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Influence of supramarginal resection on survival outcomes after gross-total resection of IDH–wild-type glioblastoma
Tito Vivas-Buitrago MD1, Ricardo A. Domingo MD1, Shashwat Tripathi BSA1, Gaetano De Biase MD1, Desmond Brown MD, PhD6, Oluwaseun O. Akinduro MD1, Andres Ramos-Fresnedo MD1, David S. Sabsevitz PhD2, Bernard R. Bendok MD7, Wendy Sherman MD3, Ian F. Parney MD, PhD6, Mark E. Jentoft MD1,4, Erik H. Middlebrooks MD1,5, Fredric B. Meyer MD6, Kaisorn L. Chaichana MD1, and Alfredo Quinones-Hinojosa MD1
doi : 10.3171/2020.10.JNS203366
Volume 136: Issue 1 Page Range: 1–8
The authors’ goal was to use a multicenter, observational cohort study to determine whether supramarginal resection (SMR) of FLAIR-hyperintense tumor beyond the contrast-enhanced (CE) area influences the overall survival (OS) of patients with isocitrate dehydrogenase–wild-type (IDH-wt) glioblastoma after gross-total resection (GTR).
Fluorescence real-time kinetics of protoporphyrin IX after 5-ALA administration in low-grade glioma
Sadahiro Kaneko MD1,2, Eric Suero Molina Dr med, MBA1, Peter Sporns Dr med, MHBA3,4, Stephanie Schipmann Dr med1, David Black5,6, and Walter Stummer Dr med1
doi : 10.3171/2020.10.JNS202881
Volume 136: Issue 1 Page Range: 9–15
5-Aminolevulinic acid (5-ALA) induces fluorescence in high-grade glioma (HGG), which is used for resection. However, the value of 5-ALA–induced fluorescence in low-grade glioma (LGG) is unclear. Time dependency and time kinetics have not yet been investigated. The purpose of this study was to investigate real-time kinetics of protoporphyrin IX (PpIX) in LGG based on hyperspectral fluorescence-based measurements and identify factors that predict fluorescence.
Asleep or awake motor mapping for resection of perirolandic glioma in the nondominant hemisphere? Development and validation of a multimodal score to tailor the surgical strategy
Marco Rossi MD1,3, Guglielmo Puglisi PhD2,3, Marco Conti Nibali MD1,3, Luca Viganò PhD1,3, Tommaso Sciortino MD1,3, Lorenzo Gay MD1,3, Antonella Leonetti PhD2,3, Paola Zito MD4, Marco Riva MD2,3, and Lorenzo Bello MD1,3
doi : 10.3171/2020.11.JNS202715
Volume 136: Issue 1 Page Range: 16–29
Resection of glioma in the nondominant hemisphere involving the motor areas and pathways requires the use of brain-mapping techniques to spare essential sites subserving motor control. No clear indications are available for performing motor mapping under either awake or asleep conditions or for the best mapping paradigm (e.g., resting or active, high-frequency [HF] or low-frequency [LF] stimulation) that provides the best oncological and functional outcomes when tailored to the clinical context. This work aimed to identify clinical and imaging factors that influence surgical strategy (asleep motor mapping vs awake motor mapping) and that are associated with the best functional and oncological outcomes and to design a “motor mapping score” for guiding tumor resection in this area.
Clinical utility of brain biopsy for presumed CNS relapse of systemic lymphoma
Desmond A. Brown MD, PhD1, Anshit Goyal MBBS, MS1, Kent R. Richter BS3, Jack M. Haglin BS3, Benjamin T. Himes MD, PhD1, Victor M. Lu MBBS, PhD1, Kendall Snyder MD1, Joshua Hughes MD4, Paul A. Decker MS2, Michael Opoku-Darko MD1, Michael J. Link MD1, Terry C. Burns MD, PhD1, and Ian F. Parney MD, PhD1
doi : 10.3171/2020.12.JNS202517
Volume 136: Issue 1 Page Range: 30–39
The objective of this study was to determine the frequency with which brain biopsy for presumed CNS relapse of systemic hematological malignancies yields new, actionable diagnostic information. Hematological malignancies represent a disparate group of genetic and histopathological disorders. Proclivity for brain involvement is dependent on the unique entity and may occur synchronously or metasynchronously with the systemic lesion. Diffuse large B-cell lymphomas (DLBCLs) have a high propensity for brain involvement. Patients in remission from systemic DLBCL may present with a lesion suspicious for brain relapse. These patients often undergo brain biopsy. The authors’ a priori hypothesis was that brain biopsy in patients with a history of systemic DLBCL and a new brain MRI lesion would have lower diagnostic utility compared with patients with non-DLBCL systemic malignancies.
Elective versus nonelective brain tumor resections: a 5-year propensity score matching cost comparison analysis
Alvin Y. Chan MD1, Elliot H. Choi MS1, Michael Y. Oh MD1, Sumeet Vadera MD1, Jefferson W. Chen MD, PhD1, Kiarash Golshani MD1, William C. Wilson MD2, and Frank P. K. Hsu MD, PhD1
doi : 10.3171/2020.12.JNS203401
Volume 136: Issue 1 Page Range: 40–44
Elective surgical cases generally have lower costs, higher profit margins, and better outcomes than nonelective cases. Investigating the differences in cost and profit between elective and nonelective cases would help hospitals in planning strategies to withstand financial losses due to potential pandemics. The authors sought to evaluate the exact cost and profit margin differences between elective and nonelective supratentorial tumor resections at a single institution.
On the cutting edge of glioblastoma surgery: where neurosurgeons agree and disagree on surgical decisions
Domenique M. J. Müller MD1, Pierre A. Robe MD, PhD2, Hilko Ardon PhD3, Frederik Barkhof PhD4,5, Lorenzo Bello MD6, Mitchel S. Berger MD7, Wim Bouwknegt MD8, Wimar A. Van den Brink PhD9, Marco Conti Nibali MD6, Roelant S. Eijgelaar MSc10, Julia Furtner PhD11, Seunggu J. Han MD12, Shawn L. Hervey-Jumper MD7, Albert J. S. Idema MD13, Barbara Kiesel MD14, Alfred Kloet MD15, Emmanuel Mandonnet PhD16, Jan C. De Munck PhD4, Marco Rossi MD6, Tommaso Sciortino MD6, W. Peter Vandertop PhD1, Martin Visser MSc4, Michiel Wagemakers PhD17, Georg Widhalm MD, PhD14, Marnix G. Witte PhD10, Aeilko H. Zwinderman PhD18, and Philip C. De Witt Hamer PhD1
doi : 10.3171/2020.11.JNS202897
Volume 136: Issue 1 Page Range: 45–55
The aim of glioblastoma surgery is to maximize the extent of resection while preserving functional integrity. Standards are lacking for surgical decision-making, and previous studies indicate treatment variations. These shortcomings reflect the need to evaluate larger populations from different care teams. In this study, the authors used probability maps to quantify and compare surgical decision-making throughout the brain by 12 neurosurgical teams for patients with glioblastoma.
Mutation status and postresection survival of patients with non–small cell lung cancer brain metastasis: implications of biomarker-driven therapy
Pavan P. Shah BS1, Jennifer L. Franke BS1, Ravi Medikonda BA1, Christopher M. Jackson MD1, Siddhartha Srivastava BS1, John Choi BS1, Patrick M. Forde MBBCh3, Julie R. Brahmer MD3, David S. Ettinger MD3, Josephine L. Feliciano MD3, Benjamin P. Levy MD3, Kristen A. Marrone MD3, Jarushka Naidoo MBBCh3, Kristin J. Redmond MD, MPH2, Lawrence R. Kleinberg MD2, and Michael Lim MD1
doi : 10.3171/2020.10.JNS201787
Volume 136: Issue 1 Page Range: 56–66
Non–small cell lung cancer (NSCLC) is the most common primary tumor to develop brain metastasis. Prognostic markers are needed to better determine survival after neurosurgical resection of intracranial disease. Given the importance of mutation subtyping in determining systemic therapy and overall prognosis of NSCLC, the authors examined the prognostic value of mutation status for postresection survival of patients with NSCLC brain metastasis.
Glioma-related epilepsy in patients with diffuse high-grade glioma after the 2016 WHO update: seizure characteristics, risk factors, and clinical outcomes
Lianwang Li MD1, Shengyu Fang MD1, Guanzhang Li MD1, Kenan Zhang MD1, Ruoyu Huang MD1, Yinyan Wang MD2, Chuanbao Zhang MD2, Yiming Li MD2, Wei Zhang MD2, Zhong Zhang MD2, Qiang Jin MD2, Dabiao Zhou MD2, Xing Fan MD1,2, and Tao Jiang MD1,2,3
doi : 10.3171/2020.12.JNS203351
Volume 136: Issue 1 Page Range: 67–75
The aim of this study was to investigate the epidemiological characteristics, associated risk factors, and prognostic value of glioma-related epilepsy in patients with diffuse high-grade gliomas (DHGGs) that were diagnosed after the 2016 updated WHO classification was released.
Brain tumor–related epilepsy and risk factors for metastatic brain tumors: analysis of 601 consecutive cases providing real-world data
Kenichiro Asano MD, PhD1, Seiko Hasegawa MD, PhD2, Masashi Matsuzaka MD, PhD3,4, and Hiroki Ohkuma MD, PhD1
doi : 10.3171/2020.11.JNS202873
Volume 136: Issue 1 Page Range: 76–87
It is necessary to accurately characterize the epidemiology and trends of brain tumor–related epilepsy (BTE) in patients with metastatic brain tumors. This study aimed to determine the incidence of BTE associated with metastatic brain tumors and retrospectively investigate the risk factors for BTE.
Use of predictive spatial modeling to reveal that primary cancers have distinct central nervous system topography patterns of brain metastasis
Josh Neman PhD1,2,5,6,7, Meredith Franklin PhD3,6, Zachary Madaj MS8, Krutika Deshpande MS1,6, Timothy J. Triche Jr. PhD8, Gal Sadlik MS1,6, John D Carmichael MD1,6,7, Eric Chang MD4,5,6,7, Cheng Yu PhD1,6,7, Ben A Strickland MD1,6, and Gabriel Zada MD1,5,6,7
doi : 10.3171/2021.1.JNS203536
Volume 136: Issue 1 Page Range: 88–96
Brain metastasis is the most common intracranial neoplasm. Although anatomical spatial distributions of brain metastasis may vary according to primary cancer subtype, these patterns are not understood and may have major implications for treatment.
Trends in physician reimbursements and procedural volumes for radiosurgery versus open surgery in brain tumor care: an analysis of Medicare data from 2009 to 2018
Meeki Lad MPH1, Radhika Gupta BS2, Alex Raman MS3, Neil Parikh BS3, Raghav Gupta MD1,4, Ankush Chandra MD, MS5,6, Ashok Para MD1, Manish K. Aghi MD, PhD6, and Justin Moore MD, MPH, PhD7
doi : 10.3171/2020.11.JNS202284
Volume 136: Issue 1 Page Range: 97–108
Given its minimally invasive nature and effectiveness, stereotactic radiosurgery (SRS) has become a mainstay for the multimodal treatment of intracranial neoplasm. However, no studies have evaluated recent trends in the use of SRS versus those of open resection for the management of brain tumor or trends in the involvement of neurosurgeons in SRS (which is primarily delivered by radiation oncologists). Here, the authors used publicly available Medicare data from 2009 to 2018 to elucidate trends in the treatment of intracranial neoplasm and to compare reimbursements between these approaches.
Neurofibromatosis type 2–associated meningiomas: an international multicenter study of outcomes after Gamma Knife stereotactic radiosurgery
Nasser Mohammed MD, MCh1, Yi-Chieh Hung MD1, Zhiyuan Xu MD1, Tomas Chytka MD2, Roman Liscak MD, PhD2, Manjul Tripathi MBBS, MCh3, David Arsanious MD4, Christopher P. Cifarelli MD, PhD4, Marco Perez Caceres5, David Mathieu MD5, Herwin Speckter MSc6, Gautam U. Mehta MD7, Gregory P. Lekovic MD, PhD7, and Jason P. Sheehan MD1
doi : 10.3171/2020.12.JNS202814
Volume 136: Issue 1 Page Range: 109–114
The management of neurofibromatosis type 2 (NF2)–associated meningiomas is challenging. The role of Gamma Knife radiosurgery (GKRS) in the treatment of these tumors remains to be fully defined. In this study, the authors aimed to examine the role of GKRS in the treatment of NF2-associated meningiomas and to evaluate the outcomes and complications after treatment.
Does intrathecal nicardipine for cerebral vasospasm following subarachnoid hemorrhage correlate with reduced delayed cerebral ischemia? A retrospective propensity score–based analysis
Ofer Sadan MD, PhD1, Hannah Waddel BS2, Reneé Moore PhD2, Chen Feng PhD3, Yajun Mei PhD3, David Pearce MD1, Jacqueline Kraft MD1, Cederic Pimentel MD1, Subin Mathew MD1, Feras Akbik MD, PhD1, Pouya Ameli MD1, Alexis Taylor MD1, Lisa Danyluk MSN4, Kathleen S. Martin DNP4, Krista Garner DNP4, Jennifer Kolenda DNP4, Amit Pujari MD6, William Asbury PharmD5, Blessing N. R. Jaja MD, PhD7, R. Loch Macdonald MD, PhD8, C. Michael Cawley MD9, Daniel L. Barrow MD9, and Owen Samuels MD1
doi : 10.3171/2020.12.JNS203673
Volume 136: Issue 1 Page Range: 115–124
Cerebral vasospasm and delayed cerebral ischemia (DCI) contribute to poor outcome following subarachnoid hemorrhage (SAH). With the paucity of effective treatments, the authors describe their experience with intrathecal (IT) nicardipine for this indication.
Intermediate-grade brain arteriovenous malformations and the boundary of operability using the supplemented Spetzler-Martin grading system
Joshua S. Catapano MD1, Fabio A. Frisoli MD1, Candice L. Nguyen BS1, Mohamed A. Labib MD, CM1, Tyler S. Cole MD1, Jacob F. Baranoski MD1, Helen Kim PhD2, Robert F. Spetzler MD1, and Michael T. Lawton MD1
doi : 10.3171/2020.11.JNS203298
Volume 136: Issue 1 Page Range: 125–133
Supplemented Spetzler-Martin grading (Supp-SM), which is the combination of Spetzler-Martin and Lawton-Young grades, was validated as being more accurate than stand-alone Spetzler-Martin grading, but an operability cutoff was not established. In this study, the authors surgically treated intermediate-grade AVMs to provide prognostic factors for neurological outcomes and to define AVMs at the boundary of operability.
Rescue therapy for vasospasm following aneurysmal subarachnoid hemorrhage: a propensity score–matched analysis with machine learning
Michael L. Martini PhD1, Sean N. Neifert BS1, William H. Shuman BS1, Emily K. Chapman BA1, Alexander J. Schüpper MD1, Eric K. Oermann MD1, J Mocco MD1, Michael Todd MD2, James C. Torner PhD3, Andrew Molyneux MBBChir4, Stephan Mayer MD5, Peter Le Roux MD6, Mervyn D. I. Vergouwen MD7, Gabriel J. E. Rinkel MD7, George K. C. Wong MBChB8, Peter Kirkpatrick MBChB9, Audrey Quinn10, Daniel Hänggi MD11, Nima Etminan MD12, Walter M. van den Bergh MD, PhD13, Blessing N. R. Jaja MD, PhD14,15,16, Michael Cusimano MD17, Tom A. Schweizer PhD16, Jose I. Suarez MD18, Hitoshi Fukuda MD19, Sen Yamagata MD19, Benjamin Lo MD20, Airton Leonardo de Oliveira Manoel MD21, Hieronymus D. Boogaarts MD22, R. Loch Macdonald MD, PhD23, and on behalf of the SAHIT Collaboration
doi : 10.3171/2020.12.JNS203778
Volume 136: Issue 1 Page Range: 134–147
Rescue therapies have been recommended for patients with angiographic vasospasm (aVSP) and delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH). However, there is little evidence from randomized clinical trials that these therapies are safe and effective. The primary aim of this study was to apply game theory–based methods in explainable machine learning (ML) and propensity score matching to determine if rescue therapy was associated with better 3-month outcomes following post-SAH aVSP and DCI. The authors also sought to use these explainable ML methods to identify patient populations that were more likely to receive rescue therapy and factors associated with better outcomes after rescue therapy.
Somatic mosaicism in the MAPK pathway in sporadic brain arteriovenous malformation and association with phenotype
Sen Gao PhD1,8, Jeffrey Nelson MS1,8, Shantel Weinsheimer PhD,1,8,9, Ethan A. Winkler MD, PhD2, Caleb Rutledge MD2, Adib A. Abla MD2, Nalin Gupta MD, PhD2, Joseph T. Shieh MD, PhD,6,9, Daniel L. Cooke MD3, Steven W. Hetts MD3, Tarik Tihan MD4, Christopher P. Hess MD, PhD3, Nerissa Ko MD5, Brian P. Walcott MD2,10, Charles E. McCulloch PhD7, Michael T. Lawton MD11, Hua Su MD1,8, Ludmila Pawlikowska PhD1,8,9, and Helen Kim PhD1,8,9
doi : 10.3171/2020.11.JNS202031
Volume 136: Issue 1 Page Range: 148–155
Sporadic brain arteriovenous malformation (BAVM) is a tangled vascular lesion characterized by direct artery-to-vein connections that can cause life-threatening intracerebral hemorrhage (ICH). Recently, somatic mutations in KRAS have been reported in sporadic BAVM, and mutations in other mitogen-activated protein kinase (MAPK) signaling pathway genes have been identified in other vascular malformations. The objectives of this study were to systematically evaluate somatic mutations in MAPK pathway genes in patients with sporadic BAVM lesions and to evaluate the association of somatic mutations with phenotypes of sporadic BAVM severity.
PHASES score and treatment scoring with cigarette smoking in the long-term prediction of rupturing of unruptured intracranial aneurysms
Seppo Juvela MD, PhD1
doi : 10.3171/2020.11.JNS203480
Volume 136: Issue 1 Page Range: 156–162
Treatment indications in unruptured intracranial aneurysms (UIAs) are challenging because of the lack of prospective natural history studies without treatment selection and the decreasing incidence of aneurysm rupture. The purpose of this study was to test whether the population, hypertension, age, size of aneurysm, earlier aneurysm rupture, site of aneurysm (PHASES) score obtained from an individual-based meta-analysis could predict the long-term rupture risk of UIAs.
Coding cerebral bypasses: a proposed nomenclature to better describe bypass constructs and revascularization techniques
Ali Tayebi Meybodi MD1,2, Arjun Gadhiya MBBS2, Leandro Borba Moreira MD1, and Michael T. Lawton MD1
doi : 10.3171/2020.9.JNS202362
Volume 136: Issue 1 Page Range: 163–174
Bypass surgery has evolved into a complex surgical art with a variety of donor arteries, recipient arteries, interpositional grafts, anastomoses, and suturing techniques. Although innovation in contemporary bypasses has increased, the literal descriptions of these new bypasses have not kept pace. The existing nomenclature that joins donor and recipient arteries with a hyphen is simplistic, underinformative, and in need of improvement. This article proposes a nomenclature that systematically incorporates anatomical and technical details with alphanumeric abbreviations and is a clear, concise, and practical “code” for bypass surgery.
Long-term stability of Onyx: is there any indication for repeated angiography after dural arteriovenous fistula embolization?
Richard Vold?ich MD1, David Netuka MD, PhD1, František Charvát MD, PhD2, and Vladimír Beneš MD, PhD1
doi : 10.3171/2020.12.JNS203811
Volume 136: Issue 1 Page Range: 175–184
The natural course of dural arteriovenous fistulas (DAVFs) is unfavorable. Transarterial embolization with Onyx is currently the therapeutic method of choice, although the long-term stability of Onyx has been questioned. The literature reports a significant difference in the recurrence rate after complete DAVF occlusion and lacks larger series with long-term follow-up. The authors present the largest series to date with a long-term follow-up to determine the stability of Onyx, prospectively comparing magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) as follow-up diagnostic methods.
Radiosurgery as a microsurgical adjunct: outcomes after microsurgical resection of intracranial arteriovenous malformations previously treated with stereotactic radiosurgery
Mark Bigder MD, MPH1, Omar Choudhri MD1, Mihir Gupta MD1, Santosh Gummidipundi MS2, Summer S. Han PhD1,2, Ephraim W. Church MD1, Steven D. Chang MD1, Richard P. Levy MD, PhD3, Huy M. Do MD1,4, Michael P. Marks MD1,4, and Gary K. Steinberg MD, PhD1
doi : 10.3171/2020.9.JNS201538
Volume 136: Issue 1 Page Range: 185–196
Microsurgical resection of arteriovenous malformations (AVMs) can be aided by staged treatment consisting of stereotactic radiosurgery followed by resection in a delayed fashion. This approach is particularly useful for high Spetzler-Martin (SM) grade lesions because radiosurgery can reduce flow through the AVM, downgrade the SM rating, and induce histopathological changes that additively render the AVM more manageable for resection. The authors present their 28-year experience in managing AVMs with adjunctive radiosurgery followed by resection.
Failure modes and effects analysis of mechanical thrombectomy for stroke discovered in human brains
Yang Liu PhD1,3, Daniel Gebrezgiabhier BSE2,5, Adithya S. Reddy BSc2, Evan Davis BSc1, Yihao Zheng PhD1,6, Jorge L. Arturo Larco MD4, Albert J. Shih PhD1, Aditya S. Pandey MD2, and Luis E. Savastano MD, PhD2,4
doi : 10.3171/2020.11.JNS203684
Volume 136: Issue 1 Page Range: 197–204
Despite advancement of thrombectomy technologies for large-vessel occlusion (LVO) stroke and increased user experience, complete recanalization rates linger around 50%, and one-third of patients who have undergone successful recanalization still experience poor neurological outcomes. To enhance the understanding of the biomechanics and failure modes, the authors conducted an experimental analysis of the interaction of emboli/artery/devices in the first human brain test platform for LVO stroke described to date.
Retrosigmoid transhorizontal fissure approach to lateral pontine cavernous malformation: comparison to transpetrosal presigmoid retrolabyrinthine approach
Julia R. Schneider DO1, Amrit K. Chiluwal MD1, Mohsen Nouri MD1, Giyarpuram N. Prashant MD1, and Amir R. Dehdashti MD1
doi : 10.3171/2020.12.JNS203608
Volume 136: Issue 1 Page Range: 205–214
The retrosigmoid (RS) approach is a classic route used to access deep-seated brainstem cavernous malformation (CM). The angle of access is limited, so alternatives such as the transpetrosal presigmoid retrolabyrinthine (TPPR) approach have been used to overcome this limitation. Here, the authors evaluated a modification to the RS approach, horizontal fissure dissection by using the RS transhorizontal (RSTH) approach.
Dysgeusia induced and resolved by focused ultrasound thalamotomy: case report
Philippe De Vloo MD, PhD1,4, Alexandre Boutet MD, PhD1,2, Gavin J. B. Elias BA1,5, Robert M. Gramer BSc1,5, Suresh E. Joel PhD6, Maheleth Llinas BSc1,5, Walter Kucharczyk MD2, Alfonso Fasano MD, PhD5,7,8, Clement Hamani MD, PhD3, and Andres M Lozano MD, PhD1,5
doi : 10.3171/2020.11.JNS202882
Volume 136: Issue 1 Page Range: 215–220
Dysgeusia, or distorted taste, has recently been acknowledged as a complication of thalamic ablation or thalamic deep brain stimulation as a treatment of tremor. In a unique patient, left-sided MR-guided focused ultrasound thalamotomy improved right-sided essential tremor but also induced severe dysgeusia. Although dysgeusia persisted and caused substantial weight loss, tremor slowly relapsed. Therefore, 19 months after the first procedure, the patient underwent a second focused ultrasound thalamotomy procedure, which again improved tremor but also completely resolved the dysgeusia.
Lesion location and outcome following cingulotomy for obsessive-compulsive disorder
Clara Kwon Starkweather MD, PhD1, Sarah K. Bick MD1, Jeffrey M. McHugh BS1, Darin D. Dougherty MD2, and Ziv M. Williams MD1
doi : 10.3171/2020.11.JNS202211
Volume 136: Issue 1 Page Range: 221–230
Obsessive-compulsive disorder (OCD) is among the most debilitating and medically refractory psychiatric disorders. While cingulotomy is an anatomically targeted neurosurgical treatment that has shown significant promise in treating OCD-related symptoms, the precise underlying neuroanatomical basis for its beneficial effects has remained poorly understood. Therefore, the authors sought to determine whether lesion location is related to responder status following cingulotomy.
Neuroanatomical considerations for optimizing thalamic deep brain stimulation in Tourette syndrome
Takashi Morishita MD, PhD1, Yuki Sakai MD, PhD2,6, Hitoshi Iida MD, PhD3, Saki Yoshimura PhD1, Atsushi Ishii MD, PhD4, Shinsuke Fujioka MD, PhD5, Saori C. Tanaka PhD2, and Tooru Inoue MD, PhD1
doi : 10.3171/2021.2.JNS204026
Volume 136: Issue 1 Page Range: 231–241
Deep brain stimulation (DBS) of the centromedian thalamic nucleus has been reportedly used to treat severe Tourette syndrome, yielding promising outcomes. However, it remains unclear how DBS electrode position and stimulation parameters modulate the specific area and related networks. The authors aimed to evaluate the relationships between the anatomical location of stimulation fields and clinical responses, including therapeutic and side effects.
Traumatic axonal injury: is the prognostic information produced by conventional MRI and DTI complementary or supplementary?
Ana M. Castaño-Leon MD, PhD1, Marta Cicuendez MD, PhD3, Blanca Navarro-Main1, Igor Paredes MD, PhD1, Pablo M. Munarriz MD1, Amaya Hilario MD, PhD2, Ana Ramos MD, PhD2, Pedro A. Gomez MD, PhD1, and Alfonso Lagares MD, PhD1
doi : 10.3171/2020.11.JNS203124
Volume 136: Issue 1 Page Range: 242–256
A traumatic axonal injury (TAI) diagnosis has traditionally been based on conventional MRI, especially on those sequences with a higher sensitivity to edema and blood degradation products. A more recent technique, diffusion tensor imaging (DTI), can infer the microstructure of white matter (WM) due to the restricted diffusion of water in organized tissues. However, there is little information regarding the correlation of the findings obtained by both methods and their use for outcome prognosis. The main objectives of this study were threefold: 1) study the correlation between DTI metrics and conventional MRI findings; 2) evaluate whether the prognostic information provided by the two techniques is supplementary or complementary; and 3) determine the incremental value of the addition of these variables compared to a traditional prognostic model.
Comparison of transorbital ultrasound measurements to predict intracranial pressure in brain-injured patients requiring external ventricular drainage
Jin Young Youm MS1, Jae Hoon Lee MD2, and Hyun Seok Park MD3
doi : 10.3171/2021.1.JNS204218
Volume 136: Issue 1 Page Range: 257–263
The optic nerve sheath diameter (ONSD) excluding the dura mater (ONSDE; i.e., the subarachnoid diameter) and the ONSD including the dura mater (ONSDI) have been used differently in studies, but the predictive ability of these two different measurements of the ONSD as measured by invasive intracranial pressure (ICP) monitoring has never been compared. Additionally, studies on the prediction of ICP using central retinal artery (CRA) Doppler ultrasonography are scarce. The authors aimed to determine how the two different ONSD measurements, the ONSD/eyeball transverse diameter (ETD) ratio, and transorbital Doppler ultrasonography parameters are associated with ICP via external ventricular drainage (EVD).
Sex-based differences in outcomes for adult patients presenting to the emergency department with a concussion
Brian H. Rowe MD, MSc, CCFP(EM)1,5, Esther H. Yang MSc1, Lindsay A. Gaudet MSc2, Leeor Eliyahu MD, CCFP3, Daniela R. Junqueira PharmD, MSc, PhD1, Jeremy Beach MBBS, MD, FRCP(C)4,7, Martin Mrazik PhD6, Garnet Cummings MD, FRCPC1, and Donald Voaklander PhD5
doi : 10.3171/2021.1.JNS203753
Volume 136: Issue 1 Page Range: 264–273
Patients with concussion frequently present to the emergency department (ED). Studies of athletes and children indicate that concussion symptoms are often more severe and prolonged in females compared with males. Given infrequent study of concussion symptoms in the general adult population, the authors conducted a sex-based comparison of patients with concussion.
Effect of the FDA Safety and Innovation Act on racial and gender diversity in neurosurgical device trials
Neha Siddiqui MS1,2, Ryan G. Chiu MD2, Ravi S. Nunna MD2, Georgia Glastris MS2, and Ankit I. Mehta MD2
doi : 10.3171/2020.10.JNS202155
Volume 136: Issue 1 Page Range: 274–281
The US FDA uses evidence from clinical trials in its determination of safety and utility. However, these trials have often suffered from limited external validity and generalizability due to unrepresentative study populations with respect to clinical patient demographics. Section 907 of the FDA Safety and Innovation Act (FDASIA) of 2012 attempted to address this issue by mandating the reporting of certain study demographics in new device applications. However, no study has been performed on its effectiveness in the participant diversity of neurosurgical device trials.
US FDA best practices for initiating early feasibility studies for neurological devices in the United States
Robert Herrmann PhD1, Maureen Dreher PhD2, Andrew Farb MD3, Michael Hoffmann MS1, Christopher M. Loftus MD1, Nina Mezu-Nwaba PharmD, MPH, MSc1, Vivek Pinto PhD1, Xiaolin Zheng PhD1, and Carlos Peña PhD1
doi : 10.3171/2020.11.JNS203653
Volume 136: Issue 1 Page Range: 282–286
This article describes the efforts of the US Food and Drug Administration (FDA) Office of Neurological and Physical Medicine Devices to facilitate early clinical testing of potentially beneficial neurological devices in the US. Over the past 5 years, the FDA has made significant advances to this aim by developing early feasibility study best practices and encouraging developers and innovators to initiate their clinical studies in the US. The FDA uses several regulatory approaches to help start neurological device clinical studies, such as early engagement with sponsors and developers, in-depth interaction during the FDA review phase of a regulatory submission, and provision of an FDA toolkit that reviewers can apply to the most challenging submissions.
Neurosurgery Research and Education Foundation funding conversion to National Institutes of Health funding
Luke G. F. Smith MD1, E. Antonio Chiocca MD, PhD2, Gregory J. Zipfel MD3, Adam G. F. Smith BS1, Michael W. Groff MD2, Regis W. Haid MD4, and Russell R. Lonser MD1
doi : 10.3171/2020.11.JNS203871
Volume 136: Issue 1 Page Range: 287–294
The Neurosurgery Research and Education Foundation (NREF) provides research support for in-training and early career neurosurgeon-scientists. To define the impact of this funding, the authors assessed the success of NREF awardees in obtaining subsequent National Institutes of Health (NIH) funding.
Impact of international research fellows in neurosurgery: results from a single academic center
Wuyang Yang MD, MS1, Jordina Rincon-Torroella MD1, James Feghali MD1, Adham M. Khalafallah MD1, Wataru Ishida MD1, Alexander Perdomo-Pantoja MD1, Alfredo Quiñones-Hinojosa MD1, Michael Lim MD1, Gary L. Gallia MD, PhD1, Gregory J. Riggins MD, PhD1, William S. Anderson MD, PhD1, Sheng-Fu Larry Lo MD1, Daniele Rigamonti MD1, Rafael J. Tamargo MD1, Timothy F. Witham MD1, Ali Bydon MD1, Alan R. Cohen MD1, George I. Jallo MD1, Alban Latremoliere PhD1, Mark G. Luciano MD, PhD1, Debraj Mukherjee MD1, Alessandro Olivi MD1, Lintao Qu MD, PhD1, Ziya L. Gokaslan MD1, Daniel M. Sciubba MD1, Betty Tyler BA1, Henry Brem MD1, and Judy Huang MD1
doi : 10.3171/2021.1.JNS203824
Volume 136: Issue 1 Page Range: 295–305
International research fellows have been historically involved in academic neurosurgery in the United States (US). To date, the contribution of international research fellows has been underreported. Herein, the authors aimed to quantify the academic output of international research fellows in the Department of Neurosurgery at The Johns Hopkins University School of Medicine.
Erratum. Coding cerebral bypasses: a proposed nomenclature to better describe bypass constructs and revascularization techniques
Michael T. Lawton MD1
doi : 10.3171/2021.8.JNS202362a
Volume 136: Issue 1 Page Range: 306
The Young Neurosurgeons Committee of the American Association of Neurological Surgeons: the first 30 years
Sakibul Huq BS1, Chris A. Philips2, Walavan Sivakumar MD3, David L. Dornbos III MD4, Christopher S. Graffeo MD, MS5, Debraj Mukherjee MD, MPH1, Stacey Q. Wolfe MD6, and Jeremiah N. Johnson MD7
doi : 10.3171/2021.2.JNS204311
Volume 136: Issue 1 Page Range: 307–313
Letter to the Editor. Individualized blood pressure targets in the postoperative care of patients with ICH
Nathan Beucler MD1,2, Aurore Sellier MD1, and Arnaud Dagain MD, MSc1,3
doi : 10.3171/2021.4.JNS211038
Volume 136: Issue 1 Page Range: 314–315
Letter to the Editor. USMLE examination and implications of a recent change
Chidinma M. Wilson BA, BS1, Nolan J. Brown BS2, and Donald K. E. Detchou BA3,4
doi : 10.3171/2021.5.JNS211104
Volume 136: Issue 1 Page Range: 316–317
Letter to the Editor. The Kempe incision
Rakesh Mishra MCh1, Adesh Shrivastava MCh2, Sumit Raj MCh2, Pradeep Chouksey MCh2, and Amit Agrawal MCh2
doi : 10.3171/2021.6.JNS211349
Volume 136: Issue 1 Page Range: 318–319
Letter to the Editor. Aspirin versus anticoagulation for stroke prophylaxis: a dispute not yet closed
Ariana Alejandra Chacón-Aponte MS1, Erika Andrea Durán-Vargas MS1, Ivan David Lozada-Martínez MS2,3,4, Yelson Alejandro Picón-Jaimes MD, MSc5, Tariq Janjua MD6, and Luis Rafael Moscote-Salazar MD2,3,4
doi : 10.3171/2021.4.JNS21857
Volume 136: Issue 1 Page Range: 319–320
Letter to the Editor. What are the odds: worse outcomes with IONM?
Robert N. Holdefer PhD1, Christoph N. Seubert MD, PhD2, Stanley A. Skinner MD3, and Andrew T. Humbert MD, PhD4
doi : 10.3171/2021.4.JNS21918
Volume 136: Issue 1 Page Range: 321–322
