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Effects of ventricular entry on patient outcome during glioblastoma resection
Jacob S. Young MD1, Andrew J. Gogos MBBS1, Matheus P. Pereira BS2, Ramin A. Morshed MD1, Jing Li MD1, Matthew J. Barkovich MD3, Shawn L. Hervey-Jumper MD1, and Mitchel S. Berger MD1
doi : 10.3171/2020.7.JNS201362
Volume 135: Issue 4, page: 989–997
Tumor proximity to the ventricle and ventricular entry (VE) during surgery have both been associated with worse prognoses; however, the interaction between these two factors is poorly understood. Given the benefit of maximal tumor resection, it is imperative for surgical planning and technique to know if VE has negative consequences for patient survival and tumor dissemination.
Intraoperative seizure outcome of levetiracetam combined with perampanel therapy in patients with glioma undergoing awake brain surgery
Kazuya Motomura MD, PhD1, Lushun Chalise MD, PhD1, Hiroyuki Shimizu MD1, Junya Yamaguchi MD1, Tomohide Nishikawa MD1, Fumiharu Ohka MD, PhD1, Kosuke Aoki MD, PhD1, Kuniaki Tanahashi MD, PhD1, Masaki Hirano MD, PhD1, Toshihiko Wakabayashi MD, PhD1, and Atsushi Natsume MD, PhD1
doi : 10.3171/2020.8.JNS201400
Volume 135: Issue 4, page: 998–1007
This study aimed to evaluate the efficacy of levetiracetam (LEV) combined with perampanel (PER) therapy for intraoperative seizure treatment to determine whether a combination of LEV and PER can aid in the prevention of intraoperative intractable seizures during awake surgery.
Postoperative diffusion-weighted imaging and neurological outcome after convexity meningioma resection
Stephen T. Magill MD, PhD1, Minh P. Nguyen BS1, Manish K. Aghi MD, PhD1, Philip V. Theodosopoulos MD1, Javier E. Villanueva-Meyer MD2, and Michael W. McDermott MD1
doi : 10.3171/2020.8.JNS193537
Volume 135: Issue 4, page: 1008–1015
Convexity meningiomas are commonly managed with resection. Motor outcomes and predictors of new deficits after surgery are poorly studied. The objective of this study was to determine whether postoperative diffusion-weighted imaging (DWI) was associated with neurological deficits after convexity meningioma resection and to identify the risk factors for postoperative DWI restriction.
Resection of primary central nervous system lymphoma: impact of patient selection on overall survival
Nadav Schellekes BMSc1, Arianna Barbotti MD2, Yael Abramov MD1, Razi Sitt MSW1, Francesco Di Meco MD2, Zvi Ram MD1, and Rachel Grossman MD1
doi : 10.3171/2020.9.JNS201980
Volume 135: Issue 4, page: 1016–1025
Primary central nervous system lymphoma (PCNSL) is a rare CNS tumor with a poor prognosis. It is usually diagnosed by needle biopsy and treated mainly with high-dose chemotherapy. Resection is currently not considered a standard treatment option. A possible prolonged survival after resection of PCNSL lesions in selected patients has been suggested, but selection criteria for surgery, especially for solitary lesions, have never been established.
Second window ICG predicts gross-total resection and progression-free survival during brain metastasis surgery
Clare W. Teng BA1,2, Steve S. Cho MD, MTR1,2, Yash Singh BS1, Emma De Ravin BS1,2, Keren Somers BS1, Love Buch BS1, Steven Brem MD1, Sunil Singhal MD3, Edward J. Delikatny PhD4, and John Y. K. Lee MD, MSCE1
doi : 10.3171/2020.8.JNS201810
Volume 135: Issue 4, page: 1026–1035
Metastases are the most common intracranial malignancies and complete resection can provide relief of neurological symptoms and reduce recurrence. The authors’ prospective pilot study in 2017 demonstrated promising results for the application of high-dose, delayed imaging of indocyanine green (ICG), known as second window ICG (SWIG), in patients undergoing surgery for brain metastases. In this prospective cohort study, the authors evaluated intraoperative imaging and clinical outcomes of treatment using SWIG.
Intraoperative continuous vagus nerve monitoring with repetitive direct stimulation in surgery for jugular foramen tumors
Ken Matsushima MD1, Michihiro Kohno MD, PhD1,2, Norio Ichimasu MD1, Yujiro Tanaka MD1, Nobuyuki Nakajima MD, PhD1, and Masanori Yoshino MD, PhD2
doi : 10.3171/2020.8.JNS202680
Volume 135: Issue 4, page: 1036–1043
Surgery for tumors around the jugular foramen has significant risks of dysphagia and vocal cord palsy due to possible damage to the lower cranial nerve functions. For its treatment, long-term tumor control by maximum resection while avoiding permanent neurological damage is required. To accomplish this challenging goal, the authors developed an intraoperative continuous vagus nerve monitoring system and herein report their experience with this novel neuromonitoring method.
Outcomes after stereotactic radiosurgery for schwannomas of the oculomotor, trochlear, and abducens nerves
Anne-Marie Langlois MD1, Christian Iorio-Morin MD, PhD1, Andrew Faramand MD2, Ajay Niranjan MD2, L. Dade Lunsford MD2, Nasser Mohammed MD3, Jason P. Sheehan MD3, Roman Liš?ák MD4, Dušan Urgošík MD4, Douglas Kondziolka MD5, Cheng-chia Lee MD, PhD6, Huai-che Yang MD6, Ahmet F. Atik MD7, and David Mathieu MD1
doi : 10.3171/2020.8.JNS20887
Volume 135: Issue 4, page: 1044–1050
Cranial nerve (CN) schwannomas are intracranial tumors that are commonly managed by stereotactic radiosurgery (SRS). There is a large body of literature supporting the use of SRS for vestibular schwannomas. Schwannomas of the oculomotor nerves (CNs III, IV, and VI) are rare skull base tumors, occurring close to the brainstem and often involving the cavernous sinus. Resection can cause significant morbidity, including loss of nerve function. As for other schwannomas, SRS can be used to manage these tumors, but only a handful of cases have been published so far, often among reports of other uncommon schwannoma locations.
Stereotactic radiosurgery as the first-line treatment for intracanalicular vestibular schwannomas
Akiyoshi Ogino MD, PhD1,3,4, L. Dade Lunsford MD1,3, Hao Long MD1,3, Stephen Johnson MD1, Andrew Faramand MD1,3, Ajay Niranjan MD, MBA1,3, John C. Flickinger MD2,3, and Hideyuki Kano MD, PhD1,3
doi : 10.3171/2020.9.JNS202818
Volume 135: Issue 4, page: 1051–1057
This report evaluates the outcomes of stereotactic radiosurgery (SRS) as the first-line treatment of intracanalicular vestibular schwannomas (VSs).
Stereotactic radiosurgery as the primary management for patients with Koos grade IV vestibular schwannomas
Akiyoshi Ogino MD, PhD1,3,4, L. Dade Lunsford MD1,3, Hao Long MD1,3, Stephen Johnson MD1, Andrew Faramand MD1,3, Ajay Niranjan MD, MBA1,3, John C. Flickinger MD2,3, and Hideyuki Kano MD, PhD1,3
doi : 10.3171/2020.8.JNS201832
Volume 135: Issue 4, page: 1058–1066
While extensive long-term outcome studies support the role of stereotactic radiosurgery (SRS) for smaller-volume vestibular schwannomas (VSs), its role in the management for larger-volume tumors remains controversial.
An evaluation of the SAFIRE grading scale as a predictor of long-term outcomes for patients in the Barrow Ruptured Aneurysm Trial
Joshua S. Catapano MD1, Mohamed A. Labib MD, CM1, Fabio A. Frisoli MD1, Megan S. Cadigan BS1, Jacob F. Baranoski MD1, Tyler S. Cole MD1, James J. Zhou MD1, Candice L. Nguyen BS1, Alexander C. Whiting MD1, Andrew F. Ducruet MD1, Felipe C. Albuquerque MD1, and Michael T. Lawton MD1
doi : 10.3171/2020.7.JNS193431
Volume 135: Issue 4, page: 1067–1071
The SAFIRE grading scale is a novel, computable scale that predicts the outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients in acute follow-up. However, this scale also may have prognostic significance in long-term follow-up and help guide further management.
A human brain test bed for research in large vessel occlusion stroke
Daniel Gebrezgiabhier BSE1,2, Yang Liu PhD3,4, Adithya S. Reddy BSc1, Evan Davis BSc3, Yihao Zheng PhD3,5, Albert J. Shih PhD3, Aditya S. Pandey MD1, and Luis E. Savastano MD, PhD1,6
doi : 10.3171/2020.7.JNS202278
Volume 135: Issue 4, page: 1072–1080
Endovascular removal of emboli causing large vessel occlusion (LVO)–related stroke utilizing suction catheter and/or stent retriever technologies or thrombectomy is a new standard of care. Despite high recanalization rates, 40% of stroke patients still experience poor neurological outcomes as many cases cannot be fully reopened after the first attempt. The development of new endovascular technologies and techniques for mechanical thrombectomy requires more sophisticated testing platforms that overcome the limitations of phantom-based simulators. The authors investigated the use of a hybrid platform for LVO stroke constructed with cadaveric human brains.
Inpatient mortality and healthcare resource utilization of nontraumatic intracerebral hemorrhage complications in the US
Christine Park BA1, Lefko T. Charalambous BS1, Zidanyue Yang MB2, Syed M. Adil BS1, Sarah E. Hodges BA1, Hui-Jie Lee PhD2, Laura Zitella Verbick PhD3, Aaron R. McCabe PhD3, and Shivanand P. Lad MD, PhD1
doi : 10.3171/2020.8.JNS201839
Volume 135: Issue 4, page: 1081–1090
Nontraumatic, primary intracerebral hemorrhage (ICH) accounts for 2 million strokes worldwide annually and has a 1-year survival rate of 50%. Recent studies examining functional outcomes from ICH evacuation have been performed, but limited work has been done quantifying the incidence of subsequent complications and their healthcare economic impact. The purpose of this study was to quantify the incidence and healthcare resource utilization (HCRU) for major complications that can arise from ICH.
Feasibility and safety of the strategy of first stenting without retrieval using Solitaire FR as a treatment for emergent large-vessel occlusion due to underlying intracranial atherosclerosis
Jong-Hoon Kim MD, PhD1, Young-Jin Jung MD1, and Chul-Hoon Chang MD1
doi : 10.3171/2020.8.JNS202504
Volume 135: Issue 4, page: 1091–1099
The optimal treatment for underlying intracranial atherosclerosis (ICAS) in patients with emergent large-vessel occlusion (ELVO) remains unclear. Reocclusion during endovascular treatment (EVT) occurs frequently (57.1%–77.3%) after initial recanalization with stent retriever (SR) thrombectomy in ICAS-related ELVO. This study aimed to compare treatment outcomes of the strategy of first stenting without retrieval (FRESH) using the Solitaire FR versus SR thrombectomy in patients with ICAS-related ELVO.
Predicting neuroimaging eligibility for extended-window endovascular thrombectomy
Adam de Havenon MD1, Kole Mickolio MS1, Steven O’Donnell MD3, Greg Stoddard MS4, J. Scott McNally MD, PhD5, Matthew Alexander MD5, Philipp Taussky MD2, and Al-Wala Awad MD2
doi : 10.3171/2020.8.JNS20386
Volume 135: Issue 4, page: 1100–1104
Endovascular thrombectomy (EVT) and tissue plasminogen activator (tPA) are effective ischemic stroke treatments in the initial treatment window. In the extended treatment window, these treatments may offer benefit, but CT and MR perfusion may be necessary to determine patient eligibility. Many hospitals do not have access to advanced imaging tools or EVT capability, and further patient care would require transfer to a facility with these capabilities. To assist transfer decisions, the authors developed risk indices that could identify patients eligible for extended-window EVT or tPA.
The role of cell-free DNA in fibrinolysis for intraventricular hemorrhage
Fangke Xie MD1, Qiang Tan MD2, Anyong Yu MD, PhD1, Peiwen Guo MD2, Ling Wang MD2, Zongwei Zeng MD2, Liang Liang MD2, Jishu Xian MD2, Hua Feng MD, PhD2, and Zhi Chen MD, PhD2
doi : 10.3171/2020.7.JNS201429
Volume 135: Issue 4, page: 1105–1112
Tissue plasminogen activator (tPA) fibrinolysis did not improve functional outcomes of patients with intraventricular hemorrhage (IVH), largely because of the unsatisfactory clot clearance. The presence of neutrophil extracellular traps (NETs) within the clot has been confirmed to impair tPA fibrinolysis, but the mechanism has been unclear. The authors hypothesized that cell-free DNA (cfDNA), the main framework of NETs, might be the important reason for the fibrinolysis resistance, and they validated the hypothesis, hoping to provide a new target to promote intraventricular fibrinolysis.
Basal ganglia cavernous malformations: case series and systematic review of surgical management and long-term outcomes
Yiping Li MD1, Anadjeet Khahera MD2, Jason Kim MS3, Mauricio Mandel MD, PhD1, Summer S. Han MA, PhD1,4, and Gary K. Steinberg MD, PhD1
doi : 10.3171/2020.7.JNS2098
Volume 135: Issue 4, page: 1113–1121
Reports on basal ganglia cavernous malformations (BGCMs) are rare. Here, the authors report on their experience in resecting these malformations to offer insight into this infrequent disease subtype.
Development of cerebral microbleeds in patients with cerebral hyperperfusion following carotid endarterectomy and its relation to postoperative cognitive decline
Suguru Igarashi MD1, Toshihiko Ando MD1, Tatsuhiko Takahashi MD1, Jun Yoshida MD1, Masakazu Kobayashi MD1,2, Kenji Yoshida MD1, Kazunori Terasaki PhD2, Shunrou Fujiwara PhD1, Yoshitaka Kubo MD1, and Kuniaki Ogasawara MD1,2
doi : 10.3171/2020.7.JNS202353
Volume 135: Issue 4, page: 1122–1128
A primary cause of cognitive decline after carotid endarterectomy (CEA) is cerebral injury due to cerebral hyperperfusion. However, the mechanisms of how cerebral hyperperfusion induces cerebral cortex and white matter injury are not known. The presence of cerebral microbleeds (CMBs) on susceptibility-weighted imaging (SWI) is independently associated with a decline in global cognitive function. The purpose of this prospective observational study was to determine whether cerebral hyperperfusion following CEA leads to the development of CMBs and if postoperative cognitive decline is related to these developed CMBs.
Derivation and validation of a quantitative screening model for blunt cerebrovascular injury
Keita Shibahashi MD, PhD1, Hidenori Hoda MD1, Takuto Ishida MD, PhD1, Takayuki Motoshima MD2, Kazuhiro Sugiyama MD1, and Yuichi Hamabe MD1
doi : 10.3171/2020.8.JNS202589
Volume 135: Issue 4, page: 1129–1138
The objective of this study was to derive and validate a new screening model using a nomogram that allows clinicians to quantify the risk of blunt cerebrovascular injury (BCVI).
Ventricular size determination and management of ventriculomegaly and hydrocephalus in patients with diffuse intrinsic pontine glioma: an institutional experience
Adriana Fonseca MD,1, Palma Solano MD2, Vijay Ramaswamy MD, PhD1, Uri Tabori MD, PhD1, Annie Huang MD, PhD1, James M. Drake MD3, Derek S. Tsang MD, MSc4, Normand Laperriere MD4, Ute Bartels MD1, Abhaya V. Kulkarni MD, PhD3, and Eric Bouffet MD1
doi : 10.3171/2020.10.JNS203257
Volume 135: Issue 4, page: 1139–1145
There is no consensus on the optimal clinical management of ventriculomegaly and hydrocephalus in patients with diffuse intrinsic pontine glioma (DIPG). To date, the impact on survival in patients with ventriculomegaly and CSF diversion for hydrocephalus in this population remains to be elucidated. Herein, the authors describe their institutional experience.
Utility of image-guided external ventriculostomy: analysis of contemporary practice in the United Kingdom and Ireland
Aaron Lawson McLean MSc1, Aimun A. B. Jamjoom PhD2, Michael T. C. Poon MSc3, Difei Wang PhD4, Isaac Phang PhD5, Mohamed Okasha PhD6, Matthew Boissaud-Cooke MBChB7, Adam P. Williams MBChB8, and Aminul I. Ahmed PhD9
doi : 10.3171/2020.8.JNS20321
Volume 135: Issue 4, page: 1146–1154
Freehand external ventricular drain (EVD) insertion is associated with a high rate of catheter misplacement. Image-guided EVD placement with neuronavigation or ultrasound has been proposed as a safer, more accurate alternative with potential to facilitate proper placement and reduce catheter malfunction risk. This study aimed to determine the impact of image-guided EVD placement on catheter tip position and drain functionality.
Volumetric quantification of aneurysmal subarachnoid hemorrhage independently predicts hydrocephalus and seizures
Badih J. Daou MD1, Siri Sahib S. Khalsa MD1, Sharath Kumar Anand BS2, Craig A. Williamson MD1, Noah S. Cutler BS1, Bryan L. Aaron BS1, Sudharsan Srinivasan MSE1, Venkatakrishna Rajajee MBBS1, Kyle Sheehan MD1, and Aditya S. Pandey MD1
doi : 10.3171/2020.8.JNS201273
Volume 135: Issue 4, page: 1155–1163
Hydrocephalus and seizures greatly impact outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH); however, reliable tools to predict these outcomes are lacking. The authors used a volumetric quantitative analysis tool to evaluate the association of total aSAH volume with the outcomes of shunt-dependent hydrocephalus and seizures.
Endoscopic transorbital approach to the insular region: cadaveric feasibility study and clinical application (SevEN-005)
Eui Hyun Kim MD, PhD1,2, Jihwan Yoo MD1, In-Ho Jung MD1, Ji Woong Oh MD, PhD1, Ju-Seong Kim MD3, Jin Sook Yoon MD, PhD4, Ju Hyung Moon MD1,2, Seok-Gu Kang MD, PhD1,2, Jong Hee Chang MD, PhD1,2, and Tae Hoon Roh MD, PhD5
doi : 10.3171/2020.8.JNS202255
Volume 135: Issue 4, page: 1164–1172
The insula is a complex anatomical structure. Accessing tumors in the insula remains a challenge due to its anatomical complexity and the high chance of morbidity. The goal of this study was to evaluate the feasibility of an endoscopic transorbital approach (ETOA) to the insular region based on a cadaveric study.
Utility of indocyanine green in the detection of radiologically silent hemangioblastomas: case report
Alice Senta Ryba MD1, Juan Sales-Llopis MD2, Stefan Wolfsberger MD1, Aki Laakso MD, PhD3, Roy Thomas Daniel MBBS, MCh4, and Pablo González-López MD, PhD2
doi : 10.3171/2020.8.JNS202176
Volume 135: Issue 4, page: 1173–1179
Hemangioblastomas (HBs) are rare, benign, hypervascularized tumors. Fluorescent imaging with indocyanine green (ICG) can visualize tumor angioarchitecture. The authors report a case of multiple HBs involving two radiologically silent lesions only detected intraoperatively by ICG fluorescence. A 26-year-old woman presented with a cystic cerebellar mass on the tentorial surface of the left cerebellar hemisphere on MRI. A left paramedian suboccipital approach was performed to remove the mural nodule with the aid of ICG injection. The first injection, applied just prior to removing the nodule, highlighted the tumor and vessels. After resection, two new lesions, invisible on the preoperative MRI, surprisingly enhanced on fluorescent imaging 35 minutes after the ICG bolus. Both silent lesions were removed. Histological analysis of all three lesions revealed they were positive for HB. The main goal of this report is to hypothesize possible explanations about the mechanism that led to the behavior of the two silent lesions. Intraoperative ICG videoangiography was useful to understand the 3D angioarchitecture and HB flow patterns to perform a safe and complete resection in this case. Understanding the HB ultrastructure and pathophysiological mechanisms, in conjunction with the properties of ICG, may expand potential applications for their diagnosis and future treatments.
Minimal anterior and posterior combined transpetrosal approach for large petroclival meningiomas
Hiroki Morisako MD1, Hiroki Ohata MD1, Bharat Shinde MCh1, Atsufumi Nagahama MD1, Yusuke Watanabe MD1, and Takeo Goto MD1
doi : 10.3171/2020.8.JNS202060
Volume 135: Issue 4, page: 1180–1189
Petroclival meningiomas (PCMs) remain difficult to remove, and radical tumor resection continues to pose a relatively high risk of neurological morbidity in patients with these lesions because of the proximity of the tumor to neurovascular structures. The anterior and posterior combined (APC) transpetrosal approach allows resection of a large petroclival lesion with minimal retraction of the temporal lobe. However, this approach is thought to be complex and time-consuming. The authors simplified this approach by minimizing the petrosectomy and used this method for large PCMs. This retrospective study describes the surgical technique and surgical outcomes of large PCMs.
Severe traumatic brain injury management in Tanzania: analysis of a prospective cohort
Halinder S. Mangat MD1,2, Xian Wu MPH3, Linda M. Gerber PhD3, Hamisi K. Shabani MD, PhD4, Albert Lazaro MBBS4, Andreas Leidinger MD, PhD2,4, Maria M. Santos MD2,4, Paul H. McClelland MD2, Hanna Schenck5, Pascal Joackim MBBS4, Japhet G. Ngerageza MD, MMed, MSc4, Franziska Schmidt MD2, Philip E. Stieg MD, PhD2, and Roger Hartl MD2
doi : 10.3171/2020.8.JNS201243
Volume 135: Issue 4, page: 1190–1202
Given the high burden of neurotrauma in low- and middle-income countries (LMICs), in this observational study, the authors evaluated the treatment and outcomes of patients with severe traumatic brain injury (TBI) accessing care at the national neurosurgical institute in Tanzania.
Postoperative recurrence of chronic subdural hematoma is more frequent in patients with blood type A
Satoshi Hirai MD1, Kenji Yagi MD, PhD1, Keijiro Hara MD, PhD1, Eiichiro Kanda MD, PhD2, Shunji Matsubara MD, PhD1, and Masaaki Uno MD, PhD1
doi : 10.3171/2020.7.JNS202330
Volume 135: Issue 4, page: 1203–1207
Because of an aging society, the incidence of chronic subdural hematoma (CSDH) is increasing. This lesion is treated with simple burr hole irrigation, but one of the major issues is that CSDH frequently recurs. ABO blood type may be associated with a bleeding tendency and inflammation. However, its association with the recurrence of CSDH remains unknown. Therefore, the authors of the present study aimed to retrospectively investigate the association between ABO blood type and CSDH recurrence.
A propensity-adjusted comparison of middle meningeal artery embolization versus conventional therapy for chronic subdural hematomas
A propensity-adjusted comparison of middle meningeal artery embolization versus conventional therapy for chronic subdural hematomas
doi : 10.3171/2020.9.JNS202781
Volume 135: Issue 4, page: 1208–1213
Middle meningeal artery (MMA) embolization is a promising treatment strategy for chronic subdural hematomas (cSDHs). However, studies comparing MMA embolization and conventional therapy (surgical intervention and conservative management) are limited. The authors aimed to compare MMA embolization versus conventional therapy for cSDHs using a propensity-adjusted analysis.
Composition and organization of the sagittal stratum in the human brain: a fiber dissection study
Igor Lima Maldonado MD, PhD1,2,3, Christophe Destrieux MD, PhD1,2, Eduardo Carvalhal Ribas MD, PhD4, Bruna Siqueira de Abreu Brito Guimarães MD5, Patrícia Pontes Cruz MD6, and Hugues Duffau MD, PhD7,8
doi : 10.3171/2020.7.JNS192846
Volume 135: Issue 4, page: 1214–1222
The sagittal stratum is divided into two layers. In classic descriptions, the stratum sagittale internum corresponds to optic radiations (RADs), whereas the stratum sagittale externum corresponds to fibers of the inferior longitudinal fasciculus. Although advanced for the time it was proposed, this schematic organization seems simplistic considering the recent progress on the understanding of cerebral connectivity and needs to be updated. Therefore, the authors sought to investigate the composition of the sagittal stratum and to detail the anatomical relationships among the macroscopic fasciculi.
The nerve to the levator scapulae muscle as donor in brachial plexus surgery: an anatomical study and case series
Roberto Sergio Martins MD, PhD1, Mario Gilberto Siqueira MD, PhD1, Carlos Otto Heise MD, PhD1, Luciano Foroni MD, PhD1, Hugo Sterman Neto MD1, and Manoel Jacobsen Teixeira MD, PhD1
doi : 10.3171/2020.8.JNS201216
Volume 135: Issue 4, page: 1223–1230
Nerve transfers are commonly used in treating complete injuries of the brachial plexus, but donor nerves are limited and preferentially directed toward the recovery of elbow flexion and shoulder abduction. The aims of this study were to characterize the anatomical parameters for identifying the nerve to the levator scapulae muscle (LSN) in brachial plexus surgery, to evaluate the feasibility of transferring this branch to the suprascapular nerve (SSN) or lateral pectoral nerve (LPN), and to present the results from a surgical series.
Analysis of the effect of intraoperative neuromonitoring during resection of benign nerve sheath tumors on gross-total resection and neurological complications
Thomas J. Wilson MD1, Forrest Hamrick BS2, Saud Alzahrani MD3, Christopher F. Dibble MD, PhD4, Sravanthi Koduri MD5, Courtney Pendleton MD6, Sara Saleh MD5, Zarina S. Ali MD7, Mark A. Mahan MD2, Rajiv Midha MD3, Wilson Z. Ray MD4, Lynda J. S. Yang MD, PhD5, Eric L. Zager MD7, and Robert J. Spinner MD6
doi : 10.3171/2020.8.JNS202885
Volume 135: Issue 4, page: 1231–1240
The aim of this study was to examine the role of intraoperative neuromonitoring (IONM) during resection of benign peripheral nerve sheath tumors in achieving gross-total resection (GTR) and in reducing postoperative neurological complications.
Schwann cell delivery via a novel 3D collagen matrix conduit improves outcomes in critical length nerve gap repairs
S. Shelby Burks MD1, Anthony Diaz MS1, Agnes E. Haggerty PhD1, Natalia de la Oliva PhD1, Rajiv Midha MD, MSc2, and Allan D. Levi MD, PhD1
doi : 10.3171/2020.8.JNS202349
Volume 135: Issue 4, page: 1241–1251
The current clinical standard of harvesting a nerve autograft for repair of long-segment peripheral nerve injuries (PNIs) is associated with many potential complications. Guidance channels offer an alternative therapy. The authors investigate whether autologous Schwann cells (SCs) implanted within a novel collagen-glycosaminoglycan conduit will improve axonal regeneration in a long-segment PNI model.
The history of neurosurgery at the University of Nebraska Medical Center
Erin J. Torell MA1, Tyler S. Pistone MD2, and Andrew P. Gard MD2
doi : 10.3171/2020.8.JNS20634
Volume 135: Issue 4, page: 1252–1258
The Department of Neurosurgery at the University of Nebraska Medical Center has grown considerably from one neurosurgeon in 1923 into a first-class department with diverse subspecialty care and innovative faculty. Founding neurosurgeon Dr. J. Jay Keegan, a student of Harvey Cushing, instituted a legacy of clinical and research excellence that he passed on to his successors. The department created a lecture series to honor Keegan’s pioneering techniques and impact in the field, featuring prominent neurosurgeons from across the country. Keegan’s successors, such as Dr. Lyal Leibrock, grew the department through a unique partnership with private practice. The current faculty has continued the tradition of exceptional resident training and innovative patient care.
The history of neurosurgery at Baylor College of Medicine
Visish M. Srinivasan MD1, Caroline C. Hadley MD1, Akash J. Patel MD1, Bruce L. Ehni MD1, Howard L. Weiner MD1,2, Ganesh Rao MD1,3, Frederick F. Lang Jr. MD1,3, Raymond E. Sawaya MD1,3, and Daniel Yoshor MD1
doi : 10.3171/2020.7.JNS201196
Volume 135: Issue 4, page: 1259–1269
The development of neurosurgery at Baylor College of Medicine began with the medical school’s relocation to the new Texas Medical Center in Houston in 1943. An academic service was organized in 1949 as a section of neurosurgery within Baylor’s Department of Surgery. Soon the practice, led by Dr. George Ehni, evolved to include clinical services at Methodist, Jefferson Davis (forerunner of Ben Taub), Texas Children’s, the Veterans Affairs, and the University of Texas MD Anderson Cancer Center hospitals. A neurosurgery residency program was established in 1954. As the clinical practice expanded, neurosurgery was upgraded from a section to a division and then to a department. It has been led by four chiefs/chairs over the past 60 years—Dr. George Ehni (1959–1979), Dr. Robert Grossman (1980–2004), Dr. Raymond Sawaya (2005–2014), and Dr. Daniel Yoshor (2015–2020). Since the 1950s, the department has drawn strength from its robust residency program, its research base in the medical school, and its five major hospital affiliates, which have largely remained unchanged (with the exception of Baylor St. Luke’s Medical Center replacing Methodist in 2004). The recent expansion of the residency program to 25 accredited positions and the growing strength of relationships with the “Baylor five” hospitals affiliated with Baylor College of Medicine portend a bright future.
From Krönlein, through madness, to a useful modern surgery: the journey of the transorbital corridor to enter the neurosurgical armamentarium
Lena Mary Houlihan MD1, Evgenii Belykh MD, PhD1, Xiaochun Zhao MD1, Michael G. J. O’Sullivan MD2, and Mark C. Preul MD1
doi : 10.3171/2020.8.JNS201251
Volume 135: Issue 4, page: 1270–1279
Transorbital surgery has gained recent notoriety because of its incorporation into endoscopic skull base surgery. The use of this surgical corridor has been pervasive throughout the 20th century. It has been utilized by multiple disciplines for both clinical and experimental purposes, although its historical origin is medically and ethically controversial. Hermann Knapp first introduced the orbital surgical technique in 1874, and Rudolf Krönlein introduced his procedure in 1889. Rivalry between Walter Dandy in neurosurgery and Raynold Berke in ophthalmology further influenced methods of tackling intracranial and intraorbital pathologies. In 1946, Walter Freeman revolutionized psychosurgery by completing seemingly successful transorbital leucotomies and promoting their minimally invasive and benign surgical characteristics. However, as Freeman’s legacy came into disrepute, so did the transorbital brain access corridor, again resulting in its stunted evolution. Microsurgery and endoscopy further influenced the use, or lack thereof, of the transorbital corridor in neurosurgical approaches. Historical analysis of present goals in modern skull base surgery echoes the principles established through an approach described almost 150 years ago: minimal invasion, minimal morbidity, and priority of patient satisfaction. The progression of the transorbital approach not only reflects psychosocial influences on medical therapy, as well as the competition of surgical pioneers for supremacy, but also describes the diversification of skull base techniques, the impact of microsurgical mastery on circumferential neurosurgical corridors, the influence of technology on modernizing skull base surgery, and the advancing trend of multidisciplinary surgical excellence.
Professional conduct oversight in neurosurgery
James R. Bean MD1, Alex B. Valadka MD2, and Frederic T. Knape JD3
doi : 10.3171/2020.12.JNS204230
Volume 135: Issue 4, page: 1280–1283
Letter to the Editor. Hidden traces of the exemplary mentorship of Harvey Cushing in Europe
Naci Balak MD1
doi : 10.3171/2021.3.JNS21529
Volume 135: Issue 4, page: 1284
Letter to the Editor. Exploring cognitive functions in low-grade glioma surgery
Giuseppe Maria Della Pepa MD1, Quintino Giorgio D’Alessandris MD, PhD1, Benedetta Burattini MD1, Davide Quaranta MD, PhD1, Carmelo Lucio Sturiale MD, PhD1, Pier Paolo Mattogno MD1, Roberto Pallini MD1, and Alessandro Olivi MD1
doi : 10.3171/2021.2.JNS21186
Volume 135: Issue 4, page: 1285–1286
