak device/clot integration with persistent occlusion, residual occlusion in small branching and perforating arteries, arterial collapse, and arterial traction with avulsion.

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Julia R. Schneider, Amrit K. Chiluwal, Mohsen Nouri, Giyarpuram N. Prashant, and Amir R. Dehdashti

In Brief

The authors sought to investigate use of the retrosigmoid transhorizontal (RSTH) approach to dissect the horizontal fissure and to gain better access for resection of lateral pontine cavernous malformation. This approach had a shorter operative time than the transpetrosal presigmoid retrolabyrinthine technique. Also, the RSTH approach provided a direct and safer route to the lesion via the infratrigeminal safe entry zone. The RSTH route should be considered an alternative technique for selected patients with pontine cavernous malformation.

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Philippe De Vloo, Alexandre Boutet, Gavin J. B. Elias, Robert M. Gramer, Suresh E. Joel, Maheleth Llinas, Walter Kucharczyk, Alfonso Fasano, Clement Hamani, and Andres M Lozano
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Clara Kwon Starkweather, Sarah K. Bick, Jeffrey M. McHugh, Darin D. Dougherty, and Ziv M. Williams

In Brief

In patients with obsessive-compulsive disorder (OCD), the authors evaluated the relation of the neuroanatomical location of cingulotomy treatment to symptomatic improvement to determine whether the lesion placement sites during treatment are related to responder status. Using an anatomical registration matrix, the authors found that cingulotomy lesions that were placed more superiorly and posteriorly within Brodmann area 32 conferred a higher likelihood of response, a finding that is important because the precise underlying neuroanatomical basis for the beneficial effects of this treatment in OCD patients has thus far been poorly understood.

Open access
Takashi Morishita, Yuki Sakai, Hitoshi Iida, Saki Yoshimura, Atsushi Ishii, Shinsuke Fujioka, Saori C. Tanaka, and Tooru Inoue

In Brief

This study aimed to evaluate the relationships between the anatomical location of stimulation fields and clinical responses in thalamic deep brain stimulation for treatment-resistant Tourette syndrome. The existence of a sweet spot to ameliorate the tic symptoms and the stimulation field associated with limbic side effects was revealed. This study demonstrates one strategy for effective deep brain stimulation lead implantation and programming.

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Ana M. Castaño-Leon, Marta Cicuendez, Blanca Navarro-Main, Igor Paredes, Pablo M. Munarriz, Amaya Hilario, Ana Ramos, Pedro A. Gomez, and Alfonso Lagares

In Brief

Researchers described the presence of macroscopic traumatic axonal injury-related lesions by conventional MRI and alterations in fractional anisotropy in 28 white matter bundles by diffusion tensor imaging in 277 patients with moderate to severe TBI. The combination of the information provided by the two neuroimaging techniques in a model improved the performance of the model compared to traditional prognostic models, suggesting a complementary role. External validation of the new model has yet to be determined.

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Jin Young Youm, Jae Hoon Lee, and Hyun Seok Park

In Brief

The exact method of defining the boundary in the optic nerve sheath diameter (ONSD) measurements has not been determined. The authors aimed to compare different methods of obtaining this measurement. They found that, compared with the ONSD excluding the dura mater, the ONSD including the dura mater better estimated the intracranial pressure (ICP). The ONSD/eyeball transverse diameter ratio including the dura mater with a cutoff value of 0.264 best predicted increased ICP. This measurement may be helpful in patients who require invasive ICP monitoring.

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Brian H. Rowe, Esther H. Yang, Lindsay A. Gaudet, Leeor Eliyahu, Daniela R. Junqueira, Jeremy Beach, Martin Mrazik, Garnet Cummings, and Donald Voaklander

In Brief

This study examined the differences in outcomes and risk factors for persistent symptoms between men and women in a community sample of adult patients with concussion who presented to three Canadian emergency departments. While demographic differences between the sexes were uncommon, women reported more symptoms and experienced a delay in recovery after discharge. These results represented real-world evidence of sex differences in patients with concussion and reinforced the need to consider patient sex in the management and future research.

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Neha Siddiqui, Ryan G. Chiu, Ravi S. Nunna, Georgia Glastris, and Ankit I. Mehta

In Brief

Researchers determine the impact of the FDA Safety Innovation Act (SIA), which is meant to increase diversity in clinical trials for device approvals, on neurosurgical devices. It was found that race and ethnicity were significantly different from the general population in neurosurgical device trials, both before and after the implementation of the SIA. This study demonstrates the need for more effective mechanisms to increase participant diversity in the realm of neurosurgery device clinical trials.

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Robert Herrmann, Maureen Dreher, Andrew Farb, Michael Hoffmann, Christopher M. Loftus, Nina Mezu-Nwaba, Vivek Pinto, Xiaolin Zheng, and Carlos Peña

In Brief

The authors provided an overview of FDA efforts to facilitate the initiation of early feasibility clinical studies using novel neurological and physical medicine devices. The FDA uses several approaches to work with innovators and developers to initiate these early feasibility clinical studies in the US. The approaches outlined in this article will help ensure that high-quality, safe, and effective neurological devices reach US patients in a timely manner.

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Luke G. F. Smith, E. Antonio Chiocca, Gregory J. Zipfel, Adam G. F. Smith, Michael W. Groff, Regis W. Haid, and Russell R. Lonser

In Brief

The authors assessed the association among promising neurosurgeon-scientists of being awarded Neurosurgery Research and Education Foundation (NREF) in-training and early career funding with subsequently receiving National Institutes of Health (NIH) funding. The study results indicate that a significant portion of awardees of NREF grants went on to obtain NIH funding, which resulted in a large multiplicative impact of NREF in-training and early career funding.

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Wuyang Yang, Jordina Rincon-Torroella, James Feghali, Adham M. Khalafallah, Wataru Ishida, Alexander Perdomo-Pantoja, Alfredo Quiñones-Hinojosa, Michael Lim, Gary L. Gallia, Gregory J. Riggins, William S. Anderson, Sheng-Fu Larry Lo, Daniele Rigamonti, Rafael J. Tamargo, Timothy F. Witham, Ali Bydon, Alan R. Cohen, George I. Jallo, Alban Latremoliere, Mark G. Luciano, Debraj Mukherjee, Alessandro Olivi, Lintao Qu, Ziya L. Gokaslan, Daniel M. Sciubba, Betty Tyler, Henry Brem, and Judy Huang

In Brief

The object of this paper was to demonstrate the academic impact of international research fellows in the field of neurosurgery. Despite facing major challenges, international research fellows make substantial academic contributions and reciprocate mentorship in the neurosurgical department. This finding should encourage continued recruitment of global talents to the field of neurosurgery.

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Sakibul Huq, Chris A. Philips, Walavan Sivakumar, David L. Dornbos III, Christopher S. Graffeo, Debraj Mukherjee, Stacey Q. Wolfe, and Jeremiah N. Johnson
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Nathan Beucler, Aurore Sellier, and Arnaud Dagain
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Chidinma M. Wilson, Nolan J. Brown, and Donald K. E. Detchou
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Rakesh Mishra, Adesh Shrivastava, Sumit Raj, Pradeep Chouksey, and Amit Agrawal
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Ariana Alejandra Chacón-Aponte, Erika Andrea Durán-Vargas, Ivan David Lozada-Martínez, Yelson Alejandro Picón-Jaimes, Tariq Janjua, and Luis Rafael Moscote-Salazar
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Robert N. Holdefer, Christoph N. Seubert, Stanley A. Skinner, and Andrew T. Humbert
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In Brief

The authors retrospectively assessed the safety, efficacy, and scale of off-label aneurysm treatment with the Pipeline embolization device at an experienced center. Across 416 aneurysms, they found that off-label use was common and had similar efficacy as on-label use, but with a higher rate of ischemic complications that was within the prespecified safety criteria of earlier trials but nonetheless demands attention. These performance data highlight the scale and feasibility of off-label use of the Pipeline embolization device in real-world practice.

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In Brief

The authors investigated potential causes of verbal fluency decline in subthalamic nucleus deep brain stimulation (STN DBS) for Parkinson disease. They found that DBS lead penetration of a Broca area to (lateral) superior frontal gyrus fiber pathway negatively impacted verbal fluency more than did active contact location. Avoidance of the Broca–lateral SFG pathway during surgical planning may spare verbal fluency while preserving excellent motor outcomes in STN DBS for Parkinson disease.

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In Brief

This study examines pre- and perioperative risk factors for diabetes insipidus (DI) among more than 2500 transsphenoidal surgery patients. Intraoperative CSF encounter, craniopharyngioma diagnosis, postoperative hyponatremia, and young age all increased the risk of postoperative DI. When solely examining pituitary adenomas, young age and CSF encounter increased DI risk. As the largest patient series on this topic, this study identifies which patients should be more diligently followed to quickly identify and treat postoperative DI.

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In Brief

In this study, researchers compared the healthcare utilization in elderly patients with trigeminal neuralgia (TN) managed using surgery, radiosurgery (RS), or percutaneous techniques (PTs). Surgery was the most durable procedure with the least number of subsequent procedures, followed by RS and PTs over 5 years. PTs resulted in the highest utilization of healthcare resources and need for reoperations. These findings may be considered for informed decision-making in elderly patients with TN.

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In Brief

The authors attempted to determine whether an intra-arterial injection of mesenchymal stem cells (MSCs) after endovascular stent placement in an animal model would improve endothelialization and reduce thrombus formation. Optical coherence tomography showed improved endothelialization following MSC injection, but there was no effect on thrombus formation. MSCs may be exploited to augment the integration of endovascular stents into the vessel wall, but additional studies are needed to determine the durability and mechanism of this effect.

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In Brief

The authors examined the types and prevalence of motor speech changes with subthalamic nucleus deep brain stimulation (DBS) for Parkinson's disease, as well as their relationship to preoperative speech, intraoperative testing, and postoperative lead localization. They found that intraoperative motor speech examination strongly predicted postoperative outcomes and that stimulation sites associated with maximal Movement Disorder Society Unified Parkinson's Disease Rating Scale improvement and worsened dysarthria were distinct. This study indicated that DBS electrode repositioning could reduce dysarthria while maintaining motor improvement.

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In Brief

The objective of this paper was to review a single-surgeon case series of 37 patients who underwent deep brain stimulation (DBS) system reimplantation after explantation for infection to identify factors contributing to recrudescent infection. Only patients with cerebritis suffered recrudescent infection, and those patients had an extremely high rate of reinfection. The authors review the largest case series of DBS system reimplantations to date and elucidate a novel and significant risk factor for recrudescent reinfection.

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In Brief

Endoscopic colloid cyst removal relies on a transforaminal corridor, but colloid cysts between the fornices and leaflets of the septum pellucidum are not amenable to a transforaminal route. The objective of this paper was to describe the anatomical features of and endoscopic technique for intraseptal colloid cysts. The authors provide convincing evidence that this colloid cyst variant can be treated with an endoscopic transseptal-interforniceal approach, thus expanding the established benefits of neuroendoscopy to patients with this variant.

Free access

In Brief

The aim of this study was to validate the efficacy and safety of the updated Brain Injury Guidelines (uBIG) for complicated mild traumatic brain injury. The authors found that the uBIG accurately identified high-risk patients who died or received neurosurgical intervention. These results could lead to the implementation of a new clinical decision rule like the uBIG in emergency departments to care for patients with complicated mild traumatic brain injury.

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In Brief

Although bipolar disorder is a leading cause of disability globally, little is known about why some patients respond to therapy and others are refractory, precluding the development of an effective treatment for patients with refractory disease. The authors investigated brain circuitry in subjects with refractory bipolar disorder compared to subjects responsive to therapy and healthy controls. Key differences between groups were identified, suggesting that aberrant brain circuitry in patients with refractory disease may represent a future surgical target for deep brain stimulation.

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In Brief

The authors explored complication-related factors influencing cranioplasty timing following traumatic brain injury (TBI), as the "3-month rule" is unfounded but widely quoted. No difference was found in the incidence of complications when the time after craniectomy was divided into early (≤ 90 days), intermediate (91–180 days), and late (> 180 days) periods, or for a subset of "ultra-early" procedures. Demonstrating the safety of early cranioplasty allows us to realize its clinical and systemic benefits after TBI (e.g., fewer trephination-syndrome effects, shorter length of stay, and fewer readmissions).

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In Brief

Through this multicenter collaboration, a connectomic analysis was performed in patients with autism spectrum disorder (ASD) who manifested extreme behaviors and underwent deep brain stimulation (DBS). Stimulation of different targets engaged similar brain circuitry closely related to the anterior limb of the internal capsule. The current work elucidates putative mechanisms by which DBS could improve symptoms of extreme behaviors in patients with ASD.

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In Brief

The authors compared the Fisch type A approach with the endoscopic endonasal far-medial supracondylar approach to the jugular foramen (JF). The endonasal route provides a direct approach to the pars nervosa (PN). The Fisch type A approach allows for more freedom of movement, but it may require sacrifice of the pars venosa to reach the PN ventromedially. The surgical maneuverability of the extreme medial approach was not found to be inferior to that of the Fisch type A approach. Select cases of chordomas, chondrosarcomas, and JF schwannomas should be considered for an extreme medial approach.

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In Brief

This article describes thoughts and concerns from neurosurgery applicants regarding the virtual recruitment format necessitated by the COVID-19 pandemic. The applicants demonstrated overwhelming support for a mix of virtual and in-person recruitment, with their biggest concern the impaired ability to assess program culture. Applicants highlighted opportunities to improve the recruitment experience, including optimized interview invitation release, centralized scheduling methods, and interview caps for applicants.

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In Brief

Because management of giant pituitary macroadenomas presents a significant challenge, the authors describe surgical nuances and outcomes in the treatment of a large series of patients with these lesions. Gross-total resection was only 38.9%, but tumor stability was achieved in 71.3% with a morbidity rate of 11.1%. Surgical goals for removal of giant pituitary tumors should include attempts at maximal safe resection to minimize the risk of residual tumor apoplexy by tailoring the approach along the major axis of the tumor.

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In Brief

Treatment options for recurrent brain tumors may be limited. The authors examined the initial safety and efficacy of resection plus cesium-131 brachytherapy in a robust institutional experience. Interval resection with intraoperative cesium-131 brachytherapy implantation was a safe and effective salvage therapy for recurrent brain tumors. This study provides important clinical evidence to support the use of CNS-directed brachytherapy as a part of effective interdisciplinary management of recurrent brain tumors.

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In Brief

Accurate stratification of the stability of unruptured intracranial aneurysms (IAs) is crucial to guide treatment decisions in affected patients. In this prospective study, the authors aimed to develop multidimensional models to predict the 2-year stability of unruptured IAs treated conservatively, incorporating clinical features, morphological features, and adjacent hemodynamic features. The multidimensional models had higher predictive accuracies than previous models, which may yield a valuable tool for individualized risk assessment of unruptured IAs in the anterior circulation.

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In Brief

The authors aimed to assess aneurysm wall enhancement (AWE) in unruptured posterior communicating artery (PcomA) aneurysms with oculomotor nerve palsy, which can be a subgroup of evolving aneurysms with high rupture risk. The degree of AWE in PcomA aneurysms with oculomotor nerve palsy was higher than that in asymptomatic growing PcomA aneurysms. This finding suggests the potential utility of AWE for risk stratification in evolving aneurysms.

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In Brief

In this prospective, longitudinal cohort study with 659 acromegaly patients, the authors investigated the immediate and long-term endocrine outcomes after initial transsphenoidal surgery based on the strict 2010 remission criteria, analyzed the clinical determinants, and explored the patterns of outcome changes during a long follow-up (median 51 months). This study will assist in informing patient consultations on possible treatment outcomes and planning for individualized adjuvant treatments in advance.

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In Brief

The aim of this study was to develop and validate an updated prediction model for survival estimation in patients with isocitrate dehydrogenase wild-type glioblastoma. The study found that individualized estimates of survival time can be obtained with reasonable accuracy from the updated prediction model. The different tools from this study, including a user-friendly web application, can be used pre- and postoperatively by health care professionals to explain the anticipated outcome of treatment.

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In Brief

This project set out to determine the socioeconomic correlates with the neurosurgical workforce in the US. Key findings include greater average distances to access neurosurgical care for Hispanic and Native American populations. Methods to reduce these disparities are still to be determined.

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In Brief

There are few prior studies of giant pituitary adenomas (≥ 4 cm at maximum diameter) and those that exist are from high-volume institutions whose outcomes may not be representative of many cancer centers. In this study, 3696 adults with giant pituitary adenomas were identified from a large national cancer registry. This population had significantly worse morbidity and mortality than did patients with nongiant pituitary adenomas. Outcomes were significantly better at high-volume facilities than low-volume facilities.

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In Brief

This study examines the rates of Clostridioides difficile infection, postprocedural infection, and EVD-associated infection after limiting the administration of postoperative antimicrobial prophylaxis to 24 hours. C. difficile rates declined without a concomitant increase in infection rates. This work supports limiting the duration of postoperative antimicrobial prophylaxis across neurosurgical procedures.