Volume 132: Issue 5 (May 2020)
inJournal of NeurosurgeryIllustration from Ivan et al. (pp 1517–1528). Copyright Kenneth Probst. Published with permission.
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In Brief
The authors studied the association between apnea and seizure activity by investigating recorded data from patients in an epilepsy monitoring unit. They found that central apnea was correlated with seizure spread to the amygdala, which suggests that this region is important for the onset of respiratory dysfunction in epilepsy patients and may be important in the pathophysiology of sudden unexpected death in epilepsy.
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In Brief
The authors identified differences in brain networks prior to temporal lobe epilepsy surgery that lead to different seizure outcomes. This information can be used to identify the patients who will most benefit from surgical treatment.
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In Brief
The authors examined the yield of noninvasive modalities such as voxel-based morphometric MRI postprocessing, FDG-PET, subtraction ictal SPECT coregistered to MRI (SISCOM), and magnetoencephalography (MEG) in a cohort of patients with operculoinsular epilepsy and negative MRI. Presurgical evaluation of operculoinsular epilepsy presents particular challenges, which the authors attempted to meet in this study.
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In Brief
The authors performed a retrospective analysis of a prospectively collected series of 42 consecutive patients undergoing posterior quadrant disconnection for epilepsy surgery. In the field of posterior quadrant disconnection, this represents the largest series with the longest follow-up. For the first time, outcome predictor analysis, neuropsychological outcome, and SEEG methodology application are described. Moreover, surgery was tailored based on the anatomo-electro-clinical correlations.
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In Brief
The authors used micro-electrocorticography (µECoG) on the sensorimotor cortex to examine corresponding patterns of neural activity associated with finger movements. The findings may provide insight into the tuning of the motor cortex toward specific types of motor behaviors and may aid in the refinement of brain-computer interface control algorithms, which are highly relevant for overall therapeutic efficacy and application to neuroprosthetics.
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In Brief
The authors compared two large-scale clinical trials of deep brain stimulation for Parkinson’s disease to determine which factors account for differences in the reported outcomes. This analysis reveals that differences between these two major studies can be attributed to preoperative patient characteristics, most notably levodopa responsiveness, and emphasizes the importance of the preoperative selection criterion of levodopa response.
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In Brief
For the first time, researchers have reported comparative device and therapy failure rates out to 15 years for hundreds of DBS, SCS, and VNS patients at a single institution over 22 years. These results provide the fundamental statistics necessary for clinicians to answer patients when asked how long they can expect to utilize both their device and therapy and, by analyzing these aspects separately, the authors have demonstrated that all three therapies maintain therapeutic efficacy beyond initial device failures - an important distinction to emphasize when counseling patients in light of the well-established complication rates associated with these devices.
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In Brief
Magnetic resonance–guided focused ultrasound (MRgFUS) is shown to be both a safe and effective treatment of essential tremor (ET) for patients previously excluded from treatment due to presumed unsuitable skull density ratios (SDRs). Because an SDR cutoff of 0.45 ± 0.05 served as exclusion criterion from past clinical trials evaluating MRgFUS for ET, these findings represent an immediate opportunity for more patients to access this modality as an alternative to current therapy.
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In Brief
The authors report on a series of cases in which they were able to treat infection of intrathecal baclofen pumps by explanting the infected pump and reimplanting a new pump in the same procedure. This allows for optimal resolution of the infection, while minimizing the risk of baclofen withdrawal.
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In Brief
Authors of this study examined the effectiveness of treating patients with trigeminal neuralgia and multiple sclerosis via initial or repeated percutaneous glycerol injections. This is the largest study to assess the efficacy of these procedures, totaling 401 injections over 35 years, and to show that patients with multiple sclerosis can achieve meaningful and lasting pain relief with efficacy comparable to that in patients with idiopathic trigeminal neuralgia.
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In Brief
The authors undertook this study to further understanding of the complex anatomy of the foramen ovale as related to treatments such as percutaneous stereotactic radiofrequency rhizotomy. Six anatomical foramen ovale shapes appeared to change predictably in the surgical perspective and to affect accessibility. Anatomical illustrations and photographs reinforce understanding of normal and variable anatomy. Morphometric findings bring insights from both anatomical and surgical perspectives, which are important for surgeons performing percutaneous stereotactic radiofrequency rhizotomy cannulation of this foramen.
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In Brief
Whole exome sequencing results of 25 adult diffuse gliomas were analyzed. The study reveals that DNA damage repair deficiency may play an important role in glioma formation.
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In Brief
The authors retrospectively reviewed their experience treating 1139 meningioma patients and report the observed incidence of extracranial meningioma metastases. They also report their results of screening meningioma patients for extracranial metastases; using their screening criteria (greater than two prior recurrences), they found that the number needed to screen is 3.83 to identify one patient with extracranial metastases. This is important because it will help guide the management of patients with multiply recurrent meningioma, and it provides a proposed screening algorithm for meningioma metastases.
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In Brief
The authors examined the effects of regulation of glycolysis by miR-448 in the response of glioma cells to radiation treatment. The results suggest that miR-448 can promote radiosensitivity by negatively regulating glycolysis in glioma through a newly identified miR-448–HIF-1α axis that may be a valuable therapeutic target in glioma treatment.
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In Brief
用核磁共振光谱和perfusion imaging, the authors compared the anisotropic abnormality revealed by diffusion tensor imaging to the contrast-enhancing (CE) tumor region. The results showed that the anisotropic abnormality may indicate a hypoxic region, while the CE volume showed aberrant neovascularization. A prognostic quantitative measure can be obtained to evaluate glioblastoma aggressiveness, by integrating the volumes of two regions. The findings suggest that combining both tumor regions may lead to better surgical targeting.
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In Brief
The authors conducted a radiosurgical treatment planning study, comparing parameters for the treatment of multiple large brain metastases using Gamma Knife and CyberKnife systems to parameters from treatment plans that had been generated for patients undergoing radiosurgery with a linear accelerator. It is important to identify the most suitable treatment modality for the individual patient, in terms of both plan quality and efficiency of delivery.
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In Brief
Using the updated Japanese Leksell Gamma Knife study 0901 data set plus detailed enhanced MRI observations, the authors applied sophisticated statistical methods, such as competing risk analysis and propensity score matching, and performed a case-matched study. The authors proved that the incidences of local tumor progression after Gamma Knife radiosurgery without whole-brain radiation therapy, as well as tumor recurrence and radiation necrosis, does not differ between patients with 5–10 brain metastases and those with 2–4.
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In Brief
The authors performed the first study regarding the use of sodium fluorescein to guide the resection of pituitary adenomas. Their results imply an important advancement in pituitary surgery, minimizing its risks and maximizing safe resection, which translates into better outcomes for the patients.
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In Brief
The authors studied the prognostic role of doses to neuroanatomical structures in Gamma Knife radiosurgery of pituitary adenomas for long-term clinical outcomes and pituitary function. Patients who are treated with a high dose of radiation to the pituitary stalk relative to the normal gland are at a higher risk of developing endocrinopathy. Optimization of the gradient index toward the stalk and normal gland may help preserve endocrine function.
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In Brief
The role of primary stereotactic radiosurgery in patients with medically refractory acromegaly who are not operative candidates or refuse resection is poorly understood. Currently, there are few studies that have analyzed the results of primary stereotactic radiosurgery for acromegaly, and the effectiveness of primary versus conventional postoperative stereotactic radiosurgery for these patients is unknown. Therefore, the aim of this multicenter, retrospective matched cohort study was to compare the outcomes of primary versus postoperative stereotactic radiosurgery for the treatment of patients with acromegaly who had similar radiological and endocrinological disease burdens prior to stereotactic radiosurgery.
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In Brief
The authors reviewed their surgical experience with anterior communicating artery aneurysms and introduce the A1-A2 junctional triangle and A1-A1 precommunicating triangle to identify safe corridors for access and microsurgical clipping.
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In Brief
The authors retrospectively analyzed the medical records of 1291 patients who underwent elective intracranial tumor surgery by a single surgeon with respect to their use of aspirin (ASA) and found no effect on complication rate. This is important because the data suggest that patients under ASA treatment can maintain ASA in elective craniotomy without increased risk of complication.
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In Brief
The current study analyzes the impact of aneurysm shape and configuration of the aneurysm neck on cerebral infarction in patients undergoing microsurgical clipping of intracranial aneurysms. A better understanding of the factors that increase the risk of infarction should help to improve outcomes for patients with intracranial aneurysms.
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In Brief
This study is important to emphasize that even patients with so-called asymptomatic cerebral arteriovenous malformations can present with neurocognitive impairment.
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In Brief
The authors explored the use of the Rivermead Post-Concussion Symptom Questionnaire as a means of identifying patients with a cluster of residual symptoms after aneurysmal subarachnoid hemorrhage (aSAH), which they have termed post-aSAH syndrome. This symptom cluster, which has not been previously described, has important negative effects on patient’s quality of life and overall function. Identifying patients with post-aSAH syndrome is a key step in providing appropriate rehabilitation that addresses the complexity of their needs.
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In Brief
The authors provide direct evidence to support the hypothesis that elevation of vascular endothelial growth factor increases the chance of bleeding from brain arteriovenous malformation lesions, which is unpredictable and life threatening. This study indicates that inhibition of angiogenesis could reduce bleeding from malformed vessels.
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In Brief
The authors compared hemodynamic analysis using quantitative digital subtraction angiography (QDSA) with angioarchitecture analyses using conventional DSA for evaluating the risk of supratentorial arteriovenous malformation (AVM) hemorrhage. Important findings were that a stasis index (ratio of the inflow to outflow gradient) of the most dominant drainage vein, measured with QDSA hemodynamic analysis, is an independent risk factor for AVM hemorrhage and that the hemorrhagic risk models established based on angioarchitecture and hemodynamics exhibited equivalent diagnostic performance.
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In Brief
作者2相比外部心室流失(EVD) management strategies in patients with subarachnoid hemorrhage, continuous drain with gradual wean and intermittent drain with rapid wean. This study is important because it will help determine optimal strategies for management and discontinuation of EVDs.
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In Brief
The authors compared data from before and after an institutional policy change to determine whether routine screening for deep venous thrombosis affects the rates of pulmonary embolism or mortality in a neurosurgical population. They found that in their neurosurgical ICU, routine screening with ultrasonography does not appear to confer a benefit to patients beyond that obtained with selective use of ultrasonography.
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In Brief
The authors searched for factors to predict if an intracranial aneurysm will occlude after Pipeline embolization. This can help in choosing the patients who will receive the maximum benefit from this procedure.
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In Brief
The authors have developed a novel method to improve brain perfusion. This method may assist in offering a new modality of treatment for neurocritically ill patients suffering from reduced cerebral blood flow states such as in traumatic brain injury or vasospasm.
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In Brief
The authors describe the development of a scoring system to predict mortality due to subdural hematoma in elderly patients with a history of minor or no prior trauma. The Subdural Hematoma in the Elderly (SHE) score considers patient age, admission neurological status, and subdural hematoma size, and shows significant predictive ability.
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In Brief
The authors have described the association between craniectomy and the growth of contusions. Findings could have implications in the management of patients suffering traumatic brain injury.
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In Brief
The authors compared the outcomes of endoscopic treatment of patients with a recurrent colloid cyst with those of patients with a primary colloid cyst. This study is important because the data show that the minimally invasive endoscopic technique for removal of primary colloid cysts is feasible and equally safe in patients with recurrent cysts.
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In Brief
In this study the authors used cadaveric dissections to quantify the surgical area and angular and linear exposures to the lateral mesencephalic sulcus by subtemporal, paramedian, and extreme-lateral variants of the supracerebellar infratentorial approach. The findings of this study provide an important source for supporting the selection of surgical approaches to access the lateral mesencephalic sulcus.
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In Brief
Intraoperative neuromonitoring of olfaction has never been performed. A standard olfactometer was used in the surgical theater with hydrogen sulfide. Contributive recordings were obtained for 5 of 8 patients (3 patients had fewer than 70 epochs with an amplitude < 45 μV). Olfactory-evoked potentials showed N1 responses (mean 442.8 ± 40.0 msec). The study shows that olfactory-evoked potentials can be measured in response to olfactory stimuli under general anesthesia.
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