The aim of this study was to evaluate the long-term outcomes of elbow and shoulder function in patients with brachial plexus injuries (BPIs) receiving nerve reconstruction in the delayed setting (6-12 months after injury). In the delayed setting, nerve reconstruction was found to effectively restore functional elbow flexion and acceptable shoulder abduction in non-pan-plexus patients with BPI, but not in pan-plexus BPI. Judicious use of the donor nerves in pan-plexus injuries is required in addition to preserving a donor nerve for a backup plan such as free-functioning muscle transplantation or tendon transfers.
Here, researchers compared patients who had undergone primary microvascular decompression (MVD) versus those who had undergone MVD after percutaneous rhizotomy. Patients with a history of rhizotomy did have a higher rate of facial numbness but did not experience reduced pain-free survival following MVD. Patients without a history of multiple comorbidities may undergo primary MVD to avoid such numbness. Additionally, patients with a history of rhizotomy and persistent pain may still experience favorable outcomes following subsequent MVD.
The study investigated the use of the Woven EndoBridge (WEB) device with and without concomitant stent for intracranial aneurysms. Aneurysm occlusion rates were similar in both groups (with and without stent), but stent-assisted cases had higher thromboembolic complications. This research contributes to the current understanding of the novel treatment device and indicates that employing a stent concurrently might increase the likelihood of thromboembolic complications.
In this study, the authors examined the connection between frailty and outcomes for patients receiving stereotactic radiosurgery (SRS) for brain metastases (BMs). They found that higher frailty scores at the time of SRS were predictive of shorter intervals of overall survival and progression-free survival. This study provides encouraging implications for the use of the simplified 5-factor modified frailty index as a prognostic factor for patients receiving SRS to BMs in future clinical practice.
The goal of this study was to evaluate updated results using the triple-modality asleep motor mapping technique for perirolandic gliomas. Using a combination of motor evoked potentials with bipolar and monopolar stimulation for cortical and subcortical mapping, permanent motor deficits were kept to a low rate (3.8%), with no permanent deficits seen in the low-grade subgroup. This technique provides excellent feedback to the surgeon to maintain integrity of the descending motor pathways.
This study evaluated the use of MRI connectivity-guided radiofrequency thalamotomy in severe tremor due to essential tremor or Parkinson's disease. After 14 months, tremor scores improved by 64% in the treated hand and deteriorated by 10% in the nontreated hand (p < 0.01). Tremor etiology and prior deep brain stimulation failure did not significantly affect outcome. The most common reported side effect was mild gait ataxia. Further studies will help determine the exact role of this approach in tremor management.
Researchers compared the effectiveness and safety of flow diverters and stent-assisted coiling for unruptured intracranial vertebral artery dissecting aneurysms. Flow diverters provided comparable rates of periprocedural cerebrovascular complications, favorable clinical outcomes, and follow-up complete occlusion, lower rates of follow-up recanalization, and likely higher rates of in-stent stenosis compared with stent-assisted coiling. These findings support the benefits of flow diverters over stent-assisted coiling in unruptured intracranial vertebral artery dissecting aneurysms.
This study aimed to comprehensively understand the clinical course and treatment outcomes of recurrent skull base chordoma on the basis of 95 recurrences in 40 patients. The key finding revealed that combining surgery and radiation yielded the longest progression-free survival (median 120 months). The value of this study lies in providing insights into effective therapies, notably the combination approach, thereby enhancing management strategies for this challenging tumor and potentially extending survival beyond 5 years in 48% of patients.
The aim of this study was to compare 5-aminolevulinic acid (5-ALA) fluorescence and white-light microsurgery for glioblastoma resection. The proportion of gross-total resection was significantly higher in the 5-ALA fluorescence group than in the white-light group, and gross-total resection, but not 5-ALA fluorescence, was an independent predictor of progression-free and overall survival. Use of 5-ALA fluorescence-guided surgery, which was assessed in a single randomized study led in 2006, still optimizes the extent of glioblastoma resection in patients managed according to the current standards of care.
The objective of this study was to investigate the association between persistent postoperative hyperglycemia and mortality in patients undergoing an elective craniotomy. The authors found that an increased 30-day mortality risk was associated with persistent random blood glucose levels > 7.8 mmol/L, which fell below the recommended treatment threshold of ≥ 10.0 mmol/L in the guidelines. This study offers key insights into comprehensive blood glucose management for patients after they receive an elective craniotomy.
Surgery for meningiomas, the most common extra-axial brain tumors, can be complicated by high blood loss, and many lesions are not amenable to preoperative embolization. Interest has arisen regarding the ability of tranexamic acid (TXA) to reduce intraoperative blood loss. The present meta-analysis found that TXA decreased transfusion requirements and intraoperative blood loss without a commensurate increase in the risk of venous thromboembolic events. Further investigation in the form of a randomized controlled trial is merited.
研究人员调查了b的关系etween somatostatin receptors (SSTRs) and tumor invasion, as well as the correlation between tumor invasiveness and pharmacological response to somatostatin analogs (SSAs). Tumor invasion was negatively correlated with the SSTR2 level but was not associated with other SSTR subtypes. Patients with invasive tumors had a poorer response to SSA therapy. The study gives a new insight into invasive tumors and SSTR2 expression in acromegaly.
The authors aimed to demonstrate the efficacy and safety profile of the new flow redirection endoluminal device with X technology (FRED X) based on a multicenter experience in the United States. The results showed excellent device maneuverability and placement, a minimal complication rate, and adequate aneurysm occlusion at the midterm follow-up. This is the first study assessing the FRED X experience in the United States. Long-term follow-up is still needed.
The authors assessed for the presence of healthcare disparities in DBS care. Female gender, minority race, geographic barriers, low socioeconomic status, and the presence of multiple comorbidities were all associated with the underutilization of DBS. As the indications for DBS continue to grow, greater focus on addressing healthcare disparities is warranted to ensure equitable access.
The authors aimed to comprehensively review the surgical anatomy of the frontal lobe and provide a detailed description of the keyhole frontal lobectomy technique. They also analyzed the surgical outcomes achieved with this approach. The study successfully implemented the minimally invasive surgery (MIS) technique in 47 patients with glioma. The mean craniotomy diameter was 4.7 cm. Complications were observed in 5 patients. By providing a systematic approach, the study contributes to the optimization and replication of this MIS technique.
The present study evaluates the safety, efficacy, and benefits of monopolar radiofrequency thermocoagulation (RFTC) at the end of stereoelectroencephalography (SEEG). The outcome at the last follow-up visit showed rare seizure freedom (6.5%) but frequent ? 50% reduced seizure frequency (64.5%). The use of monopolar SEEG-guided RFTC provides more freedom in choosing SEEG contacts for thermocoagulation and a larger volume of the thermolesion.
As large language models became openly available, a curiosity arose: Could they be tested and used as an expert opinion for complex neurosurgical disease? The publicly available, context-enriched ChatGPT model revealed that such a trained model could indeed generate comprehensive responses to curated questions on vestibular schwannoma, similar to a cadre of international neurosurgical experts. The study is only a beginning and heralds the inevitable utility of machine intelligence in medicine.
本文的目的是展示use of phase-contrast MRI (PC-MRI) as a valuable adjunct to measure CSF flow in ventricular shunts. The authors identified the distal catheter as the optimal location for accurate PC-MRI flow measurements. Use of PC-MRI in the proximal shunt catheter should be avoided due to pulsatile oscillations of CSF leading to unreliable flow measurements. The inclusion of the PC-MRI sequence adds an accurate and quantitative metric to the clinical evaluation of shunt function.
The authors sought to analyze and compare exposure of the cerebellar interpeduncular region before and after quadrangular lobule of the cerebellum (QLC) resection and provide a case series to evaluate its clinical applicability. QLC resection significantly increased the exposure area, mainly in the anteroposterior axis. This surgical strategy appears to be safe and may help the neurosurgeon when operating on the lateral aspect of the cerebellomesencephalic fissure.
Idiopathic normal pressure hydrocephalus (iNPH) occurs in older patients and ventriculoperitoneal shunt (VPS) surgery is the definitive treatment, but frailty is prevalent in older patients and has been shown to be an independent predictor of significant neurosurgical morbidity and mortality. In nearly 10,000 iNPH VPS patients, increasing frailty, assessed by the Risk Analysis Index (RAI), was an independent risk factor for mortality and complications. The discriminatory accuracy of RAI was demonstrated to be superior to that of the modified 5-item Frailty Index for mortality, nonhome discharge, and extended length of stay.
The authors describe the legendary career of Dr. Sanford Larson, including his leadership in spinal neurosurgery and his role in educating the next generation of leaders in neurosurgery. Dr. Larson's contributions to neurological surgery are reviewed and remembrances are included from several of his past pupils. Dr. Larson was a pioneering neurosurgeon, scientist, and educator who established neurological surgery as an authority in complex spine care and developed a nationally renowned neurological surgery training program at the Medical College of Wisconsin. Dr. Larson's contributions to neurological surgery will not be forgotten.
The primary goals of surgical treatment of tuberculum sellae meningioma are represented by maximal safe resection and visual recovery. The purpose of this study was to describe the role of the endoscopic endonasal approach (EEA) for these lesions, with special focus on the visual results. Four categories related to postoperative outcome were found: the lower the preoperative visual impairment score (VIS), the higher the rate of postoperative VIS improvement. This finding will serve as useful information for surgeons who intend to adopt EEA.
作者评估了立体定向的准确性space registration with conventional CT and cone-beam computed tomography (CBCT) scanners, with the aid of an in vitro anthropomorphic phantom. The CT image was defined as the gold standard. The results show that CBCT is equivalent to CT for Leksell frame-based stereotactic space registration. This study supports the use of CBCT scans for stereotactic procedures, particularly frame-based registration.
This study presents a quantitative analysis and the key nuances of the infragalenic triangle (IGT), one of the anatomical triangles recently introduced to guide the dissection to reach brainstem cavernous malformations. The IGT is a reliable anatomical landmark for accessing the dorsal midbrain and posteromedial thalamus via the supracerebellar infratentorial approach; it can be expanded with microsurgical techniques for greater surgical access and maneuverability. These findings equip surgeons with practical knowledge to navigate this complex anatomical region safely.
The authors review their experience with the intraoperative usage of newly developed high-spatial-resolution microelectrode electrocorticography grids. There were no adverse events related to the use of these grids, and cortical recordings could be reliably obtained if pertinent sterilization and handling concerns were accounted for. Although their clinical utility remains incompletely characterized, these grids can capture cortical activity with millimeter precision and can be readily incorporated into neurosurgical craniotomy procedures.
The objective of this study was to determine hemorrhage risk after Gamma Knife radiosurgery (GKRS) for melanoma brain metastases. A patient's risk of definite hemorrhage was 17% at 36 months, and 5% required surgery. This rate is similar to or lower than the previously reported risk of hemorrhage prior to GKRS. The risk dropped over time and 95% of hemorrhages occurred within the 1st year. These data may assist in counseling patients prior to treatment.
这项工作显示了恶性手术的疗效ant scalp tumors and the necessity of multidisciplinary care for optimal outcomes. This analysis suggests that aggressive resection (level II and higher) is effective at reducing locoregional recurrence and is not associated with a higher risk of complications relative to resection without craniectomy. This is the largest reported series of such tumors and establishes the safety and utility of surgery in their treatment.
Researchers reviewed the current medical literature to compare the effectiveness of middle meningeal artery embolization (MMAE) as a standalone treatment to that of combined surgery and embolization. Results suggest that embolization may be an effective standalone treatment for chronic subdural hematomas (cSDHs), yielding similar outcomes to combined surgery and embolization. These findings provide the basis for future clinical trials to assess the effectiveness of MMAE as a primary standalone treatment for cSDHs.
This study examined the impact of subthalamic nucleus (STN) deep brain stimulation (DBS) on urinary dysfunction and constipation in Parkinson's disease, as well as the impact of DBS lead localization on autonomic dysfunction. Anterior STN DBS improved constipation, and brain atrophy was correlated with worsening of urinary dysfunction. These findings may enhance STN DBS targeting, programming, and patient selection with respect to autonomic symptoms in Parkinson's disease.
The authors describe visual deficits associated with intraventricular meningiomas and outline techniques to reduce risk to visual fibers during resection of these tumors. After diffusion tensor reconstructions of white matter tracts were implemented into standard operative planning, new permanent visual field deficits after surgery were no longer found in this institutional series. By visualizing white matter pathway fibers and planning safe operative corridors, surgeons can likely avoid the most common neurological deficits associated with intraventricular meningioma surgery.
The authors evaluated the specificity of 5-ALA labeling for fluorescence-guided surgery in glioblastoma resections using SCOPE-seq, a technology for linking live cell imaging with single-cell RNA sequencing. The study challenges the purported specificity of 5-ALA for labeling neoplastic tumor cells by demonstrating pervasive labeling of both neoplastic and nonneoplastic cells in the tumor microenvironment. Results from model systems identified potential mechanisms of nonspecific labeling.
Cavernous venous malformations can develop in and around any part of the CNS. Dural and extradural cavernomas have a specific natural history, behaving more like neoplastic lesions. Clinical, genetic, and physiological overlapping underlines a common pathophysiological pathway shared by all cavernous venous malformations regardless of origin. Reclassification of dural and extradural cavernomas within the larger group of cavernous venous malformations can foster a better understanding of these lesions.
Intradural cavernous venous malformations belong to a specific subgroup of malformations that encompasses classic intra-axial malformations, cranial nerve lesions, cisternal malformations, intraventricular malformations, and spinal intradural extramedullary malformations. The natural history of these malformations is classically characterized by repetitive hemorrhages leading to diverse clinical manifestations. A tailored surgical approach using anatomical knowledge and modern tools and techniques allows safe curative treatment.
The authors present the largest to date, multiinstitutional cohort of endoscopic repair of encephaloceles of the lateral sphenoid sinus, an otherwise rare and elusive pathology. They validate a previously published classification scheme that clustered encephaloceles based on their relationship with the foramen rotundum. The authors then described the surgical nuances necessary for each subtype of defect and the expected postoperative outcomes.
Nonenhancing motor eloquent gliomas harbor significant preoperative grading challenges. Navigated transcranial magnetic stimulation provides structural and functional data that assist in the grading process. Higher-grade gliomas show abnormal interhemispheric excitability, lower cortical functional activation that occurs alongside with higher amplitude, and shorter latency of the motor evoked potentials. This information can help surgical teams to assess the impact of a tumor in the motor pathway and improve counseling of the patients during the informed consent process.
Researchers characterized the natural history of sporadic vestibular schwannomas (VSs) showing either a scalloped tumor aspect in the cerebellopontine angle or the appearance of a CSF-filled space surrounding the intracanalicular tumor within an enlarged canal, both signs described previously as radiological signs of regression. All tumors demonstrated progressive tumor regression or remained stable during follow-up. Progressive deterioration in hearing was observed, less significant if the inner ear signal on the high-resolution T2-weighted image had improved. These two radiological aspects are indicative of VS in progressive or stabilized regression, and their identification should be an additional argument for a conservative management.
Researchers established and externally validated a risk prediction model for de novo intracranial aneurysm formation. Based on a systematic review and meta-analysis, the authors established a convenient and intuitive de novo intracranial aneurysm risk prediction model and verified its predictive value by external validation. Reasonable use of the model can not only aid in clinical decision-making but also play a positive role in the prevention of aneurysmal subarachnoid hemorrhage to a certain extent.
The object of this study was to explore the clinical features of moyamoya disease (MMD) and the efficacy of encephaloduroarteriosynangiosis (EDAS) in elderly patients with MMD and to identify the risk factors for long-term stroke events. The key finding was a lower postoperative long-term stroke rate among elderly patients with MMD in the EDAS group than in the conservative treatment group. EDAS may be an effective method of preventing neurological deterioration and improving the long-term prognosis of MMD in elderly patients.
The authors used the diffusion tensor imaging (DTI) along the perivascular space (ALPS) (DTI-ALPS) method to investigate potential glymphatic dysfunction in idiopathic normal pressure hydrocephalus (iNPH). The ALPS index score was significantly lower in iNPH patients, but it was also affected by biological sex and ventriculomegaly. The ALPS index could serve as a marker of disease severity, both clinically and in terms of neuroimaging, but future studies need to address potential confounding factors.
Researchers evaluated the utility and associated complications of radionuclide shuntography (RS) in an institutional cohort. The overall sensitivity and specificity of RS for detecting shunt malfunction was 92.3% and 96.2%, respectively, and there were no complications or infections attributable to RS. This study shows that radionuclide shuntograms are a valuable tool in patients presenting with symptoms concerning for shunt malfunction.
The effects of stent-assisted coiling on the degree of embolization, complications, and prognosis in the treatment of patients with ruptured intracranial aneurysms were evaluated. The use of stent-assisted coils in the treatment of ruptured intracranial aneurysms did not increase the incidence of complications and did not improve the prognosis, but it significantly improved the degree of embolization. It was demonstrated that stent-assisted coils are a safe and effective method for the treatment of ruptured intracranial aneurysms.
A limited number of case reports have shown that stenting can relieve symptoms caused by obstruction of the venous sinuses by meningioma. In this series, the authors showed that stenting a sinus involved by meningioma is usually possible with a low level of complications. However, further procedures are often necessary to maintain stent patency, other sites of venous compromise frequently coexist, and some patients remain symptomatic despite successful treatment of the index lesion.
Researchers aimed to investigate the evolutionary features of the Zabramski classification of lesions and the classification system's value in predicting clinical outcome in patients with sporadic cerebral cavernous malformations (CCMs). The prospective hemorrhage rates of CCMs may be forecasted on the basis of their initial Zabramski classification. The full clinical significance of this study is that the Zabramski classification is helpful in estimating clinical outcome and can assist with decision-making in patients with sporadic CCM.
Skull density ratio (SDR) is a key indicator of the permeability of the skull to the ultrasound waves delivered in magnetic resonance–guided focused ultrasound (MRgFUS) for the treatment of tremor. SDR values vary across the skull, and the distribution of SDR values, specifically high kurtosis in SDR values, was found to be associated with larger, more stable lesions, and increased tremor suppression at long-term follow-up. SDR kurtosis may provide a more meaningful prognostic factor than the conventionally used mean SDR.