Volume 136: Issue 2 (Feb 2022)
inJournal of NeurosurgeryIllustration from Morshed et al. (pp 441–448). Copyright Kenneth Probst. Published with permission.
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In Brief
Insular gliomas invade surrounding structures not by chance but follow certain extension routes. The authors studied these patterns by analyzing the co-involvement of 12 anatomical structures at presentation in 59 patients with surgically treated gliomas and correlated these patterns with demographic, pathological, genetic, and survival data. The analysis indicated that most insular gliomas were confined to the olfactocentric girdle of the limbic system. Extension into the hippocampocentric girdle but not surrounding opercula was associated with a significantly poorer outcome.
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In Brief
The objective of this study was to establish platform-specific social media guidelines by investigating how stakeholders in the brain tumor community utilize Facebook, Twitter, and YouTube. The authors found that themes differed in popularity across platforms, and conscious incorporation of these themes into content may increase account visibility. The authors propose that medical professionals can increase online accessibility of evidence-based information and better connect with their patient populations on social media by incorporating the latest evidence from the literature and by following guidelines.
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In Brief
The researchers defined a better timing of mannitol administration during craniotomy for supratentorial tumor resection. They found that earlier administration immediately after anesthesia induction, as compared to routine administration at skin incision, improved brain relaxation upon dural opening. This study provides data on the temporal changes of mannitol's brain relaxation–improving effect, contributing to the further understanding and accurate clinical application of mannitol under various medical conditions.
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In Brief
Predicting outcomes after brain tumor surgery and adjuvant treatment is difficult due to the complex interlocking brain networks that underpin memory functioning. The authors used advanced neuroimaging to reveal that memory deficits are associated with treatment-induced disruption of the default mode network. Conversely, the microstructural properties of this network, estimated from diffusion MRI, confer memory resilience. These results suggest that brain network analysis provides quantitative information that may contribute to optimizing the onco-functional balance for patients.
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In Brief
Researchers altered the metabolism of glioblastoma and immune cells in the tumor microenvironment using a novel glutamate modulation drug, BHV-4157, in order to enhance immunotherapy. Treatment with BHV-4157 and anti–programmed cell death protein 1 immunotherapy provided a synergistic survival benefit in mice that was mediated by changes in CD4+ and CD8+ T-cell populations. These findings are pertinent because they suggest a novel combinatorial strategy that requires further investigation with preclinical and clinical studies of glioblastoma.
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In Brief
作者报告endo的安全性copic endonasal approach (EEA) and the findings of a retrospective single-center series of 1002 operations performed since 2010. Pituitary adenoma was the most common pathology treated, but a substantial portion of operations utilized expanded EEA beyond the sella. There were no intraoperative deaths. The 90-day mortality rate was very low, as was the rate of permanent neurological morbidity. The risk factors of serious postoperative complications included meningioma pathology, chordoma pathology, and expanded intradural surgery. Overall, endoscopic endonasal surgery has an acceptable safety profile at experienced centers in the modern era, with low rates of mortality and permanent morbidity.
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In Brief
The authors sought to determine whether routine fluid restriction reduces the rate of syndrome of inappropriate antidiuretic hormone secretion (SIADH) in patients with pituitary adenoma after transsphenoidal resection. In patients treated with routine postoperative fluid restriction, the SIADH rate was 5%; in patients treated without fluid restriction, the SIADH rate was 15% (p = 0.01). This study uniquely tested for confounders and found no associations between SIADH and characteristics such as use of selective serotonin reuptake inhibitor, anticonvulsant, diuretic, or antipsychotic medications; history of hypertension or lung cancer; or patient race.
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In Brief
作者实验pectively analyzed the case records of 274 patients at their institution who underwent surgery with the anterior transpetrosal approach (ATPA) from 1984 (shortly before ATPA was first reported in 1985) to 2017. This study provides data from the long history of ATPA development, including ongoing variations to minimize surgical complications during removal of petroclival lesions. Unresolved problems with currently used ATPA techniques are highlighted, along with discussion of how to reduce surgical complications.
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In Brief
This study evaluates the impact of direct surgeon feedback on surgical supply cost. The key finding from this study suggests that providing surgeons with an itemized receipt of each surgical supply raises awareness of operating room costs and may reduce the overall cost of surgical supplies.
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In Brief
The authors analyzed the clinical outcomes of patients who underwent endoscopic endonasal approach and transorbital approach procedures for lesions involving the petrous apex to determine the perspectives and proper applications of these two approaches. This is the first study about the feasibility of endoscopic endonasal and transorbital approaches to petrous apex lesions.
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In Brief
The objective of this study was to provide information about an audiovestibular symptom complex that may be associated with small, medium, or large meningiomas strategically located over the vestibular aperture and vestibular aqueduct. A key finding of this review was the fact that the majority of patients had improvement in their vestibular and tinnitus-type symptoms postoperatively. Most neurosurgeons are not familiar with the anatomy of this region or the association between this tumor location and symptom complex. With this additional knowledge neurosurgeons may be able to help symptomatic patients in the future.
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In Brief
Vessel wall MRI for intracranial aneurysms has emerged as a tool that might predict aneurysm instability. To clarify the role of aneurysm wall enhancement, the authors investigated the clinical insights into the segmentation of wall enhancement and aneurysm growth scenarios. Focal aneurysm wall enhancement was associated with bleb formation, whereas absence of wall enhancement showed aneurysm stability. The present study highlights the pattern of wall enhancement and would accelerate studies of vessel wall imaging of intracranial aneurysms.
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In Brief
The 5-factor modified frailty index (mFI-5) remains to be validated in patients with cerebrovascular pathology. The authors evaluated the association of mFI-5 score with procedural complications in patients with unruptured aneurysms treated with open and endovascular techniques. The mFI-5 score demonstrated a significant association with major complication in both surgical and endovascular institutional cohorts and outperformed other comorbidity scales included in the National Surgical Quality Improvement Program (NSQIP) database. Integration of mFI-5 into clinical workflows may improve decision-making, counseling, and optimization of patients with unruptured aneurysms for intervention.
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In Brief
The authors sought to understand the anatomic basis and surgical outcomes of arteriovenous malformations (AVMs) involving the optic apparatus, both in their experience and the literature. Managing AVMs involving the optic nerve, chiasm, and tract is challenging, but these AVMs are surgically resectable with fair outcomes. Neurosurgeons with sufficient experience can and should offer resection to patients with these rare lesions. If microsurgery is done carefully with the techniques the authors describe, patients can have satisfactory outcomes.
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In Brief
本研究的目的是分析治疗outcomes of 1-stage clipping of multiple unruptured intracranial aneurysms (UIAs) via keyhole approaches. Surgical outcomes were satisfactory in terms of the status of clipped aneurysms, complication rates, and operative duration. However, there exists a risk of postoperative transient neurological deficit with no clear causes, especially in patients with hypertension. One-stage clipping of multiple UIAs via keyhole approaches can be a reasonable treatment strategy for patients with multiple aneurysms that are not amenable to partial or complete neurointervention.
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In Brief
The aim of this study was to validate pressure measurements and waveform morphology reliability across endovascular catheter sizes. Mean pressure measurements are accurate through all tested microcatheters. Pulse pressure and waveform morphology reached 85% accuracy with an inner diameter of ≥ 0.027 inches. Measurements through a 0.070-inch catheter with an indwelling microcatheter with an outer diameter of ≤ 0.042 inches allows accurate pulse pressure transduction. With the growing use of neuroendovascular manometry, this study provides further insight into the capabilities of available devices.
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In Brief
Chronic encapsulated expanding hematoma (CEEH) is a rare complication after stereotactic radiosurgery (SRS) for intracranial arteriovenous malformation (AVM). Researchers described the incidence, imaging features, management, and outcomes of this rare complication after reviewing their 30-year database of more than 1000 patients who had undergone AVM SRS. CEEH had an incidence rate of 0.0045 event per person-year in their experience. To prevent progressive neurological symptoms, enlargement, and recurrence, complete removal of the CEEH is necessary and is associated with gratifying outcomes.
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In Brief
The objective of this analysis was to evaluate for ways to optimize outcomes with very large arteriovenous malformations. Dose-response outcomes suggest that dose escalation up to 17 Gy improves obliteration and volumetric response. This large multi-institutional study found no increase in adverse events with this dose escalation, and the risk of adverse events at radiosurgery was limited to baseline, nonmodifiable risk features.
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In Brief
The current study evaluated predictors of long-term seizure outcome after surgery in 355 patients with drug-resistant epilepsy and focal cortical dysplasia after noninvasive multimodal evaluation. At the latest follow-up, 72% of patients were seizure free and 11.8% were not receiving antiepileptic drugs. Type III FCD was the strongest predictor of seizure freedom. Multiple types of seizure, acute postoperative seizures, and type I FCD were predictors of persistent seizures. About 80% of patients with persistent seizures had their first seizure within 6 months postsurgery.
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In Brief
The authors conducted a systematic review and patient-level meta-analysis of available literature on insular epilepsy surgery. Open and minimally invasive approaches are analyzed and discussed. Open surgery offers promising seizure freedom results (60% in pediatric patients and 69% in adults); however, it is associated with up to 10% permanent and 34% temporary neurological deficit rates. Based on their findings, the authors created an algorithm that can serve as a clinical guide to providers for surgical candidates with insular epilepsy.
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In Brief
The authors evaluated the prevalence and impact of choroidal artery infarction after temporal lobe epilepsy surgery. Choroidal artery infarctions present with various neurological deficits of variable severity. This study found that the occurrence of choroidal artery infarctions is rare, and most patients report postoperative improvement of quality of life in cases of seizure freedom. This study helps us to understand the postinfarction clinical presentation and quality of life, and discusses strategies to help avoid this complication.
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In Brief
作者试图前瞻性地确定rate of visual field deficit (VFD) in patients who underwent anteromedial temporal resection with continuous guidance provided with intraoperative microscope overlays showing optic radiation tractography. Guidance with microscope overlay had a VFD rate of 5%. A significant VFD occurred in a single patient owing to retractor placement. Optic radiation tractography has a low rate of VFD and still achieves excellent seizure-remission outcomes.
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In Brief
Neurosurgery became an experimental discipline with the arrival of Wilder Penfield in Montreal to head the Subdepartment of Neurosurgery at McGill University's Royal Victoria Hospital in 1924. His success and that of his American and European research fellows in the generation of new knowledge from laboratory investigations was recognized by the Rockefeller Foundation, which led to the founding of the Montreal Neurological Institute.
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In Brief
The purpose of this study was to describe 2 decades of innovation in US neurosurgical education, scientific research, and governance. The One Neurosurgery Summit organizations, including the Society of Neurological Surgeons, American Association of Neurological Surgeons, Congress of Neurological Surgeons, American Board of Neurological Surgery, American Academy of Neurological Surgery, and Accreditation Council for Graduate Medical Education Residency Review Committee for Neurological Surgery, have coordinated an effective program of educational system development. Best practices in professional pedagogy and leadership development are described and shared.
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In Brief
The authors describe the birth of neurosurgery in the state of Oklahoma with the arrival of Harry Wilkins and his herculean efforts. He and others were pivotal to the development of what is now the Department of Neurosurgery at the University of Oklahoma, which has led through conflict and national tragedy. The University of Oklahoma, in productive community partnerships, has continued a long tradition of excellence in clinical care and investigation, and its educational program remains its cornerstone.
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In Brief
The objective of this study was to evaluate trends in the numbers of authors of neurosurgical publications and how this number has changed over time, particularly in the past 2 decades. In addition to an overall substantial increase in the number of authors, this study found that single-author publications have decreased greatly, whereas studies with more than 10 authors have increased greatly. A potential underlying driver of our study's observations is an academic culture that may emphasize the easily quantifiable metric of peer-reviewed publications over the more difficult task of assessing the quality or influence of that research.
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In Brief
Different protocols for diffusion tensor imaging–fiber tracking (DTI-FT) of important language tracts were evaluated for their respective clinical usefulness by 18 experienced neurosurgeons. Tractography based on anatomical landmarks reliably enabled visualization of the principal tracts. Integration of repetitive navigated transcranial magnetic stimulation (rTMS) language mapping data might provide additional useful information, but purely rTMS-based tractography is currently not robust. This study highlights individual strengths and weaknesses of the compared protocols, facilitating future research aimed at validating and establishing useful approaches for preoperative language tractography.
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In Brief
Researchers aimed to report the outcomes of spinal cord stimulation in patients with central poststroke pain and to explore factors related to outcomes in a multicenter retrospective study. In this multicenter case series with 166 patients, about 60% of patients responded to trial stimulation and about 60% of the patients who underwent implantation showed satisfactory pain relief at last follow-up. Spinal cord stimulation has therapeutic potential for intractable central poststroke pain.
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