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Developing a professionalism and harassment policy for organized neurosurgery
Ellen L. Air, Katie O. Orrico, Deborah L. Benzil, Alan M. Scarrow, James R. Bean, Catherine A. Mazzola, Linda M. Liau, James T. Rutka, and Karin M. Muraszko
doi : 10.3171/2021.1.JNS218000
Annual conferences, educational courses, and other meetings draw a diverse community of individuals, yet also create a unique environment without the traditional guard rails. Unlike events held at one's home institution, clear rules and jurisdiction have not been universally established. To promote the open exchange of ideas, as well as an environment conducive to professional growth of all participants, the leading neurosurgical professional organizations joined to delineate the expectations for anyone who participates in sponsored events. The One Neurosurgery Summit Taskforce on Professionalism and Harassment developed a foundational policy that establishes common expectations for behavior and a unified roadmap for the prompt response to untoward events. We hope that publishing this policy will inspire other medical organizations to establish their own meeting and conference policies. More importantly, we wish to bring greater attention to everyone's responsibility for ensuring a safe and respectful space for education, scientific debate, and networking during organized events.
Extent of resection, molecular signature, and survival in 1p19q-codeleted gliomas
Andrew L. A. Garton, Connor J. Kinslow, Ali I. Rae, Amol Mehta, Susan C. Pannullo, Rajiv S. Magge, Rohan Ramakrishna, Guy M. McKhann, Michael B. Sisti, Jeffrey N. Bruce, Peter Canoll, Simon K. Cheng, Adam M. Sonabend, and Tony J. C. Wang
doi : 10.3171/2020.2.JNS192767
Genomic analysis in neurooncology has underscored the importance of understanding the patterns of survival in different molecular subtypes within gliomas and their responses to treatment. In particular, diffuse gliomas are now principally characterized by their mutation status (IDH1 and 1p/19q codeletion), yet there remains a paucity of information regarding the prognostic value of molecular markers and extent of resection (EOR) on survival. Furthermore, given the modern emphasis on molecular rather than histological diagnosis, it is important to examine the effect of maximal resection on survival in all gliomas with 1p/q19 codeletions, as these will now be classified as oligodendrogliomas under the new WHO guidelines.
Altered corticospinal microstructure and motor cortex excitability in gliomas: an advanced tractography and transcranial magnetic stimulation study
Ayesha Sunil Mirchandani, Ahmad Beyh, José Pedro Lavrador, Henrietta Howells, Flavio Dell’Acqua, and Francesco Vergani
doi : 10.3171/2020.2.JNS192994
This prospective case-control study was conducted to examine whether spherical deconvolution (SD) can unveil microstructural abnormalities in the corticospinal tract (CST) caused by IDH-mutant gliomas. To determine the significance of abnormal microstructure, the authors investigated the correlation between diffusion parameters and neurophysiological data collected with navigated transcranial magnetic stimulation (nTMS).
Validation of a scoring system to evaluate the risk of rapid growth of intracranial meningiomas in neurofibromatosis type 2 patients
Samiya Abi Jaoude, Matthieu Peyre, Vincent Degos, Stéphane Goutagny, Béatrice Parfait, and Michel Kalamarides
doi : 10.3171/2020.3.JNS192382
Intracranial meningiomas occur in about half of neurofibromatosis type 2 (NF2) patients and are very frequently multiple. Thus, estimating individual meningiomas’ growth rates is of great interest to tailor therapeutic interventions. The Asan Intracranial Meningioma Scoring System (AIMSS) has recently been published to estimate the risk of tumor growth in sporadic meningiomas. The current study aimed to determine predictors of rapid meningioma growth in NF2 patients and to evaluate the AIMSS score in a specific NF2 cohort.
A Safe Transitions Pathway for post-craniotomy neurological surgery patients: high-value care that bypasses the intensive care unit
Jacob S. Young, Andrew K. Chan, Jennifer A. Viner, Sujatha Sankaran, Alvin Y. Chan, Sarah Imershein, Aldea Meary-Miller, Philip V. Theodosopoulos, Line Jacques, Manish K. Aghi, Edward F. Chang, Shawn L. Hervey-Jumper, Tracy Ward, Liz Gibson, Mariann M. Ward, Peter Sanftner, Stacy Wong, Dominic Amara, Stephen T. Magill, Joseph A. Osorio, Brinda Venkatesh, Ralph Gonzales, Catherine Lau, Christy Boscardin, Michael Wang, Kim Berry, Laurie McCullagh, Mary Reid, Kayla Reels, Sara Nedkov, Mitchel S. Berger, and Michael W. McDermott
doi : 10.3171/2020.3.JNS192133
High-value medical care is described as care that leads to excellent patient outcomes, high patient satisfaction, and efficient costs. Neurosurgical care in particular can be expensive for the hospital, as substantial costs are accrued during the operation and throughout the postoperative stay. The authors developed a “Safe Transitions Pathway” (STP) model in which select patients went to the postanesthesia care unit (PACU) and then the neuro-transitional care unit (NTCU) rather than being directly admitted to the neurosciences intensive care unit (ICU) following a craniotomy. They sought to evaluate the clinical and financial outcomes as well as the impact on the patient experience for patients who participated in the STP and bypassed the ICU level of care.
Surgical management of carcinomas of the infratemporal fossa and skull base: patterns of failure and predictors of long-term outcomes
Moran Amit, Diana Bell, Patrick J. Hunt, Ehab Hanna, Shirley Y. Su, Michael Kupferman, Mohamed Aashiq, Hideaki Takahashi, Paul W. Gidley, Marc-Elie Nader, Franco DeMonte, and Shaan M. Raza
doi : 10.3171/2020.3.JNS192630
Infratemporal fossa (ITF) tumors are unique in histological characteristics and difficult to treat. Predictors of patient outcomes in this context are not known. The objective of this study was to identify independent predictors of outcome and to characterize patterns of failure in patients with ITF carcinoma.
Clinical findings in families with chordoma with and without T gene duplications and in patients with sporadic chordoma reported to the Surveillance, Epidemiology, and End Results program
Dilys M. Parry, Mary L. McMaster, Norbert J. Liebsch, Nicholas J. Patronas, Martha M. Quezado, Deborah Zametkin, Xiaohong R. Yang, and Alisa M. Goldstein
doi : 10.3171/2020.4.JNS193505
To gain insight into the role of germline genetics in the development of chordoma, the authors evaluated data from 2 sets of patients with familial chordoma, those with and without a germline duplication of the T gene (T-dup+ vs T-dup?), which was previously identified as a susceptibility mechanism in some families. The authors then compared the patients with familial tumors to patients with sporadic chordoma in the US general population reported to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program through 2015.
Incidence and linguistic quality of speech errors: a comparison of preoperative transcranial magnetic stimulation and intraoperative direct cortex stimulation
Ina B?hrend, Max R. Muench, Heike Schneider, Rabih Moshourab, Felix R. Dreyer, Peter Vajkoczy, Thomas Picht, and Katharina Faust
doi : 10.3171/2020.3.JNS193085
Given the interindividual variance of functional language anatomy, risk prediction based merely on anatomical data is insufficient in language area–related brain tumor surgery, suggesting the need for direct cortical and subcortical mapping during awake surgery. Reliable, noninvasive preoperative methods of language localization hold the potential for reducing the necessity for awake procedures and may improve patient counseling and surgical planning. Repetitive navigated transcranial magnetic stimulation (rnTMS) is an evolving tool for localizing language-eloquent areas. The aim of this study was to investigate the reliability of rnTMS in locating cortical language sites.
The microenvironment in sporadic and neurofibromatosis type II–related vestibular schwannoma: the same tumor or different? A comparative imaging and neuropathology study
Daniel Lewis, Carmine A. Donofrio, Claire O’Leary, Ka-loh Li, Xiaoping Zhu, Ricky Williams, Ibrahim Djoukhadar, Erjon Agushi, Cathal J. Hannan, Emma Stapleton, Simon K. Lloyd, Simon R. Freeman, Andrea Wadeson, Scott A. Rutherford, Charlotte Hammerbeck-Ward, D. Gareth Evans, Alan Jackson, Omar N. Pathmanaban, Federico Roncaroli, Andrew T. King, and David J. Coope
doi : 10.3171/2020.3.JNS193230
Inflammation and angiogenesis may play a role in the growth of sporadic and neurofibromatosis type 2 (NF2)–related vestibular schwannoma (VS). The similarities in microvascular and inflammatory microenvironment have not been investigated. The authors sought to compare the tumor microenvironment (TME) in sporadic and NF2-related VSs using a combined imaging and tissue analysis approach.
Clinical dose profile of Gamma Knife stereotactic radiosurgery for extensive brain metastases
Gregory Neil Bowden, Jong Oh Kim, Andrew Faramand, Kevin Fallon, John Flickinger, and L. Dade Lunsford
doi : 10.3171/2020.3.JNS193369
The use of Gamma Knife stereotactic radiosurgery (GKSRS) for the treatment of extensive intracranial metastases has been expanding due to its superior dosimetry and efficacy. However, there remains a dearth of data regarding the dose parameters in actual clinical scenarios. The authors endeavored to calculate the radiation dose to the brain when treating ? 15 brain metastases with GKSRS.
Predictors of visual functional outcome following treatment for cavernous sinus meningioma
Nida Fatima, Victoria Y. Ding, Summer S. Han, Steven D. Chang, and Antonio Meola
doi : 10.3171/2020.2.JNS193009
Cavernous sinus meningioma (CSM) can affect visual function and require expeditious treatment to prevent permanent visual loss. Authors of this retrospective study sought to determine the factors associated with visual functional outcomes in CSM patients treated with surgery, stereotactic radiosurgery (SRS), or stereotactic radiation therapy (SRT), alone or in combination.
A matched-pair analysis of clinical outcomes after intracavitary cesium-131 brachytherapy versus stereotactic radiosurgery for resected brain metastases
Diana A. Julie, Stefanie P. Lazow, Daniel B. Vanderbilt, Shoshana Taube, Menachem Z. Yondorf, Albert Sabbas, Susan Pannullo, Theodore H. Schwartz, and A. Gabriella Wernicke
doi : 10.3171/2020.3.JNS193419
Adjuvant radiation therapy (RT), such as cesium-131 (Cs-131) brachytherapy or stereotactic radiosurgery (SRS), reduces local recurrence (LR) of brain metastases (BM). However, SRS is less efficacious for large cavities, and the delay between surgery and SRS may permit tumor repopulation. Cs-131 has demonstrated improved local control, with reduced radiation necrosis (RN) compared to SRS. This study represents the first comparison of outcomes between Cs-131 brachytherapy and SRS for resected BM.
Near-complete regression 19 years after Gamma Knife radiosurgery of vestibular schwannoma with massive pseudoprogression: case report
Lai-fung Li, Chung-ping Yu, Anderson Chun-on Tsang, Benedict Beng-teck Taw, and Wai-man Lui
doi : 10.3171/2020.3.JNS20389
Gamma Knife radiosurgery (GKRS) is a frequent treatment choice for patients with small- to moderate-sized vestibular schwannoma (VS). However, pseudoprogression after GKRS is commonly observed, with a reported incidence ranging from 7% to 77%. The wide range of the reported incidence of pseudoprogression reflects the fact that there is no consensus on how it should be diagnosed.
Gamma Knife radiosurgery as a primary treatment for central neurocytoma
Chiman Jeon, Kyung Rae Cho, Jung Won Choi, Doo-Sik Kong, Ho Jun Seol, Do-Hyun Nam, and Jung-Il Lee
doi : 10.3171/2020.4.JNS20350
This study was performed to evaluate the role of Gamma Knife radiosurgery (GKRS) as a primary treatment for central neurocytomas (CNs).
External validation of current prediction systems of improvement after decompression surgery in Chiari malformation type I patients: can we do better?
James Feghali, Yangyiran Xie, Yuxi Chen, Sean Li, and Judy Huang
doi : 10.3171/2020.2.JNS20181
The Chiari Severity Index (CSI) and points-based algorithm of Thakar et al. are two prognostic tools that have been developed to predict the likelihood of improvement after suboccipital decompression in adult patients with Chiari malformation type I (CM-I). This study aimed to externally validate and critically evaluate these algorithms in the interest of guiding the development of improved prediction systems.
Optimal indications and limitations of endoscopic transorbital superior eyelid surgery for spheno-orbital meningiomas
Doo-Sik Kong, Yong Hwy Kim, and Chang-Ki Hong
doi : 10.3171/2020.3.JNS20297
Spheno-orbital meningiomas (SOMs) are complicated tumors that involve multiple structures at initial presentation, such as the orbit, temporalis muscle, sphenoidal bone, cavernous sinus, and temporal or infratemporal fossa. The infiltrative growth and complexity of this type of meningioma make total resection impossible. In this study, the authors evaluated the surgical outcome of the endoscopic transorbital approach (eTOA) for SOM. In addition, they identified optimal indications for the use of eTOA and analyzed the feasibility of this approach as a minimally invasive surgery for SOMs of varying types and locations at presentation.
The orbitopterygoid corridor as a deep keyhole for endoscopic access to the paranasal sinuses and clivus
Kenichi Oyama, Kentaro Watanabe, Shunya Hanakita, Pierre-Olivier Champagne, Thibault Passeri, Eduard H. Voormolen, Anne Laure Bernat, Nicolas Penet, Takanori Fukushima, and Sébastien Froelich
doi : 10.3171/2020.3.JNS2022
The anteromedial triangle (AMT) is the triangle formed by the ophthalmic (V1) and maxillary (V2) nerves. Opening of this bony space offers a limited access to the sphenoid sinus (SphS). This study aims to demonstrate the utility of the orbitopterygopalatine corridor (OPC), obtained by enlarging the AMT and transposing the contents of the pterygopalatine fossa (PPF) and V2, as an entrance to the SphS, maxillary sinus (MaxS), and nasal cavity.
Correlation between localization of supratentorial glioma to the precentral gyrus and difficulty in identification of the motor area during awake craniotomy
Taiichi Saito, Yoshihiro Muragaki, Manabu Tamura, Takashi Maruyama, Masayuki Nitta, Shunsuke Tsuzuki, Atsushi Fukui, and Takakazu Kawamata
doi : 10.3171/2020.2.JNS193471
Identification of the motor area during awake craniotomy is crucial for preservation of motor function when resecting gliomas located within or close to the motor area or the pyramidal tract. Nevertheless, sometimes the surgeon cannot identify the motor area during awake craniotomy. However, the factors that influence failure to identify the motor area have not been elucidated. The aim of this study was to assess whether tumor localization was correlated with a negative cortical response in motor mapping during awake craniotomy in patients with gliomas located within or close to the motor area or pyramidal tract.
Predictors of 30-day hospital readmission after mechanical thrombectomy for acute ischemic stroke
Nikolaos Mouchtouris, Fadi Al Saiegh, Breanna Valcarcel, Carrie E. Andrews, Evan Fitchett, David Nauheim, David Moskal, Nabeel Herial, Pascal Jabbour, Stavropoula I. Tjoumakaris, Ashwini D. Sharan, Robert H. Rosenwasser, and M. Reid Gooch
doi : 10.3171/2020.2.JNS193249
The 30-day readmission rate is of increasing interest to hospital administrators and physicians, as it is used to evaluate hospital performance and is associated with increased healthcare expenditures. The estimated yearly cost to Medicare of readmissions is $17.4 billion. The Centers for Medicare and Medicaid Services therefore track unplanned 30-day readmissions and institute penalties against hospitals whose readmission rates exceed disease-specific national standards. One of the most important conditions with potential for improvement in cost-effective care is ischemic stroke, which affects 795,000 people in the United States and is a leading cause of death and disability. Recent widespread adoption of mechanical thrombectomy has revolutionized stroke care, requiring reassessment of readmission causes and costs in this population.
Development and validation of a risk scoring model for postoperative adult moyamoya disease
Moinay Kim, Wonhyoung Park, Yeongu Chung, Si Un Lee, Jung Cheol Park, Do Hoon Kwon, Jae Sung Ahn, and Seungjoo Lee
doi : 10.3171/2020.2.JNS193221
The current grading system for moyamoya disease (MMD) is focused on angiographic studies with limited clinical application. The authors aimed to determine relevant factors that may impact postoperative outcome and establish a scoring system to predict the functional outcome.
Thrombin-induced miRNA-24–1-5p upregulation promotes angiogenesis by targeting prolyl hydroxylase domain 1 in intracerebral hemorrhagic rats
Hanjin Cui, Ali Yang, Huajun Zhou, Yang Wang, Jiekun Luo, Jun Zhou, Tao Liu, Pengfei Li, Jing Zhou, En Hu, Zehui He, Wang Hu, and Tao Tang
doi : 10.3171/2020.2.JNS193069
Thrombin is a unique factor that triggers post-intracerebral hemorrhage (ICH) angiogenesis by increasing hypoxia-inducible factor–1? (HIF-1?) at the protein level. However, HIF-1? mRNA remains unchanged. MicroRNAs (miRNAs) mediate posttranscriptional regulation by suppressing protein translation from mRNAs. This study aimed to determine if miRNAs might be involved in thrombin-induced angiogenesis after ICH by targeting HIF-1? or its upstream prolyl hydroxylase domains (PHDs).
Invasive neuromonitoring with an extended definition of delayed cerebral ischemia is associated with improved outcome after poor-grade subarachnoid hemorrhage
Michael Veldeman, Walid Albanna, Miriam Weiss, Catharina Conzen, Tobias Philip Schmidt, Henna Schulze-Steinen, Martin Wiesmann, Hans Clusmann, and Gerrit Alexander Schubert
doi : 10.3171/2020.3.JNS20375
The current definition of delayed cerebral ischemia (DCI) is based on clinical characteristics precluding its use in patients with poor-grade subarachnoid hemorrhage (SAH). Additional concepts to evaluate the unconscious patient are required. Invasive neuromonitoring (INM) may allow timely detection of metabolic and oxygenation crises before irreversible damage has occurred.
Critical role of platelet-derived growth factor–? in angiogenesis after indirect bypass in a murine moyamoya disease model
Tomohide Hayashi, Seiji Yamamoto, Takeru Hamashima, Hisashi Mori, Masakiyo Sasahara, and Satoshi Kuroda
doi : 10.3171/2020.3.JNS193273
This study aimed to clarify the underlying mechanism of pathognomonic angiogenesis between the temporal muscle and neocortex after indirect bypass for moyamoya disease by shedding light on the role of platelet-derived growth factor receptor–? (PDGFR?) in angiogenesis.
Efficacy of intraarterial superselective indocyanine green videoangiography in cerebral arteriovenous malformation surgery in a hybrid operating room
Kenji Shimada, Tadashi Yamaguchi, Takeshi Miyamoto, Shu Sogabe, Masaaki Korai, Toshiyuki Okazaki, Yasuhisa Kanematsu, Junichiro Satomi, Shinji Nagahiro, and Yasushi Takagi
doi : 10.3171/2020.3.JNS20319
Although intravenous indocyanine green (ICG) videoangiography has been reported to be useful when applied to cerebral arteriovenous malformation (AVM) surgery, the ICG that remains after the procedure makes it difficult to understand the anatomy, to evaluate nidus blood flow changes, and to repeat ICG videoangiography within a short time. Intraarterial ICG videoangiography has emerged as a way to overcome these limitations. The current study presents the results of intraarterial ICG videoangiography undertaken in patients with cerebral AVMs.
Thick and diffuse cisternal clot independently predicts vasospasm-related morbidity and poor outcome after aneurysmal subarachnoid hemorrhage
E. François Aldrich, Randall Higashida, Abdel Hmissi, Elizabeth J. Le, R. Loch Macdonald, Angelina Marr, Stephan A. Mayer, Sébastien Roux, and Nicolas Bruder
doi : 10.3171/2020.3.JNS193400
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with significant morbidity and mortality. The presence of thick, diffuse subarachnoid blood may portend a worse clinical course and outcome, independently of other known prognostic factors such as age, aneurysm size, and initial clinical grade.
Comparative efficacy of autologous versus cadaveric saphenous vein grafts in cerebral revascularization surgery
Christopher J. Stapleton, Ahmed E. Hussein, Mandana Behbahani, Ali Alaraj, Sepideh Amin-Hanjani, and Fady T. Charbel
doi : 10.3171/2020.3.JNS192546
Cerebral bypasses are performed for the purpose of either flow augmentation for ischemic cerebrovascular disease or flow replacement for vessel sacrifice during complex aneurysm or tumor surgery. Saphenous vein grafts (SVGs) are commonly used interposition grafts. The authors of this study sought to compare the efficacy of autologous versus cadaveric SVGs in a large series of cerebral bypasses using interposition vein grafts with long-term angiographic follow-up.
RECO Flow Restoration Device Versus Solitaire FR With the Intention for Thrombectomy Study (REDIRECT): a prospective randomized controlled trial
Jie Cao, Hang Lin, Min Lin, Kaifu Ke, Yunfeng Zhang, Yong Zhang, Weihong Zheng, Xingyu Chen, Wei Wang, Meng Zhang, Jinggang Xuan, Ya Peng, and for the REDIRECT Trial Investigators
doi : 10.3171/2020.3.JNS193356
The RECO flow restoration (FR) device is a new stent retriever designed for rapid flow restoration in acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Here, the authors compared the efficacy and safety of the RECO device with the predicate Solitaire FR stent retriever.
Direct versus indirect bypass procedure for the treatment of ischemic moyamoya disease: results of an individualized selection strategy
Troels H. Nielsen, Kumar Abhinav, Eric S. Sussman, Summer S. Han, Yingjie Weng, Teresa Bell-Stephens, CNRN, Jeremy J. Heit, and Gary K. Steinberg
doi : 10.3171/2020.3.JNS192847
The only effective treatment for ischemic moyamoya disease (iMMD) is cerebral revascularization by an extracranial to intracranial bypass. The preferred revascularization method remains controversial: direct versus indirect bypass. The purpose of this study was to test the hypothesis that method choice should be personalized based on angiographic, hemodynamic, and clinical characteristics to balance the risk of perioperative major stroke against treatment efficacy.
Mechanisms and outcomes of the supercharged end-to-side nerve transfer: a review of preclinical and clinical studies
Nicholas von Guionneau, Karim A. Sarhane, Gerald Brandacher, Shehan Hettiaratchy, Allan J. Belzberg, and Sami Tuffaha
doi : 10.3171/2020.3.JNS191429
Proximal peripheral nerve injuries often result in poor functional outcomes, chiefly because of the long time period between injury and the reinnervation of distal targets, which leads to muscle and Schwann cell atrophy. The supercharged end-to-side (SETS) nerve transfer is a recent technical innovation that introduces donor axons distally into the side of an injured nerve to rapidly innervate and support end organs while allowing for additional reinnervation after a proximal repair at the injury site. However, the mechanisms by which donor axons grow within the recipient nerve, contribute to muscle function, and impact the regeneration of native recipient axons are poorly understood. This uncertainty has slowed the transfer’s clinical adoption. The primary objective of this article is to comprehensively review the mechanisms underpinning axonal regeneration and functional recovery after a SETS nerve transfer. A secondary objective is to report current clinical applications in the upper limb and their functional outcomes. The authors also propose directions for future research with the aim of maximizing the clinical utility of the SETS transfer for peripheral nerve surgeons and their patients.
Covering the proximal nerve stump with chondroitin sulfate proteoglycans prevents traumatic painful neuroma formation by blocking axon regeneration after neurotomy in Sprague Dawley rats
Fu-Lin He, Shuai Qiu, Jian-Long Zou, Fan-Bin Gu, Zhi Yao, Zhe-Hui Tu, Yuan-Yuan Wang, Xiao-Lin Liu, Li-Hua Zhou, and Qing-Tang Zhu
doi : 10.3171/2020.3.JNS193202
Neuropathic pain caused by traumatic neuromas is an extremely intractable clinical problem. Disorderly scar tissue accumulation and irregular and immature axon regeneration around the injury site mainly contribute to traumatic painful neuroma formation. Therefore, successfully preventing traumatic painful neuroma formation requires the effective inhibition of irregular axon regeneration and disorderly accumulation of scar tissue. Considering that chondroitin sulfate proteoglycans (CSPGs) can act on the growth cone and effectively inhibit axon regeneration, the authors designed and manufactured a CSPG-gelatin blocker to regulate the CSPGs’ spatial distribution artificially and applied it in a rat model after sciatic nerve neurectomy to evaluate its effects in preventing traumatic painful neuroma formation.
Analysis of risk factors and clinical sequelae of direct electrical cortical stimulation–induced seizures and afterdischarges in patients undergoing awake mapping
Zachary A. Abecassis, Amit B. Ayer, Jessica W. Templer, Ketan Yerneni, Nikhil K. Murthy, and Matthew C. Tate
doi : 10.3171/2020.3.JNS193231
Intraoperative stimulation has emerged as a crucial adjunct in neurosurgical oncology, aiding maximal tumor resection while preserving sensorimotor and language function. Despite increasing use in clinical practice of this stimulation, there are limited data on both intraoperative seizure (IS) frequency and the presence of afterdischarges (ADs) in patients undergoing such procedures. The objective of this study was to determine risk factors for IS or ADs, and to determine the clinical consequences of these intraoperative events.
What factors impact the clinical outcome of magnetic resonance imaging–guided focused ultrasound thalamotomy for essential tremor?
Kenji Fukutome, Yoshihiro Kuga, Hideyuki Ohnishi, Hidehiro Hirabayashi, and Hiroyuki Nakase
doi : 10.3171/2020.2.JNS192814
Magnetic resonance imaging–guided focused ultrasound (MRgFUS) is a novel and useful treatment for essential tremor (ET); however, the factors impacting treatment outcome are unknown. The authors conducted this study to determine the factors affecting the outcome of MRgFUS.
Effects of implantation of a deep brain stimulation device on patient weight in Parkinson’s disease and essential tremor
Nikolas R. Monteferrante, Brian G. Wilhelmi, Margaret Lambert, and Francisco A. Ponce
doi : 10.3171/2020.2.JNS192354
Deep brain stimulation (DBS) is a well-established therapy for treating neurological movement disorders. Some patients who have received DBS therapy have noticed significant weight gain. Further investigation into correlations between patient characteristics and weight gain following DBS device implantation, which the authors here have done, will provide physicians with useful clinical information.
Preoperative factors associated with adverse events during awake craniotomy: analysis of 609 consecutive cases
Hirokazu Takami, Nikki Khoshnood, and Mark Bernstein
doi : 10.3171/2020.4.JNS20378
Awake surgery is becoming more standard and widely practiced for neurosurgical cases, including but not limited to brain tumors. The optimal selection of patients who can tolerate awake surgery remains a challenge. The authors performed an updated cohort study, with particular attention to preoperative clinical and imaging characteristics that may have an impact on the viability of awake craniotomy in individual patients.
A simple and cost-effective model for ventricular catheter placement training: technical note
Nathan Todnem, Khoi D. Nguyen, Vamsi Reddy, Dayton Grogan, Taylor Waitt, and Cargill H. Alleyne Jr.
doi : 10.3171/2020.2.JNS19161
External ventricular drain (EVD) placement is one of first cranial procedures neurosurgery residents are expected to perform independently. While proper training improves patient outcomes, there are few options for practicing EVD placement prior to placing the EVD in patients in a clinical setting. Proposed solutions to this include using cadaveric models and virtual simulations, but barriers exist with these as well in regard to authenticity. EVD simulators using virtual reality technologies are a promising new technique for training, but the cost of these devices poses a barrier to general/widespread accessibility among smaller programs or underserved hospitals. The authors desribe a novel, yet simple, and cost-effective technique (less than $5 per mold) for developing a brain model constructed of homemade ballistics gelatin that can be used for teaching and practicing the placement of EVD.
Levels of caspase-1 in cerebrospinal fluid of patients with traumatic brain injury: correlation with intracranial pressure and outcome
Jon Pérez-B?rcena, Catalina Cresp?, Guillem Frontera, Juan Antonio Llompart-Pou, Osman Salazar, Victor Goliney, Javier Ib??ez, M. Ross Bullock, and Juan Pablo de Rivero Vaccari
doi : 10.3171/2020.2.JNS193079
The objectives of this study were to evaluate levels of inflammasome-signaling proteins in serum and CSF of patients with traumatic brain injury (TBI), and to correlate these protein levels with intracranial pressure (ICP) and clinical outcomes at 6 months after injury.
Cardiac-gated intracranial elastance in a swine model of raised intracranial pressure: a novel method to assess intracranial pressure–volume dynamics
Omer Doron, Ofer Barnea, Nino Stocchetti, Tal Or, Erez Nossek, and Guy Rosenthal
doi : 10.3171/2020.3.JNS193262
Previous studies have demonstrated the importance of intracranial elastance; however, methodological difficulties have limited widespread clinical use. Measuring elastance may offer potential benefit in helping to identify patients at risk for untoward intracranial pressure (ICP) elevation from small rises in intracranial volume. The authors sought to develop an easily used method that accounts for the changing ICP that occurs over a cardiac cycle and to assess this method in a large-animal model over a broad range of ICPs.
Complications, outcomes, and management strategies of non-missile penetrating head injuries
Bradley M. Harrington, Armin Gretschel, Carl Lombard, Russell R. Lonser, and Adriaan J. Vlok
doi : 10.3171/2020.4.JNS20122
While high-velocity missile injury (gunshot) is associated with kinetic and thermal injuries, non-missile penetrating head injury (NMPHI) results in primary damage along the tract of the piercing object that can be associated with significant secondary complications. Despite the unique physical properties of NMPHI, factors associated with complications, expected outcomes, and optimal management have not been defined. In this study, the authors attempted to define those factors.
Isolated severe blunt traumatic brain injury: effect of obesity on outcomes
Jennifer T. Cone, Elizabeth R. Benjamin, Daniel B. Alfson, and Demetrios Demetriades
doi : 10.3171/2020.3.JNS193458
Obesity has been widely reported to confer significant morbidity and mortality in both medical and surgical patients. However, contemporary data indicate that obesity may confer protection after both critical illness and certain types of major surgery. The authors hypothesized that this “obesity paradox” may apply to patients with isolated severe blunt traumatic brain injuries (TBIs).
Erratum. Extent of resection, molecular signature, and survival in 1p19q-codeleted gliomas
Andrew L. A. Garton, Connor J. Kinslow, and Tony J. C. Wang
Erratum. Predictors of 30-day hospital readmission after mechanical thrombectomy for acute ischemic stroke
Nikolaos Mouchtouris and M. Reid Gooch
Letter to the Editor. Graft selection in cerebral revascularization surgery
Long Wang, Lujun Jing, Huaiyu Sun, and Xiang’en Shi
doi : 10.3171/2020.6.JNS201957
Letter to the Editor. Invasive neuromonitoring for poor-grade SAH
Sergio Garc?a-Garc?a, Diego Culebras, and Ram?n Torné
doi : 10.3171/2020.5.JNS202047
Letter to the Editor. Reporting continuous variables and statistical significance in a study of 30-day hospital readmissions after mechanical thrombectomy for acute ischemic stroke
Siou Li, Qing Xu, and Changhao Yin
doi : 10.3171/2020.5.JNS201857
Letter to the Editor. Intracranial pressure monitoring: challenge beyond the threshold numerical value
N?collas Nunes Rabelo, Mateus Gonçalves de Sena Barbosa, Matheus Pereira Silva Lemos, Sérgio Brasil, and Gustavo Frigieri
doi : 10.3171/2020.9.JNS203395
Letter to the Editor. The COVID-19 crisis and return to the Hippocratic Corpus
Masanori Kurimoto
doi : 10.3171/2020.9.JNS203484
