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Seizure and neuropsychological outcomes in a large series of selective amygdalohippocampectomies with a minimally invasive subtemporal approach
Alexander C. Whiting, Tsinsue Chen, Kyle I. Swanson, Corey T. Walker, Jakub Godzik, Joshua S. Catapano, and Kris A. Smith
doi : 10.3171/2020.3.JNS192589
Page Range:1685–1693
Debate continues over proper surgical treatment for mesial temporal lobe epilepsy (MTLE). Few large comprehensive studies exist that have examined outcomes for the subtemporal selective amygdalohippocampectomy (sSAH) approach. This study describes a minimally invasive technique for sSAH and examines seizure and neuropsychological outcomes in a large series of patients who underwent sSAH for MTLE.
Language network reorganization before and after temporal lobe epilepsy surgery
Olivia Foesleitner, Benjamin Sigl, Victor Schmidbauer, Karl-Heinz Nenning, Ekaterina Pataraia, Lisa Bartha-Doering, Christoph Baumgartner, Susanne Pirker, Doris Moser, Michelle Schwarz, Johannes A. Hainfellner, Thomas Czech, Christian Dorfer, Georg Langs, Daniela Prayer, Silvia Bonelli, and Gregor Kasprian
doi : 10.3171/2020.4.JNS193401
Page Range:1694–1702
Epilepsy surgery is the recommended treatment option for patients with drug-resistant temporal lobe epilepsy (TLE). This method offers a good chance of seizure freedom but carries a considerable risk of postoperative language impairment. The extremely variable neurocognitive profiles in surgical epilepsy patients cannot be fully explained by extent of resection, fiber integrity, or current task-based functional MRI (fMRI). In this study, the authors aimed to investigate pathology- and surgery-triggered language organization in TLE by using fMRI activation and network analysis as well as considering structural and neuropsychological measures.
Language hemispheric dominance analyzed with magnetic resonance DTI: correlation with the Wada test
Juan Delgado-Fern?ndez, Maria ?ngeles Garc?a-Pallero, Rafael Manzanares-Soler, Pilar Mart?n-Plasencia, Guillermo Blasco, Natalia Frade-Porto, Marta Navas-Garc?a, Paloma Pulido, Rafael G. Sola, and Cristina V. Torres
doi : 10.3171/2020.4.JNS20456
Page Range:1703–1710
Language lateralization is a major concern in some patients with pharmacoresistant epilepsy who will face surgery; in these patients, hemispheric dominance testing is essential to avoid further complications. The Wada test is considered the gold standard examination for language localization, but is invasive and requires many human and material resources. Functional MRI and tractography with diffusion tensor imaging (DTI) have demonstrated that they could be useful for locating language in epilepsy surgery, but there is no evidence of the correlation between the Wada test and DTI MRI in language dominance.
Editorial. Achieving optimal outcomes with deep brain stimulation for posttraumatic stress disorder
Michael D. Staudt, Ilknur Telkes, and Julie G. Pilitsis
doi : 10.3171/2020.5.JNS201127
Page Range:1711–1713
Neurostimulation for treatment-resistant posttraumatic stress disorder: an update on neurocircuitry and therapeutic targets
M. Benjamin Larkin, John P. McGinnis, Rita I. Snyder, Eric A. Storch, Wayne K. Goodman, Ashwin Viswanathan, and Sameer A. Sheth
doi : 10.3171/2020.4.JNS2061
Page Range:1715–1723
Posttraumatic stress disorder (PTSD) is a widespread and often devastating psychiatric condition. Core symptoms include intrusive and distressing thoughts, heightened reactivity, mood changes, cognitive impairments, and consequent avoidance of trauma-related stimuli. Symptoms of PTSD are often refractory to standard treatments, and neuromodulatory techniques have therefore drawn significant interest among the most treatment-resistant patients. Transcranial magnetic stimulation has demonstrated minimal efficacy, and deep brain stimulation trials are currently ongoing. PTSD is a disorder of neural circuitry; the current understanding includes involvement of the amygdala (basolateral and central nuclei), the prefrontal cortex (ventral medial and dorsolateral regions), and the hippocampus. Neuroimaging and optogenetic studies have improved the understanding of large-scale neural networks and the effects of microcircuitry manipulation, respectively. This review discusses the current PTSD literature and ongoing neurostimulation trials, and it highlights the current understanding of neuronal circuit dysfunction in PTSD. The authors emphasize the anatomical correlations of PTSD’s hallmark symptoms, offer another potential deep brain stimulation target for PTSD, and note the need for continued research to identify useful biomarkers for the development of closed-loop therapies. Although there is hope that neuromodulation will become a viable treatment modality for PTSD, this concept remains theoretical, and further research should involve institutional review board–approved controlled prospective clinical studies.
Movement during focused ultrasound therapy caused by an unstable magnetic resonance table: case report
Kazuaki Yamamoto, Hisashi Ito, Shigeru Fukutake, Takashi Odo, Tetsumasa Kamei, Toshio Yamaguchi, and Takaomi Taira
doi : 10.3171/2020.4.JNS20219
Page Range:1724–1727
Transcranial MR-guided focused ultrasound (MRgFUS) therapy is a less invasive form of stereotactic treatment for tremors and other movement disorders. Its stereotactic accuracy is ensured by stability of the stereotactic frame and MR table. The authors report a case wherein the patient’s movement was detected, and the MR images were repeated to continue the treatment.
Triple motor mapping: transcranial, bipolar, and monopolar mapping for supratentorial glioma resection adjacent to motor pathways
Andrew J. Gogos, Jacob S. Young, Ramin A. Morshed, Lauro N. Avalos, Roger S. Noss, Javier E. Villanueva-Meyer, Shawn L. Hervey-Jumper, and Mitchel S. Berger
doi : 10.3171/2020.3.JNS193434
Page Range:1728–1737
Maximal safe resection of gliomas near motor pathways is facilitated by intraoperative mapping. The authors and other groups have described the use of bipolar or monopolar direct stimulation to identify functional tissue, as well as transcranial or transcortical motor evoked potentials (MEPs) to monitor motor pathways. Here, the authors describe their initial experience using all 3 modalities to identify, monitor, and preserve cortical and subcortical motor systems during glioma surgery.
Language supplementary motor area syndrome correlated with dynamic changes in perioperative task-based functional MRI activations: case report
Jaime A. Quirarte, Vinodh A. Kumar, Ho-Ling Liu, Kyle R. Noll, Jeffrey S. Wefel, and Frederick F. Lang
doi : 10.3171/2020.4.JNS193250
Page Range:1738–1742
Development and external validation of a clinical prediction model for functional impairment after intracranial tumor surgery
Victor E. Staartjes, Morgan Broggi, Costanza Maria Zattra, Flavio Vasella, Julia Velz, Silvia Schiavolin, Carlo Serra, Jiri Bartek Jr., Alexander Fletcher-Sandersj??, Petter F?rander, Darius Kalasauskas, Mirjam Renovanz, Florian Ringel, Konstantin R. Brawanski, Johannes Kerschbaumer, Christian F. Freyschlag, Asgeir S. Jakola, Kristin Sj?vik, Ole Solheim, Bawarjan Schatlo, Alexandra Sachkova, Hans Christoph Bock, Abdelhalim Hussein, Veit Rohde, Marike L. D. Broekman, Claudine O. Nogarede, Cynthia M. C. Lemmens, Julius M. Kernbach, Georg Neuloh, Oliver Bozinov, Niklaus Krayenbühl, Johannes Sarnthein, Paolo Ferroli, Luca Regli, Martin N. Stienen, and FEBNS
doi : 10.3171/2020.4.JNS20643
Page Range:1743–1750
Decision-making for intracranial tumor surgery requires balancing the oncological benefit against the risk for resection-related impairment. Risk estimates are commonly based on subjective experience and generalized numbers from the literature, but even experienced surgeons overestimate functional outcome after surgery. Today, there is no reliable and objective way to preoperatively predict an individual patient’s risk of experiencing any functional impairment.
Direct convective delivery of adeno-associated virus gene therapy for treatment of neurological disorders
Russell R. Lonser, Asad S. Akhter, Miros?aw Zabek, J. Bradley Elder, and Krystof S. Bankiewicz
doi : 10.3171/2020.4.JNS20701
Page Range:1751–1763
Molecular biological insights have led to a fundamental understanding of the underlying genomic mechanisms of nervous system disease. These findings have resulted in the identification of therapeutic genes that can be packaged in viral capsids for the treatment of a variety of neurological conditions, including neurodegenerative, metabolic, and enzyme deficiency disorders. Recent data have demonstrated that gene-carrying viral vectors (most often adeno-associated viruses) can be effectively distributed by convection-enhanced delivery (CED) in a safe, reliable, targeted, and homogeneous manner across the blood-brain barrier. Critically, these vectors can be monitored using real-time MRI of a co-infused surrogate tracer to accurately predict vector distribution and transgene expression at the perfused site. The unique properties of CED of adeno-associated virus vectors allow for cell-specific transgene manipulation of the infused anatomical site and/or widespread interconnected sites via antero- and/or retrograde transport. The authors review the convective properties of viral vectors, associated technology, and clinical applications.
Risk of tumor recurrence in intracranial meningiomas: comparative analyses of the predictive value of the postoperative tumor volume and the Simpson classification
Dorothee C?cilia Spille, Katharina Hess, Eike Bormann, Cristina Sauerland, Caroline Brokinkel, Nils Warneke, Christian Mawrin, Werner Paulus, Walter Stummer, and Benjamin Brokinkel
doi : 10.3171/2020.4.JNS20412
Page Range:1764–1771
In meningiomas, the Simpson grading system is applied to estimate the risk of postoperative recurrence, but might suffer from bias and limited overview of the resection cavity. In contrast, the value of the postoperative tumor volume as an objective predictor of recurrence is largely unexplored. The objective of this study was to compare the predictive value of residual tumor volume with the intraoperatively assessed extent of resection (EOR).
Targeting CD146 using folic acid–conjugated nanoparticles and suppression of tumor growth in a mouse glioma model
Naoki Fukui, Toshio Yawata, Takahito Nakajo, Yu Kawanishi, Youichirou Higashi, Tatsuyuki Yamashita, Takaaki Aratake, Koichi Honke, and Tetsuya Ueba
doi : 10.3171/2020.4.JNS193078
Page Range:1772–1782
Glioma stem cells (GSCs) are responsible for tumor initiation, therapeutic resistance, and recurrence. CD146 is mainly expressed in dividing GSCs and regulates cell cycle progression. However, the evaluation of the efficacy of targeted therapy against CD146 in vivo remains to be investigated. In this study, the authors aimed to develop gene therapy targeting GSCs using chitosan oligosaccharide lactate (COL) nanoparticles (NPs) conjugated with folic acid–polyethylene glycol (FA-PEG-COL NPs) for in vitro and in vivo delivery of CD146 small-interfering RNA (siCD146) and to determine the effect of CD146 knockdown on tumor growth.
Provision of rapid and specific ex vivo diagnosis of central nervous system lymphoma from rodent xenograft biopsies by a fluorescent aptamer
Joseph Georges, Xiaodong Qi, Xiaowei Liu, Yu Zhou, Eric C. Woolf, Amber Valeri, Zein Al-Atrache, Evgenii Belykh, Burt G. Feuerstein, Mark Preul, Adrienne C. Scheck, Mark Reiser, Trent Anderson, Jonas Gopez, Denah Appelt, Steven Yocom, Jennifer Eschbacher, Hao Yan, and Peter Nakaji
doi : 10.3171/2020.4.JNS192476
Page Range:1783–1790
Differentiating central nervous system (CNS) lymphoma from other intracranial malignancies remains a clinical challenge in surgical neuro-oncology. Advances in clinical fluorescence imaging contrast agents and devices may mitigate this challenge. Aptamers are a class of nanomolecules engineered to bind cellular targets with antibody-like specificity in a fraction of the staining time. Here, the authors determine if immediate ex vivo fluorescence imaging with a lymphoma-specific aptamer can rapidly and specifically diagnose xenografted orthotopic human CNS lymphoma at the time of biopsy.
Quality-of-life trajectories after stereotactic radiosurgery for brain metastases
Adomas Bunevicius, Karen Lavezzo, Leah Shabo, Jesse McClure, and Jason P. Sheehan
doi : 10.3171/2020.4.JNS20788
Page Range:1791–1799
Quality of life (QOL) is an important endpoint measure of cancer treatment. The authors’ goal was to evaluate QOL trajectories and prognostic value in cancer patients treated with stereotactic radiosurgery (SRS) for brain metastases.
Development and clinical validation of a grading system for pituitary adenoma consistency
Martin J. Rutkowski, Ki-Eun Chang, Tyler Cardinal, Robin Du, Ali R. Tafreshi, Daniel A. Donoho, Andrew Brunswick, Alexander Micko, Chia-Shang J. Liu, Mark S. Shiroishi, John D. Carmichael, and Gabriel Zada
doi : 10.3171/2020.4.JNS193288
Page Range:1800–1807
Pituitary adenoma (PA) consistency, or texture, is an important intraoperative characteristic that may dictate operative dissection techniques and/or instruments used for tumor removal during endoscopic endonasal approaches (EEAs). The impact of PA consistency on surgical outcomes has yet to be elucidated.
The outcomes of conservatively observed asymptomatic nonfunctioning pituitary adenomas with optic nerve compression
Kihwan Hwang, Yong Hwy Kim, Jung Hee Kim, Jung Hyun Lee, Hee Kyung Yang, Jeong-Min Hwang, Chae-Yong Kim, and Jung Ho Han
doi : 10.3171/2020.4.JNS192778
Page Range:1808–1815
The authors investigated the natural history of asymptomatic nonfunctioning pituitary adenomas (NFPAs) with optic nerve compression.
Analysis of modifiable and nonmodifiable risk factors in patients undergoing pituitary surgery
Shane Shahrestani, Alexander M. Ballatori, Xiao T. Chen, Andy Ton, Ben A. Strickland, Andrew Brunswick, and Gabriel Zada
doi : 10.3171/2020.4.JNS20417
Page Range:1816–1823
Pituitary adenomas (PAs) are among the most common intracranial tumors. Understanding the clinical effects of various modifiable risk factors (MRFs) and nonmodifiable risk factors (NMRFs) is important in guiding proper treatment, yet there is limited evidence outlining the influence of MRFs and NMRFs on outcomes of PA resection. The aim of this study was to analyze MRFs and NMRFs in patients undergoing resection for PAs.
Radiographic and clinical outcomes using intraoperative magnetic resonance imaging for transsphenoidal resection of pituitary adenomas
Rupa G. Juthani, Anne S. Reiner, Ankur R. Patel, Aimee Cowan, Marie Roguski, Katherine S. Panageas, Eliza B. Geer, Sasan Karimi, Marc A. Cohen, and Viviane Tabar
doi : 10.3171/2020.4.JNS20178
Page Range:1824–1835
The utility and safety of intraoperative MRI (iMRI) for resection of pituitary adenomas is not clearly established in the context of advances in endoscopic approaches. The goal in this study was to evaluate the safety and efficacy of iMRI for pituitary adenoma resection, with endoscopic transsphenoidal (ETS) versus microscopic transsphenoidal (MTS) approaches.
Combined and simultaneous endoscopic endonasal and transorbital surgery for a Meckel’s cave schwannoma: technical nuances of a mini-invasive, multiportal approach
Alberto Di Somma, Cristobal Langdon, Matteo de Notaris, Luis Reyes, Santiago Ortiz-Perez, Isam Alobid, and Joaquim Ense?at
doi : 10.3171/2020.4.JNS20707
Page Range:1836–1845
Over the years, Meckel’s cave pathologies have been judged off-limits because of high rates of morbidity. Even though several studies have defined various surgical routes with tolerable morbidity and mortality rates, controversies related to the optimal avenue to treat different categories of Meckel’s cave and cavernous sinus neoplasms persist.
An endovascular assisted, nonocclusive cerebral bypass: a technical feasibility study in a rabbit model
Alexander Spiessberger, Fabio Strange, Basil Erwin Gruter, Stefan Wanderer, Daniela Casoni, Philipp Gruber, Michael Diepers, Luca Remonda, Javier Fandino, Javier A?on, and Serge Marbacher
doi : 10.3171/2020.3.JNS20334
Page Range:1846–1851
Temporary parent vessel occlusion performed to establish a high-flow interpositional bypass carries the risk of infarcts. The authors investigated the feasibility of a novel technique to establish a high-flow bypass without temporary parent vessel occlusion in order to lower the risk of ischemic complications.
Contralateral interoptic approach to paraclinoid aneurysms: a patient-selection algorithm based on anatomical investigation and clinical validation
Xiaochun Zhao, Ali Tayebi Meybodi, Mohamed A. Labib, Sirin Gandhi, Evgenii Belykh, Komal Naeem, Mark C. Preul, Peter Nakaji, and Michael T. Lawton
doi : 10.3171/2020.3.JNS193205
Page Range:1852–1860
Aneurysms that arise on the medial surface of the paraclinoid segment of the internal carotid artery (ICA) are surgically challenging. The contralateral interoptic trajectory, which uses the space between the optic nerves, can partially expose the medial surface of the paraclinoid ICA. In this study, the authors quantitatively measure the area of the medial ICA accessible through the interoptic triangle and propose a potential patient-selection algorithm that is based on preoperative measurements on angiographic imaging.
Difference in imaging biomarkers between transient and permanent neurological deficits after endovascular treatment of cerebrovascular aneurysms
Yiping Li, Jason Kim, Dustin Simpson, Beverly Aagaard-Kienitz, David Niemann, Ignatius N. Esene, and Azam Ahmed
doi : 10.3171/2020.4.JNS192718
Page Range:1861–1870
The literature suggests that blood-brain barrier disruption (BBBD) plays a significant role in the development of neurological events in patients with diffusion-weighted imaging (DWI) that is negative for lesions. In this prospective, single-center cohort study, the authors compared the imaging characteristics of patients suffering transient neurological events (TNEs) with those in patients suffering permanent neurological events (PNEs) after having undergone elective embolization of unruptured intracranial aneurysms.
Lack of impact of polycystic kidney disease on the outcome of aneurysmal subarachnoid hemorrhage: a matched case-control study
Heidi J. Nurmonen, Terhi Huttunen, Jukka Huttunen, Arttu Kurtelius, Satu Kotikoski, Antti Junkkari, Timo Koivisto, Mikael von und zu Fraunberg, Olli-Pekka K?m?r?inen, Maarit L?ng, Helena Isoniemi, Juha E. J??skel?inen, and Antti E. Lindgren
doi : 10.3171/2020.4.JNS20544
Page Range:1871–1878
The authors set out to study whether autosomal dominant polycystic kidney disease (ADPKD), an established risk factor for intracranial aneurysms (IAs), affects the acute course and long-term outcome of aneurysmal subarachnoid hemorrhage (aSAH).
The middle communicating artery: a novel fourth-generation bypass for revascularizing trapped middle cerebral artery bifurcation aneurysms in 2 cases
Fabio A. Frisoli, Joshua S. Catapano, Jacob F. Baranoski, and Michael T. Lawton
doi : 10.3171/2020.4.JNS193412
Page Range:1879–1886
The anterior and posterior communicating arteries are natural connections between arteries that enable different adjacent circulations to redistribute blood flow instantly in response to changing supply and demand. An analogous communication does not exist in the middle cerebral circulation. A middle communicating artery (MCoA) can be created microsurgically between separate middle cerebral artery (MCA) trunks, enabling flow to redistribute in response to changing supply and demand. The MCoA would draw blood flow from an adjacent circulation such as the external carotid circulation. The MCoA requires the application of fourth-generation techniques to reconstruct bi- and trifurcations after occluding complex MCA trunk aneurysms. In this report, the authors describe two recent cases of complex MCA bi- and trifurcation aneurysms in which the occluded efferent trunks were revascularized by creating an MCoA.
Discrepancy between MRA and DSA in identifying the shape of small intracranial aneurysms
Youngseok Kwak, Wonsoo Son, Yong-Sun Kim, Jaechan Park, and Dong-Hun Kang
doi : 10.3171/2020.4.JNS20128
Page Range:1887–1893
The authors evaluated the sensitivity and accuracy of MRA in identifying the shape of small-sized unruptured intracranial aneurysms.
Treatment of posterior circulation fusiform aneurysms
Ephraim W. Church, Mark G. Bigder, Eric S. Sussman, Santosh E. Gummidipundi, Summer S. Han, Jeremy J. Heit, Huy M. Do, Robert L. Dodd, Michael P. Marks, and Gary K. Steinberg
doi : 10.3171/2020.4.JNS192838
Page Range:1894–1900
Perforator arteries, the absence of an aneurysm discrete neck, and the often-extensive nature of posterior circulation fusiform aneurysms present treatment challenges. There have been advances in microsurgical and endovascular approaches, including flow diversion, and the authors sought to review these treatments in a long-term series at their neurovascular referral center.
Biologically effective dose and prediction of obliteration of unruptured arteriovenous malformations treated by upfront Gamma Knife radiosurgery: a series of 149 consecutive cases
Constantin Tuleasca, Iulia Peciu-Florianu, Henri-Arthur Leroy, Maximilien Vermandel, Mohamed Faouzi, and Nicolas Reyns
doi : 10.3171/2020.4.JNS201250
Page Range:1901–1911
Arteriovenous malformations (AVMs) present no pathologic tissue, and radiation dose is confined in a clear targeted volume. The authors retrospectively evaluated the role of the biologically effective dose (BED) after Gamma Knife radiosurgery (GKRS) for brain AVMs.
Cerebral venous thrombosis in traumatic brain injury: a cause of secondary insults and added mortality
Dag Ferner Netteland, Magnus Mejl?nder-Evjensvold, Nils O. Skaga, Else Charlotte Sandset, Mads Aarhus, and Eirik Helseth
doi : 10.3171/2020.4.JNS20511
Page Range:1912–1920
Cerebral venous thrombosis (CVT) is increasingly recognized in traumatic brain injury (TBI), but its complications and effect on outcome remain undetermined. In this study, the authors characterize the complications and outcome effect of CVT in TBI patients.
Plasma extracellular vesicles as a source of biomarkers in traumatic brain injury
Ross C. Puffer, Luz M. Cumba Garcia, Benjamin T. Himes, Mi-Yeon Jung, Frederic B. Meyer, David O. Okonkwo, and Ian F. Parney
doi : 10.3171/2020.4.JNS20305
Page Range:1921–1928
The objective of this study was to isolate extracellular vesicles (EVs) from plasma in a cohort of patients with traumatic brain injury (TBI) and analyze their contents for novel biomarkers that could prove useful for rapid diagnosis and classification of brain injury during initial evaluation.
Long-term follow-up of neurosurgical outcomes for adult patients in Uganda with traumatic brain injury
Michael C. Jin, Bina Kakusa, Seul Ku, Silvia D. Vaca, Linda W. Xu, Juliet Nalwanga, Joel Kiryabwire, Hussein Ssenyonjo, John Mukasa, Michael Muhumuza, Anthony T. Fuller, Michael M. Haglund, and Gerald A. Grant
doi : 10.3171/2020.4.JNS193092
Page Range:1929–1939
Traumatic brain injury (TBI) is a major cause of mortality and morbidity in Uganda and other low- and middle-income countries (LMICs). Due to the difficulty of long-term in-person follow-up, there is a paucity of literature on longitudinal outcomes of TBI in LMICs. Using a scalable phone-centered survey, this study attempted to investigate factors associated with both mortality and quality of life in Ugandan patients with TBI.
Densitometric analysis of brain computed tomography as a new prognostic factor in patients with acute subdural hematoma
Daniel Garc?a-Pérez, Irene Panero-Pérez, Carla Eiriz Fern?ndez, Luis Miguel Moreno-Gomez, Olga Esteban-Sinovas, Blanca Navarro-Main, Pedro A. G?mez L?pez, Ana M. Casta?o-Le?n, and Alfonso Lagares
doi : 10.3171/2020.4.JNS193445
Page Range:1940–1950
Acute subdural hematoma (ASDH) is a major cause of mortality and morbidity after traumatic brain injury (TBI). Surgical evacuation is the mainstay of treatment in patients with altered neurological status or significant mass effect. Nevertheless, concerns regarding surgical indication still persist. Given that clinicians often make therapeutic decisions on the basis of their prognosis assessment, to accurately evaluate the prognosis is of great significance. Unfortunately, there is a lack of specific and reliable prognostic models. In addition, the interdependence of certain well-known predictive variables usually employed to guide surgical decision-making in ASDH has been proven. Because gray matter and white matter are highly susceptible to secondary insults during the early phase after TBI, the authors aimed to assess the extent of these secondary insults with a brain parenchyma densitometric quantitative CT analysis and to evaluate its prognostic capacity.
The endonasal patient reference tracker: a novel solution for accurate noninvasive electromagnetic neuronavigation
Ayguel Wurzer, Georgi Minchev, Claudia Cervera-Martinez, Alexander Micko, Gernot Kronreif, and Stefan Wolfsberger
doi : 10.3171/2020.4.JNS20394
Page Range:1951–1958
Electromagnetic (EM) navigation provides the advantages of continuous guidance and tip-tracking of instruments. The current solutions for patient reference trackers are suboptimal, as they are either invasively screwed to the bone or less accurate if attached to the skin. The authors present a novel EM reference method with the tracker rigidly but not invasively positioned inside the nasal cavity.
The cortical organization of language: distilling human connectome insights for supratentorial neurosurgery
Anujan Poologaindran, Stephen R. Lowe, and Michael E. Sughrue
doi : 10.3171/2020.5.JNS191281
Page Range:1959–1966
Connectomics is the production and study of detailed “connection” maps within the nervous system. With unprecedented advances in imaging and high-performance computing, the construction of individualized connectomes for routine neurosurgical use is on the horizon. Multiple projects, including the Human Connectome Project (HCP), have unraveled new and exciting data describing the functional and structural connectivity of the brain. However, the abstraction from much of these data to clinical relevance remains elusive. In the context of preserving neurological function after supratentorial surgery, abstracting surgically salient points from the vast computational data in connectomics is of paramount importance. Herein, the authors discuss four interesting observations from the HCP data that have surgical relevance, with an emphasis on the cortical organization of language: 1) the existence of a motor speech area outside of Broca’s area, 2) the eloquence of the frontal aslant tract, 3) the explanation of the medial frontal cognitive control networks, and 4) the establishment of the second ventral stream of language processing. From these connectome observations, the authors discuss the anatomical basis of their insights as well as relevant clinical applications. Together, these observations provide a firm platform for neurosurgeons to advance their knowledge of the cortical networks involved in language and to ultimately improve surgical outcomes. It is hoped that this report encourages neurosurgeons to explore new vistas in connectome-based neurosurgery.
International electives in neurological surgery training: a survey of program directors from Accreditation Council for Graduate Medical Education–approved neurological surgery programs
Christopher Miller, Paige Lundy, and Sarah Woodrow
doi : 10.3171/2020.4.JNS20618
Page Range:1967–1973
The burden of neurosurgical disease in low- and middle-income countries (LMICs) has emerged as a significant factor in global health. Additionally, calls have been growing for first-world neurosurgeons to find ways to help address the international need. Allowing residents to pursue international elective opportunities in LMICs can help alleviate the burden while also providing unique educational opportunities. However, pursuing international work while in residency requires overcoming significant logistical and regulatory barriers. To better understand the general perspectives, perceived barriers, and current availability of international rotations, a survey was sent out to program directors at Accreditation Council for Graduate Medical Education (ACGME)–approved residencies.
The neurosurgery residency interview: assessing applicant perspectives on question content, utility, and stress
Scott L. Zuckerman, Natalie Limoges, Aaron M. Yengo-Kahn, Christopher S. Graffeo, Lola B. Chambless, Rohan Chitale, J Mocco, and Susan Durham
doi : 10.3171/2020.4.JNS2046
Page Range:1974–1982
Residency interviews are integral to the recruitment process yet imperfect. Through surveys of neurosurgery residency applicants, the authors describe interview content and the perceived utility and stress of topics from the applicant’s perspective.
The limited influence of neurosurgeons’ behavior on inpatient satisfaction: a retrospective multihospital analysis
Christine Park, Rasheedat T. Zakare-Fagbamila, Wes Dickson, Alessandra N. Garcia, and Oren N. Gottfried
doi : 10.3171/2020.5.JNS20923
Page Range:1983–1989
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a survey that assesses patient satisfaction, which is an important measure of the quality of hospital care and ultimately the overall hospital rating (OHR). However, the survey covers several elements of patient satisfaction beyond the patient-surgeon interaction. In this study, authors investigated which admission and experience factors had the highest impact on the OHR.
Do neurosurgeons receive more patient complaints than other physicians? Describing who is most at risk and how we can improve
Robert J. Dambrino IV, Scott L. Zuckerman, Bradley S. Guidry, Henry J. Domenico, Reid C. Thompson, Mitchell B. Galloway, James W. Pichert, and William O. Cooper
doi : 10.3171/2020.4.JNS20870
Page Range:1990–1997
The number of unsolicited patient complaints (UPCs) about surgeons correlates with surgical complications and malpractice claims. Using a large, national patient complaint database, the authors sought to do the following: 1) compare the rates of UPCs for neurosurgeons to those for other physicians, 2) analyze the risk of UPCs with individual neurosurgeon characteristics, and 3) describe the types of UPCs made about neurosurgeons.
Erratum. Triple motor mapping: transcranial, bipolar, and monopolar mapping for supratentorial glioma resection adjacent to motor pathways
Andrew J. Gogos
doi : 10.3171/2020.10.JNS193434a
Page Range:1998
Genetic and heritable considerations in patients or families with both intracranial and extracranial aneurysms
Anna L. Huguenard, Vivek P. Gupta, Alan C. Braverman, and Ralph G. Dacey
doi : 10.3171/2020.8.JNS203234
Page Range:1999–2006
Letter to the Editor. Biologically effective dose and the treatment of AVMs
John W. Hopewell, Ian Paddick, Bleddyn Jones, and Thomas Klinge
doi : 10.3171/2020.9.JNS203545
Page Range:2007–2008
Letter to the Editor. How to reduce unsolicited patient complaints to neurosurgeons
Toshihiro Ogiwara and Tetsuyoshi Horiuchi
doi : 10.3171/2020.8.JNS203240
Page Range:2010–2011
Letter to the Editor. Scoring change for Step 1 of the United States Medical Licensing Examination
Phillip A. Bonney, Frank J. Attenello, and William J. Mack
doi : 10.3171/2020.11.JNS203992
Page Range:2012–2013
Letter to the Editor. Cushing the artist: neurosurgery and the liberal arts
Marianne I. Tissot, Naja N. Hill, Austin J. Borja, Nicholas Edouard, Vamsi Reddy, and Donald K. Detchou
doi : 10.3171/2020.12.JNS204148
Page Range:2014–2015
Letter to the Editor. Improvement in the exposure of medical students to neurosurgery in Italy
Ismail Zaed, Grazia Menna, and Benedetta Tinterri
doi : 10.3171/2020.12.JNS204159
Page Range:2016
