Volume 137: Issue 2 (Aug 2022)
inJournal of NeurosurgeryImages from Minchev et al. (pp 479–488).
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In Brief
作者比较患者的结果nderwent concurrent emergent decompression and brain arteriovenous malformation (bAVM) resection with those of patients who underwent delayed bAVM resection. They report no significant difference in hospital or intensive care unit lengths of stay (LOSs), rates of complete obliteration, medical complications, and long-term outcomes. Concurrent decompression and resection of a ruptured bAVM can be performed on low-grade lesions without compromising LOS or long-term functional outcome; however, the surgeon may encounter a more challenging surgical environment.
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In Brief
The authors analyzed risk factors for the rupture of vertebral artery dissecting aneurysms and showed that fusiform shape, irregular surface, posterior inferior cerebellar artery involvement, and the stagnation sign were significantly associated with the rupture. When these potential risk factors are observed, more aggressive treatment rather than follow-up or medical therapy may be considered.
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In Brief
The objective of this study was to investigate the hemodynamic factors related to aneurysm initiation using angiographic images taken before and after aneurysm formation in patients with cerebral aneurysms. The results suggest that aneurysm formation may be initiated in a region where large tensile forces are acting on the vessel wall and total pressure loss is also large. These findings may be utilized to assess the potential risk of aneurysm initiation in brain screening in the future.
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In Brief
This study identified key risk factors for recurrent neurological events in patients with symptomatic cerebral cavernous malformations (CCMs). Four risk factors were found on multivariable analysis: bleeding at presentation, large size > 12 mm, eloquent location, and duration ≤ 1 year since last event. All factors were assigned 1 point, except duration from last event which was assigned 2 points. The acronym, BLED2, summarizes this scoring system and predicts prospective neurological events in symptomatic CCM patients.
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In Brief
The authors' objective was to compare clinical and angiographic outcomes between endovascular therapy (EVT) and microsurgery (MS) for unruptured wide-neck aneurysms (WNAs). Although there was no difference in the primary clinical outcome, secondary clinical outcomes favored EVT and secondary angiographic outcomes favored MS. There are very few published studies that compare EVT and MS for unruptured WNAs, and this study helps fill that literature gap.
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In Brief
Researchers reviewed the medical literature for the endovascular treatment of brain aneurysms with a relatively new class of devices called intrasaccular flow disruption (IFD) device. IFD devices were found to be a very safe treatment for appropriately selected brain aneurysms with low complication rates. However, aneurysm cure at 1-year follow-up is achieved in only half of patients treated with an IFD device, and the probability of aneurysm cure does not increase much after 1 year.
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In Brief
The authors analyzed in-hospital and prognostic differences between patients with aneurysmal subarachnoid hemorrhage (aSAH) treated with surgical clipping and those treated wtih endovascular coiling. The endovascular coiling group showed advantages in discharge and 90-day outcomes, in-hospital complications, and the number of in-hospital risk factors. In-hospital complications such as DCI and pneumonia may have a long-lasting impact on the prognosis of aSAH patients. This study provides new evidence for in-hospital treatment of aSAH patients in the future.
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In Brief
The authors analyzed the outcomes of microsurgical management of vertebrobasilar dissecting aneurysms, a complex pathology that often requires revascularization. The authors found that favorable outcomes are achievable, especially when the patient's presenting neurological grade is not poor. This study balances the growing endovascular literature with a large series of microsurgically treated patients.
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In Brief
In this study, the authors have demonstrated that repeated systemic administration of mesenchymal stem cells over 3 weeks resulted in greater functional improvement compared to single administration and/or vehicle infusion. Besides, the administration of mesenchymal stem cells is associated with the promotion of interhemispheric connectivity through corpus callosum in the chronic phase of cerebral infarction. This study adds a possible therapeutic option for chronic stroke with mesenchymal stem cell therapy.
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In Brief
Researchers evaluated the role of high-resolution magnetic resonance vessel wall imaging (MR-VWI) for endovascular recanalization of nonacute intracranial artery occlusion (ICAO). Successful recanalization of nonacute ICAO was associated with occlusion with residual lumen and shorter occlusion length on high-resolution MR-VWI. These results indicated that high-resolution MR-VWI can display the characteristics of occluded arterial segments and guide endovascular recanalization of nonacute ICAO.
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In Brief
The objective of this study was to find the efficacy of intraoperative electrocorticography in determining the extent of resection to obtain a better seizure outcome without memory deterioration in patients with temporal lobe epilepsy. This study confirmed that visual assessment of intraoperative electrocorticography alone could not determine the extent of resection. Hence, to concretely elucidate the epilepsy network, inclusion of computational features such as high-frequency oscillation and phase-amplitude coupling should be incorporated.
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In Brief
The authors investigated whether intraoperative physiological parameters affect ablation volume during magnetic resonance-guided laser interstitial thermal therapy (MRgLiTT) for mesial temporal lobe epilepsy (mTLE). Total ablation energy and end-tidal carbon dioxide (ETCO2) level, but not blood pressure, may affect ablation volume. Specifically, mild hypocapnia of ETCO2of 33 mm Hg or less was associated with increased ablation volume. This is one of the first studies to report an association between modifiable intraoperative physiological parameters and ablation volume. Intraoperative adjustment of ETCO2may have therapeutic implications during MRgLiTT for mTLE.
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In Brief
The authors' goal was to analyze the role of resective surgery in patients older than 60 years and to assess outcomes and safety. Older patients who underwent epilepsy surgery appeared to have equal or better outcomes at 1 year than younger patients. Although the morbidity rate appeared to be slightly higher in the older population, it remained acceptable. This study provides further evidence that older patients are suitable candidates for surgery despite controversies derived from their longer duration of epilepsy and perceived higher surgical risk.
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In Brief
The authors aimed to report postsurgical seizure outcomes of patients with temporal lobe epilepsy with normal or subtle, nonspecific MRI findings and to identify prognostic factors of postsurgical seizure control. They found that 44% of patients had Engel class I outcome, and favorable factors included focal nonmotor aware seizures and unilateral or no spikes on interictal scalp EEG. This study shows that favorable outcomes can be achieved and that some presurgical characteristics can support postsurgical seizure control.
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In Brief
Because the need to undergo awake neurosurgery may be a barrier to patients receiving deep brain stimulation (DBS), the authors investigated the impact of general anesthesia (GA) on neural activity recorded from electrodes implanted in the subthalamic nucleus for Parkinson's disease to determine whether real-time feedback on lead positioning may be sufficient during GA. Evoked resonant neural activity (ERNA) was largely preserved under GA, coinciding with the location of chronic DBS, whereas spontaneous beta and high-frequency oscillations were abolished. These findings support the use of ERNA to help guide subthalamic nucleus electrode implantation, including during GA.
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In Brief
An accurate lesion characterization is crucial to optimize focused ultrasound (FUS) treatment parameters and ultimately improve clinical outcomes. This study found that intraoperative restricted diffusion imaging (RDI) accurately identified the volume and location of FUS lesions. Lesions adjacent to the ventral border of the VIM were significantly associated with tremor improvement; in contrast, lesion extension into the inferolateral white matter was associated with ataxia. These data support the acquisition of intraoperative RDI to characterize FUS lesions.
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In Brief
The authors investigated the degree of neuronal terminal survival in Parkinson's disease patients after subthalamic nucleus deep brain stimulation (STN-DBS) using [11C]CFT PET. Dopamine transporter availability was significantly increased in the anteroventral part of the striatum in Parkinson's disease patients 1 year after STN-DBS. Importantly, a significant correlation was observed with this increase in dopamine transporter availability and motor recovery under STN-DBS. This result elucidated the partly in vivo mechanism of STN-DBS on dopaminergic neurons in patients with Parkinson's disease.
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In Brief
研究人员开发出一种新型,小型、高ccurate guidance device that can be seamlessly integrated into an existing operating room setup for stereotactic neurosurgical procedures. The system was optimized in 150 cases of stereotactic brain biopsy, and stereoelectroncephalography electrode and catheter placements. According to the obtained clinical data, the robot can significantly improve procedural accuracy without significantly adding instrument positioning time. Future applications will further increase the versatility of the device.
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In Brief
The authors tested augmented reality (AR) accuracy for deep brain targets. Combined processes of presurgical planning, automatic registration with image-visible optical codes, and surgeon-directed holographic acquisition of simulated deep brain targets yielded a mean 2.3° angle of error and 3.62-mm radial error at 85.41-mm depth. Slight improvements in AR precision will equal or exceed current stereotactic standards. AR guidance may revolutionize neurosurgery with low-cost, high-accuracy cranial targeting and a nominal operating room footprint.
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Electrical stimulation–induced speech-related negative motor responses in the lateral frontal cortex
In Brief
Researchers provided a modified intraoperative mapping strategy to explore the distribution pattern of speech-related negative motor responses (NMRs). The speech-specific NMR was mainly located in the ventral part of the ventral precentral gyrus (vPrCG), whereas the nonspeech-specific NMR was mainly located in the dorsal part of the vPrCG. These findings not only provide insight into the motor control of speech production but also will facilitate surgical planning and intraoperative brain mapping.
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In Brief
Although the parietooccipital fissure divides the temporal, occipital, and parietal lobes, where 40% of gliomas are located with the temporal lobe as the most common location, little is known about the clinical significance of this fissure to gliomas. The authors investigated the correlation between the parietooccipital fissure and medial posterior temporal gliomas and found that the fissure strongly affects glioma invasion patterns. This study highlights the importance of the parietooccipital fissure in determining the invasion pattern of posterior medial temporal gliomas and understanding their complex anatomical architecture.
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In Brief
The authors aimed to identify independent predictors of seizure outcome after supratentorial meningioma resection in patients with history of preoperative seizures. They found that postresection ischemia, tumor recurrence, high WHO grade, and higher MIB-1 index independently predicted worse seizure outcome in their cohort. These results are valuable in identifying factors driving epileptogenicity in meningioma, as well as in counseling patients on the likelihood of seizure freedom after surgical intervention.
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In Brief
The objective of our study was to determine whether adjuvant radiotherapy improves outcomes in adults with intracranial ependymoma. Gross- (GTR) or near-total resection (NTR) and adjuvant radiotherapy were associated with improved progression-free survival. Maximum safe resection, ideally GTR or NTR, should be obtained when possible, while the merits of adjuvant radiotherapy should be discussed with all patients with intracranial ependymoma.
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In Brief
The authors sought to elucidate the effects of supratotal resection (SupTR) on patterns of recurrence in patients with glioblastoma (GBM). SupTR in GBM patients resulted in a relatively low rate of local recurrence and a higher rate of distant recurrence, which may provide clinical evidence of remaining GBM origin cells that are potential therapeutic targets. Additional clinical aspects, including extent of resection and radiotherapy range, have important implications for developing more effective treatment of GBM.
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In Brief
Researchers studied patients with previously treated non-small cell lung cancer brain metastases to determine the likelihood of recurrence while off systemic therapy. New brain metastases occurred after a median of 16 months and were associated with mutations in the RAS pathway and with stopping therapy early due to adverse effects. Patients who complete systemic therapy may have a significant amount of time without new brain metastases.
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In Brief
The authors investigated whether staged stereotactic radiosurgery (S-SRS) alone or postoperative cavity SRS (C-SRS) has better outcomes for patients with midsize-to-large brain metastases (BMs). There was no significant difference in overall survival or neurological mortality between the two groups, but local control failure was more common in the S-SRS group, whereas the development of leptomeningeal disease was more common in the C-SRS group. The S-SRS-alone strategy for midsize-to-large BMs can be considered an effective and minimally invasive alternative.
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In Brief
The goal of this study was to compare outcomes between combined tyrosine kinase inhibitor (TKI) and stereotactic radiosurgery (SRS) versus TKI therapy alone in non-small cell lung cancer (NSCLC) patients with brain metastases (BMs) and epidermal growth factor receptor (EGFR) mutations. The addition of SRS to TKI therapy resulted in improvement of intracranial tumor control but not in overall survival. This study is the first entity that proves the superior intracranial tumor control of concomitant SRS and TKI therapy and provides a probable alternative treatment strategy for NSCLC patients with BMs and EGFR mutations.
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In Brief
The authors examined survival outcomes and dosimetry to critical structures in patients treated with Gamma Knife radiosurgery for ≥ 25 brain metastases (BMs) in a single session or cumulatively over their disease course. The results showed that in selected patients with a large number of cumulative BMs, multiple courses of stereotactic radiosurgery (SRS) are feasible and safe, with survival rates that compared favorably to those in larger contemporary cohorts, while avoiding whole-brain radiotherapy in most patients. The findings support SRS as standard practice in selected patients with larger numbers of BMs.
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In Brief
Tumor fluorescence has greatly improved the ability of neurosurgeons to resect gliomas, a type of brain tumor. Previously, a certain neurosurgical microscope was necessary for the visualization of fluorescence. Researchers developed a new, easy-to-use device based on a unique combination of light-emitting diodes and special loupe glasses, and tested these in a study on tumor tissue. In their study they confirm equivalent performance compared to the microscope for finding tumor, whereas the overall brightness of fluorescence was superior to the microscope. The new device is an important additional tool for improving glioma surgery.
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In Brief
作者旨在生成的完整性le data on surgery-related complications and neurological outcomes after cranioplasty by establishing a prospectively conducted, multicenter registry. This analysis of 502 patients from 16 participating centers revealed that preoperatively increased score on the modified Rankin Scale, higher American Society of Anesthesiologists Physical Status Classification System score, and traumatic brain injury as the underlying diagnosis were independent predictors of surgical revision. These new findings provide evidence-based surgical standards for cranioplasty.
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