Volume 134: Issue null (May 2021)
inJournal of NeurosurgeryIllustration from Bährend et al. (pp 1409–1418). Copyright Katharina Faust. Published with permission.
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In Brief
The authors' study uses one of the largest sets of patients with oligodendroglioma, extracted from the National Cancer Database, to perform a side-by-side analysis of the correlates and survival benefit of extent of resection in patients with these tumors. This result is important as it corroborates national guidelines and reassures the field of neurooncology that, despite the reclassification of oligodendrogliomas, our treatment techniques remain valid.
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In Brief
The authors applied spherical deconvolution tractography to investigate the presence of microstructural changes of the corticospinal tract (CST) in IDH1 glioma patients compared to healthy volunteers. They then correlated the microstructural changes observed in the CST to the presence of an altered excitability of the motor cortex, as measured by transcranial magnetic stimulation (TMS). This is the first time that a neurophysiological measurement has been used to investigate the meaning of white matter changes in the CST. The combination of advanced tractography and TMS can detect preclinical changes affecting the motor system in patients with low-grade gliomas.
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In Brief
The authors assessed risk factors for rapid growth in neurofibromatosis type 2 (NF2)–associated intracranial meningiomas and validated the recently published Asan Intracranial Meningioma Scoring System score. They found that the scoring system provides a good estimate of the overall risk of rapid tumor growth in these meningiomas. One of the challenges of managing multiple meningiomas in NF2 patients is to choose which tumor to treat, allowing best benefit/risk balance. Thus, estimating which meningiomas are most likely to grow rapidly is of great interest.
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In Brief
The authors developed a "Safe Transitions Pathway" (STP) for postoperative recovery after elective craniotomies so that selected neurosurgical patients were able to bypass the ICU. STP patients had shorter lengths of stay and no serious adverse events or complications. Patients and nursing staff did not report adverse recovery experiences, and direct costs were lower for the hospital. This report will be useful for other institutions interested in creating a recovery pathway that maximizes patient safety and resources to deliver efficient and effective care.
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In Brief
Although numerous publications have reported surgical techniques, relatively few have reported disease-related outcomes in the management of cancers of the anterolateral skull base and infratemporal fossa (ITF). To help shed light on the surgical and management challenges unique to carcinomas involving the ITF, the authors performed a retrospective review of their institutional experience. They demonstrated that resection for anterolateral skull base carcinomas in selected patients whose tumors are considered resectable can help to achieve long-term outcomes similar to those reported for carcinomas at other anatomical sites.
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In Brief
The authors evaluated the largest sample of patients with familial chordoma with and without T gene duplications and compared them to white patients with sporadic chordoma in the United States general population reported to the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Several features including young age at diagnosis, skull base presentation, or multiple primary chordomas were related to a positive family history and would suggest the opportunity for screening at-risk family members by MRI for early detection of chordoma.
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In Brief
The authors compared a noninvasive method of language localization in the human brain to the current gold standard, which involves electrical stimulation of the cortex during awake surgery. The development of reliable noninvasive methods of language localization can reduce risks during awake surgery and can increase our understanding of how language functions.
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In Brief
Through a combined tumor tissue analysis and MRI study of tumor vascularity, the researchers sought to compare differences in the tumoral microenvironment between sporadic and NF2-related vestibular schwannomas (VSs). They demonstrate that despite the considerable variation in clinical behavior between these tumors, in terms of their underlying inflammatory and microvascular characteristics, they are strikingly similar. These findings suggest that in both sporadic and NF2-related VSs, inflammation may be a relevant therapeutic target.
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In Brief
As use of radiosurgery for extensive brain metastases expands rapidly, it is critical to understand the dosing characteristics. The authors calculated the dose to the whole brain and hippocampal structures after Gamma Knife stereotactic radiosurgery (GKSRS) for extensive brain metastases. Patients treated for ≥ 15 brain metastases had a mean brain dose of 2.58 Gy; only 0.9% of the brain received a 12-Gy dose. There was no correlation between the number of metastases and the mean dose to the brain. GKSRS provides a relatively low dose of radiation to the brain, supporting continued escalation of treating multiple metastases with SRS.
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In Brief
This article highlights the predictors of visual outcomes in patients with cavernous sinus meningioma and further signifies the importance of pretreatment visual functional assessment in these patients.
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In Brief
For patients with resected brain metastases, the authors compared clinical outcomes (local disease control, distant brain disease control, and survival) for treatment with radioactive cesium-131 brachytherapy seeds and postoperative radiosurgery. The authors showed improved local control of disease with brachytherapy. This potentially provides an alternative or possibly superior treatment choice for these patients.
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In Brief
Stereotactic radiosurgery for central neurocytoma has been considered as an alternative to surgery or radiotherapy almost always in instances of residual or recurrent tumors following prior treatment or in patients with an inoperable condition. In this study, Gamma Knife radiosurgery proved to be safe and effective in newly diagnosed cases without previous surgical treatment. With adequate selection criteria, Gamma Knife radiosurgery deserves to be a primary treatment modality for central neurocytoma.
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In Brief
In this study, the authors evaluated the performance of previously published prediction scores for improvement after surgery in adult Chiari malformation type I. They found that these scores had a poor predictive ability and suffered from several limitations. Their critical analysis allowed them to identify gaps and suggestions for the development of future prediction algorithms that may serve to improve the decision-making process (surgery vs observation) in adult Chiari malformation type I.
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In Brief
The authors evaluated surgical outcomes of using the endoscopic transorbital approach (eTOA) with a superior eyelid incision as a minimally invasive technique for treatment of spheno-orbital meningiomas (SOMs). These tumors have high levels of infiltrative growth and complexity involving multiple structures at initial presentation and cannot be completely removed with conventional transcranial surgery, which can also result in serious cosmetic issues such as bony depression. An important finding was that eTOA for SOM had clinical outcomes comparable to those for transcranial surgery but without major postsurgical cosmetic defects.
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In Brief
The authors describe the surgical technique obtained by enlarging the anteromedial triangle. It is significant because it can provide a useful corridor to the nasal cavity and sinuses.
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In Brief
Identification of the motor area during awake craniotomy is essential for preservation of motor function when resecting glioma within or close to the motor area or pyramidal tract. The authors believe that their study makes a significant contribution to the literature because its results show that identification of the motor area can be difficult when a supratentorial glioma is localized to the precentral gyrus.
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In Brief
The authors sought to understand the common reasons for readmission in patients who have undergone mechanical thrombectomy and identify the predictors that led to readmission. Infection was the most common cause of 30-day readmission, followed by cardiac and cerebrovascular diagnoses and hypertension, and hospital length of stay and postprocedural hemorrhage were strong predictors of 30-day readmission in stroke patients who underwent mechanical thrombectomy. This study is a preliminary effort to better understand the nuances of stroke care and reduce preventable causes of readmission.
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In Brief
The objective of this study was to reveal relevant factors that may impact postoperative outcome and to establish a scoring system to predict the functional outcome of moyamoya disease. This is the first study to address a preoperative scoring system for moyamoya disease, using various parameters to predict postoperative outcome in relatively large internal and external cohorts, and to have confirmed its clinical value.
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In Brief
A microRNA (miRNA) array was used to identify candidate miRNAs, and then Western blotting, quantitative real-time polymerase chain reaction, and miRNA antagomir intervention were used to verify the results of the miRNA array. The authors found that thrombin reduces hypoxia inducible factor–1α degradation and initiates angiogenesis by increasing miR-24, which targets prolyl hydroxylase domain 1 after intracerebral hemorrhage (ICH). The findings revealed a new mechanism for how thrombin, a unique post-ICH angiogenic promotor, initiates the process of angiogenesis after ICH, which will help to improve the understanding of cerebral recovery after hemorrhagic injury and develop novel therapeutic strategies.
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In Brief
这项研究说明了入侵的有效性neuromonitoring (INM) in patients who cannot be examined due to their poor-grade subarachnoid hemorrhage (SAH). In patients who underwent INM, delayed cerebral ischemia events were detected earlier and therefore treated faster than events in a group of patients treated before the introduction of INM, resulting in a better outcome. To the authors' knowledge, this is the largest SAH cohort in which INM has been examined. The authors believe the results of this trial can upgrade existing evidence and recommendations concerning the use of brain tissue oxygen monitoring and cerebral microdialysis in SAH patients.
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In Brief
In this study the authors first clarified the underlying mechanism of spontaneous angiogenesis after indirect bypass surgery for moyamoya disease. The findings strongly suggest that platelet-derived growth factor receptor–α signal may play an important role in developing spontaneous angiogenesis between the temporal muscle and neocortex after encephalomyosynangiosis in moyamoya disease.
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In Brief
The authors found that intraarterial indocyanine green (ICG) videoangiography was more useful than intravenous ICG videoangiography in surgery for cerebral arteriovenous malformations. It was especially effective in the identification of the feeders, nidi, and drainers and in the assessment of the flow dynamics of the nidus. Use of Flow 800 made it simpler and easier to evaluate these findings.
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In Brief
In this post hoc analysis, the authors identified patients at high risk for vasospasm-related morbidity and mortality, as well as poor long-term clinical outcome, based on the burden of subarachnoid hemorrhage shown on CT scans, using the data from the CONSCIOUS-2 and CONSCIOUS-3 studies. Future clinical trials may consider directing attention to the group of high-risk patients with thick, diffuse clots, given their high tendency for vasospasm-related morbidity and mortality.
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In Brief
In this study, the authors compared long-term patency rates between autologous and cadaveric saphenous vein grafts (SVGs) in cerebral revascularization surgery. In the largest series to date, they demonstrated that patency rates of cadaveric SVGs are similar to those with autologous grafts and that cadaveric SVGs are a reasonable graft option for cerebral bypass procedures.
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In Brief
The authors compared the RECO flow restoration device with the Solitaire flow restoration stent retriever in acute ischemic stroke caused by large vessel occlusion. The primary efficacy endpoint (modified thrombolysis in cerebral infarction reperfusion grade ≥ 2 within three passes) was similar in the two groups. No serious adverse device effects occurred. Rates of symptomatic intracerebral hemorrhage and serious adverse effects were similar in the groups. There was no significant difference in the rates of functional independence or 90-day all-cause mortality or in procedure duration between the groups. The RECO stent retriever is effective and safe as a mechanical thrombectomy device.
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In Brief
The authors individualized moyamoya disease treatment (direct vs indirect bypass) based on preoperative and intraoperative patient factors to determine the ideal modality. They found that a direct bypass provides superior increase in blood flow to the brain with a comparable low risk of complications. These findings will guide other neurosurgeons in their choice of treatment.
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In Brief
增压end-to-side(集)神经传递is a surgical technique with great potential to improve functional outcomes after peripheral nerve injuries. However, its widespread use by peripheral nerve surgeons is hindered by a complicated and poorly understood biology. This review gives a structured approach for surgeons and scientists to evaluate the current applications and limitations of the SETS transfer. It also highlights opportunities for further investigation into the underlying mechanisms.
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In Brief
The authors found that the application of chondroitin sulfate proteoglycan (CSPG) coverage to the nerve stump helps to block irregular axon regeneration in terminal neuroma, and it is beneficial to relieve neuroma-related pain symptoms after sciatic nerve transection in Sprague Dawley rats. The results indicate that covering the proximal nerve stump with CSPGs may be a new and promising strategy to prevent traumatic painful neuroma formation in a clinical setting.
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In Brief
This study assessed the clinical risk of intraoperative seizures and afterdischarges in the setting of awake mapping. This work is important as it provides clinical insight to a known complication within awake mapping.
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In Brief
The authors examined which factors have an impact on the clinical outcome of MRI-guided focused ultrasound (MRgFUS) thalamotomy for essential tremor. MRgFUS is a novel and useful treatment for essential tremor; however, the factors affecting treatment outcome are unknown. This report is useful for the future study of target patients and the prediction of clinical outcome.
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In Brief
In this study, the authors evaluated changes in weight following deep brain stimulation surgery. Changes in weight can be alarming or distressing to patients. Understanding the associations with such changes following deep brain stimulation surgery can help clinicians inform patients and mitigate such changes.
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In Brief
The authors sought to determine clinical and imaging characteristics that may be useful in preoperative assessment of neurosurgical patients who may benefit from awake craniotomies. Important findings were that preoperative physical status was the most decisive factor in predicting whether patients can tolerate an awake craniotomy without complications, whereas older age and history of psychiatric treatment were not necessarily associated with adverse events. This study is important because it demonstrates that careful preoperative patient selection is the key to success for awake surgery.
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In Brief
The authors created an inexpensive brain model that was easy to produce and therefore easy to replicate for the purpose of ventricular catheter placement training. This model may be useful for neurosurgery resident training, especially in institutions with limited resources.
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In Brief
The authors' group has previously shown that the innate immune response after traumatic brain injury is regulated in part by the inflammasome. In this study they expand clinical knowledge about the inflammasome in a group of patients with severe traumatic brain injury. The authors believe that the study of the temporal profile of fluid biomarkers could be useful to plan therapeutic interventions in the future.
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In Brief
In this study the authors studied intracranial elastance in a cardiac-gated manner in a swine model of brain edema. Measuring elastance in this way may improve the ability to predict which brain-injured patients may be at risk for sudden untoward deterioration due to brain swelling.
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In Brief
This study represents the second largest series of non-missile penetrating head injuries published to date. A detailed statistical analysis of the data was conducted and revealed risk factors for vascular and infectious complications. The results were used to recommend management strategies for these injuries, which have not been previously defined.
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In Brief
Obesity is frequently a significant problem in trauma patients but may also have a protective effect, the "obesity paradox," likely attributable to obesity-related attenuation of the inflammatory response and influences on posttraumatic physiology. The authors investigated the influence of obesity on the outcomes of patients with severe blunt traumatic brain injury (TBI), in whom outcome is often influenced by physiological variables. The findings that obesity is not protective for mortality after severe blunt TBI and that complication rates are increased in both obese and underweight patients will be useful in guiding future investigations.
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