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Endarterectomy for symptomatic internal carotid artery web
Joseph Haynes, Eytan Raz, Omar Tanweer, Maksim Shapiro, Rogelio Esparza, David Zagzag, Howard A. Riina, Christine Henderson, Kaitlyn Lillemoe, Cen Zhang, Sara Rostanski, Shadi Yaghi, Koto Ishida, Jose Torres, Brian Mac Grory, and Erez Nossek
doi : 10.3171/2020.5.JNS201107
Page Range:1–8
The carotid web (CW) is an underrecognized source of cryptogenic, embolic stroke in patients younger than 55 years of age, with up to 37% of these patients found to have CW on angiography. Currently, there are little data detailing the best treatment practices to reduce the risk of recurrent stroke in these patients. The authors describe their institutional surgical experience with patients treated via carotid endarterectomy (CEA) for a symptomatic internal carotid artery web.
A data-driven model to identify high-risk aneurysms and guide management decisions: the Rupture Resemblance Score
Hamidreza Rajabzadeh-Oghaz, Muhammad Waqas, Sricharan S. Veeturi, Kunal Vakharia, Michael K. Tso, Kenneth V. Snyder, Jason M. Davies, Adnan H. Siddiqui, Elad I. Levy, and Hui Meng
doi : 10.3171/2020.5.JNS193264
Page Range:9–16
Previous studies have found that ruptured intracranial aneurysms (RIAs) have distinct morphological and hemodynamic characteristics, including higher size ratio and oscillatory shear index and lower wall shear stress. Unruptured intracranial aneurysms (UIAs) that possess similar characteristics to RIAs may be at a higher risk of rupture than those UIAs that do not. The authors previously developed the Rupture Resemblance Score (RRS), a data-driven computer model that can objectively gauge the similarity of UIAs to RIAs in terms of morphology and hemodynamics. The authors aimed to explore the clinical utility of RRS in guiding the management of UIAs, especially for challenging cases such as small UIAs.
Cerebral deep venous thrombosis and COVID-19: case report
Christian Hoelscher, Ahmad Sweid, Ritam Ghosh, Fadi Al Saiegh, Kavantissa M. Keppetipola, Christopher J. Farrell, Jack Jallo, Pascal Jabbour, Stavropoula Tjoumakaris, M. Reid Gooch, Robert H. Rosenwasser, and Syed O. Shah
doi : 10.3171/2020.5.JNS201542
Page Range:17–20
Herein, the authors present the case of a 54-year-old male diagnosed with coronavirus disease 2019 (COVID-19) during a screening test. The patient was asked to self-isolate at home and report with any exacerbations of symptoms. He presented later with pneumonia complicated by encephalopathy at days 14 and 15 from initial diagnosis, respectively. MRI of the brain showed bithalamic and gangliocapsular FLAIR signal abnormality with mild right-sided thalamic and periventricular diffusion restriction. A CT venogram was obtained given the distribution of edema and demonstrated deep venous thrombosis involving the bilateral internal cerebral veins and the vein of Galen. CSF workup was negative for encephalitis, as the COVID-19 polymerase chain reaction (PCR) test and bacterial cultures were negative. A complete hypercoagulable workup was negative, and the venous thrombosis was attributed to a hypercoagulable state induced by COVID-19. The mental decline was attributed to bithalamic and gangliocapsular venous infarction secondary to deep venous thrombosis. Unfortunately, the patient’s condition continued to decline, and care was withdrawn.
Comparison of robotic-assisted carotid stenting and manual carotid stenting through the transradial approach
Joshua H. Weinberg, Ahmad Sweid, Kalyan Sajja, M. Reid Gooch, Nabeel Herial, Stavropoula Tjoumakaris, Robert H. Rosenwasser, and Pascal Jabbour
doi : 10.3171/2020.5.JNS201421
Page Range:21–28
The objective of this study was to demonstrate the feasibility and safety of CorPath GRX robotic-assisted (RA) transradial (TR) carotid artery stenting (CAS) compared with manual TR CAS.
Procalcitonin in the context of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage
Michael Veldeman, Daniel Lepore, Anke H?llig, Hans Clusmann, Christian Stoppe, Gerrit Alexander Schubert, and Walid Albanna
doi : 10.3171/2020.5.JNS201337
Page Range:29–37
Aneurysmal subarachnoid hemorrhage (aSAH) initiates a deleterious cascade activating multiple inflammatory processes, which can contribute to delayed cerebral ischemia (DCI). Procalcitonin (PCT) is an established marker for sepsis treatment monitoring, and its time course in the context of DCI after aSAH remains unclear. The aim of this trial was to assess the predictive and confirmative value of PCT levels in the context of DCI.
Predictors of the development of takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage and outcomes in patients with intra-aortic balloon pumps
Joshua S. Catapano, Andrew F. Ducruet, Fabio A. Frisoli, Candice L. Nguyen, Christopher E. Louie, Mohamed A. Labib, Jacob F. Baranoski, Tyler S. Cole, Alexander C. Whiting, Felipe C. Albuquerque, and Michael T. Lawton
doi : 10.3171/2020.5.JNS20536
Page Range:38–43
Takotsubo cardiomyopathy (TC) in patients with aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. Previous studies have shown that female patients presenting with a poor clinical grade are at the greatest risk for developing TC. Intra-aortic balloon pumps (IABPs) are known to support cardiac function in severe cases of TC, and they may aid in the treatment of vasospasm in these patients. In this study, the authors investigated risk factors for developing TC in the setting of aSAH and outcomes among patients requiring IABPs.
Indocyanine green videoangiography for recipient vessel stratification in superficial temporal artery–middle cerebral artery bypass surgery
Johannes Goldberg, Peter Vajkoczy, and Nils Hecht
doi : 10.3171/2020.5.JNS20642
Page Range:44–52
In superficial temporal artery–middle cerebral artery (STA-MCA) bypass surgery, recipient vessel properties are likely one of the main reasons for bypass failure. In daily practice, most surgeons select the recipient with the largest diameter. However, selection of the ideal recipient remains debatable because there are no objective selection criteria if multiple potential recipients exist. Here, the authors assessed the benefit of using indocyanine green videoangiography (ICG-VA) to optimize recipient vessel selection in patients undergoing STA-MCA bypass surgery for hemodynamic compromise.
Direct carotid puncture for mechanical thrombectomy in acute ischemic stroke patients with prohibitive vascular access
Branden J. Cord, Sreeja Kodali, Sumita Strander, Andrew Silverman, Anson Wang, Fouad Chouairi, Andrew B. Koo, Cindy Khanh Nguyen, Krithika Peshwe, Alexandra Kimmel, Carl M. Porto, Ryan M. Hebert, Guido J. Falcone, Kevin N. Sheth, Lauren H. Sansing, Joseph L. Schindler, Charles C. Matouk, and Nils H. Petersen
doi : 10.3171/2020.5.JNS192737
Page Range:53–63
While the benefit of mechanical thrombectomy (MT) for patients with anterior circulation acute ischemic stroke with large-vessel occlusion (AIS-LVO) has been clearly established, difficult vascular access may make the intervention impossible or unduly prolonged. In this study, the authors evaluated safety as well as radiographic and functional outcomes in stroke patients treated with MT via direct carotid puncture (DCP) for prohibitive vascular access.
Is IDH status the only factor predicting prognosis in newly diagnosed anaplastic glioma patients? Outcome evaluation and prognostic factor analysis in a single-institution large series
Pierina Navarria, Federico Pessina, Elena Clerici, Zefferino Rossini, Davide Franceschini, Giuseppe D’Agostino, Ciro Franzese, Tiziana Comito, Mauro Loi, Matteo Simonelli, Elena Lorenzi, Pasquale Persico, Letterio Salvatore Politi, Marco Grimaldi, Lorenzo Bello, Armando Santoro, Maurizio Fornari, Franco Servadei, and Marta Scorsetti
doi : 10.3171/2020.5.JNS201116
Page Range:64–77
Anaplastic gliomas (AGs) are an extremely heterogeneous group of primary brain tumors. More recently, new discoveries have indicated that isocitrate dehydrogenase (IDH) mutation status is the most important parameter predicting survival. The primary aim of the present analysis was to identify prognostic factors, other than IDH status, that eventually impact survival.
The 5-factor modified frailty index: an effective predictor of mortality in brain tumor patients
Adham M. Khalafallah, Sakibul Huq, Adrian E. Jimenez, Henry Brem, and Debraj Mukherjee
doi : 10.3171/2020.5.JNS20766
Page Range:78–86
Health measures such as the Charlson Comorbidity Index (CCI) and the 11-factor modified frailty index (mFI-11) have been employed to predict general medical and surgical mortality, but their clinical utility is limited by the requirement for a large number of data points, some of which overlap or require data that may be unavailable in large datasets. A more streamlined 5-factor modified frailty index (mFI-5) was recently developed to overcome these barriers, but it has not been widely tested in neuro-oncology patient populations. The authors compared the utility of the mFI-5 to that of the CCI and the mFI-11 in predicting postoperative mortality in brain tumor patients.
Quantifying the utility of a multidisciplinary neuro-oncology tumor board
Adham M. Khalafallah, Adrian E. Jimenez, Carlos G. Romo, David Olayinka Kamson, Lawrence Kleinberg, Jon Weingart, Henry Brem, Stuart A. Grossman, and Debraj Mukherjee
doi : 10.3171/2020.5.JNS201299
Page Range:87–92
There has been limited research on the efficacy of multidisciplinary tumor boards (MDTBs) in improving the treatment of patients with tumors affecting the nervous system. The objective of the present study was to quantify the utility of MDTBs in providing alternative diagnostic interpretations and treatment plans for this patient population.
The management of clival chordomas: an Italian multicentric study
Luigi Maria Cavallo, Diego Mazzatenta, Elena d’Avella, Domenico Catapano, Marco Maria Fontanella, Davide Locatelli, Davide Luglietto, Davide Milani, Domenico Solari, Marco Vindigni, Francesco Zenga, Gianluigi Zona, and Paolo Cappabianca
doi : 10.3171/2020.5.JNS20925
Page Range:93–102
In the last 2 decades, the endoscopic endonasal approach in the treatment of clival chordomas has evolved to be a viable strategy to achieve maximal safe resection of this tumor. Here, the authors present a multicentric national study, intending to analyze the evolution of this approach over a 20-year time frame and its contribution in the treatment of clival chordomas.
Use of endoscopic transorbital and endonasal approaches for 360° circumferential access to orbital tumors
Chiman Jeon, Sang Duk Hong, Kyung In Woo, Ho Jun Seol, Do-Hyun Nam, Jung-Il Lee, and Doo-Sik Kong
doi : 10.3171/2020.6.JNS20890
Page Range:103–112
Orbital tumors are often surgically challenging because they require an extensive fronto-temporo-orbital zygomatic approach (FTOZ) and a multidisciplinary team approach to provide the best outcomes. Recently, minimally invasive endoscopic techniques via a transorbital superior eyelid approach (ETOA) or endoscopic endonasal approach (EEA) have been proposed as viable alternatives to transcranial approaches for orbital tumors. In this study, the authors investigated the feasibility of 360° circumferential access to orbital tumors via both ETOA and EEA.
Endoscopic endonasal approach for suprasellar meningiomas: introduction of a new scoring system to predict extent of resection and assist in case selection with long-term outcome data
Brett E. Youngerman, Matei A. Banu, Mina M. Gerges, Eseosa Odigie, Abtin Tabaee, Ashutosh Kacker, Vijay K. Anand, and Theodore H. Schwartz
doi : 10.3171/2020.4.JNS20475
Page Range:113–125
The endoscopic endonasal approach (EEA) has gained increasing popularity for the resection of suprasellar meningiomas (SSMs). Appropriate case selection is critical in optimizing patient outcome. Long-term outcome data are lacking. The authors systematically identified preoperative factors associated with extent of resection (EOR) and determined the relationship between EOR and long-term recurrence after EEA for SSMs.
Cochlear implantation after radiosurgery for vestibular schwannoma
Neil S. Patel, Matthew L. Carlson, Michael J. Link, Brian A. Neff, Jamie J. Van Gompel, and Colin L. W. Driscoll
doi : 10.3171/2020.4.JNS201069
Page Range:126–135
The object of this study was to ascertain outcomes of cochlear implantation (CI) following stereotactic radiosurgery (SRS) for vestibular schwannoma (VS).
Fine configuration of the dural fibrous network and the extradural neural axis compartment in the jugular foramen: an epoxy sheet plastination and confocal microscopy study
Jacob D. Bond, Zhaoyang Xu, and Ming Zhang
doi : 10.3171/2020.4.JNS20811
Page Range:136–146
The extradural neural axis compartment (EDNAC) is an adipovenous zone that is located between the meningeal (ML) and endosteal (EL) layers of the dura mater and has been minimally investigated in the jugular foramen (JF) region. In this study, the authors aimed to explore the fine architecture of the EDNAC within the JF and evaluate whether the EDNAC can be used as a component for JF compartmentalization.
Pituitary hyperplasia causing complete bitemporal hemianopia with resolution following surgical decompression: case report
Nataly Raviv, Ami Amin, Tyler J. Kenning, Carlos D. Pinheiro-Neto, David Jones, Vibhavasu Sharma, and Maria Peris-Celda
doi : 10.3171/2020.5.JNS20448
Page Range:147–151
In this report, the authors demonstrated that idiopathic pituitary hyperplasia (PH) can cause complete bitemporal hemianopia and amenorrhea, even in the setting of mild anatomical compression of the optic chiasm and normal pituitary function. Furthermore, complete resolution of symptoms can be achieved with surgical decompression.
Corticotroph hyperplasia and Cushing disease: diagnostic features and surgical management
Michael P. Catalino, David M. Meredith, Umberto De Girolami, Sherwin Tavakol, Le Min, and Edward R. Laws Jr.
doi : 10.3171/2020.5.JNS201514
Page Range:152–163
This study was done to compare corticotroph hyperplasia and histopathologically proven adenomas in patients with Cushing disease by analyzing diagnostic features, surgical management, and clinical outcomes.
Editorial. The financial value of a neurosurgery resident
Kiarash Shahlaie and Griffith R. Harsh IV
doi : 10.3171/2020.4.JNS20836
Page Range:164–168
The economic value of an on-call neurosurgical resident physician
William E. Gordon, William M. Mangham, L. Madison Michael II, and Paul Klimo Jr.
doi : 10.3171/2020.3.JNS193454
Page Range:169–175
The cost of training neurosurgical residents is especially high considering the duration of training and the technical nature of the specialty. Despite these costs, on-call residents are a source of significant economic value, through both indirectly and directly supervised activities. The authors sought to identify the economic value of on-call services provided by neurosurgical residents.
Creation of a comprehensive training and career development approach to increase the number of neurosurgeons supported by National Institutes of Health funding
Russell R. Lonser, Luke G. F. Smith, Michael Tennekoon, Kavon P. Rezai-Zadeh, Jeffrey G. Ojemann, and Stephen J. Korn
doi : 10.3171/2020.5.JNS201008
Page Range:176–184
To increase the number of independent National Institutes of Health (NIH)–funded neurosurgeons and to enhance neurosurgery research, the National Institute of Neurological Disorders and Stroke (NINDS) developed two national comprehensive programs (R25 [established 2009] for residents/fellows and K12 [2013] for early-career neurosurgical faculty) in consultation with neurosurgical leaders and academic departments to support in-training and early-career neurosurgeons. The authors assessed the effectiveness of these NINDS-initiated programs to increase the number of independent NIH-funded neurosurgeon-scientists and grow NIH neurosurgery research funding.
Fellowship, gender, and scholarly productivity: trends among academic neurosurgeons in the US
Rosemary T. Behmer Hansen, Nicole A. Silva, Rebecca Cuevas, Samantha Y. Cerasiello, Angela M. Richardson, Antonios Mammis, and Anil Nanda
doi : 10.3171/2020.5.JNS20577
Page Range:185–193
Current data on fellowship choice and completion by neurosurgical residents are limited, especially in relation to gender, scholarly productivity, and career progression. The objective of this study was to determine gender differences in the selection of fellowship training and subsequent scholarly productivity and career progression.
Developing microsurgical milestones for psychomotor skills in neurological surgery residents as an adjunct to operative training: the home microsurgery laboratory
Isaac Josh Abecassis, Rajeev D. Sen, Richard G. Ellenbogen, and Laligam N. Sekhar
doi : 10.3171/2020.5.JNS201590
Page Range:194–204
A variety of factors contribute to an increasingly challenging environment for neurological surgery residents to develop psychomotor skills in microsurgical technique solely from operative training. While adjunct training modalities such as cadaver dissection and surgical simulation are embraced and practiced at our institution, there are no formal educational milestones defined to help residents develop, measure, and advance their microsurgical psychomotor skills in a stepwise fashion when outside the hospital environment. The objective of this report is to describe an efficient and convenient “home microsurgery lab” (HML) assembled and tested by the authors with the goal of supporting a personalized stepwise advancement of microsurgical psychomotor skills.
Harvey Cushing’s international visitors
Eric Suero Molina, Michael P. Catalino, and Edward R. Laws
doi : 10.3171/2020.5.JNS193386
Page Range:205–213
Harvey Cushing is considered the father of neurosurgery, not just for his work within the United States, but also for his global influence through international visitors and trainees. Starting in 1920, the neurosurgical clinic at the Peter Bent Brigham Hospital in Boston, led by Cushing, trained surgeons from all over the globe, many of whom returned home to establish neurosurgical departments and become neurosurgical pioneers themselves. The objective of this vignette is to highlight the importance of Cushing’s international trainees, describe their contributions, and discuss how each had an impact on the development of the practice of neurosurgery worldwide. The authors demonstrate how Cushing provided the impetus for a movement that revolutionized neurology and neurosurgery worldwide. Even today, international cooperation continues to shape the success of our delicate specialty.
A practical method for dealing with missing Glasgow Coma Scale verbal component scores
Paul M. Brennan, Gordon D. Murray, and Graham M. Teasdale
doi : 10.3171/2020.6.JNS20992
Page Range:214–219
The Glasgow Coma Scale (GCS) is used for the assessment of impaired consciousness; however, it is not always possible to test each component, most commonly the verbal component. This affects the derivation of the GCS sum score, which has a role in systems for predicting patient outcome. Imputation of missing scores does not add extra information, but it does allow use of tools for predicting outcome that require complete data. The authors devised a simple and practical tool to employ when verbal component data are missing. They then assessed the tool’s utility by application to the GCS-Pupils plus age plus CT findings (GCS-PA CT) prognostic model.
Human motor endplate remodeling after traumatic nerve injury
Ranjan Gupta, Justin P. Chan, Jennifer Uong, Winnie A. Palispis, David J. Wright, Sameer B. Shah, Samuel R. Ward, Thay Q. Lee, and Oswald Steward
doi : 10.3171/2020.8.JNS201461
Page Range:220–227
Current management of traumatic peripheral nerve injuries is variable with operative decisions based on assumptions that irreversible degeneration of the human motor endplate (MEP) follows prolonged denervation and precludes reinnervation. However, the mechanism and time course of MEP changes after human peripheral nerve injury have not been investigated. Consequently, there are no objective measures by which to determine the probability of spontaneous recovery and the optimal timing of surgical intervention. To improve guidance for such decisions, the aim of this study was to characterize morphological changes at the human MEP following traumatic nerve injury.
Gamma Knife central lateral thalamotomy for the treatment of neuropathic pain
Andrea Franzini, Luca Attuati, Ismail Zaed, Shayan Moosa, Antonella Stravato, Pierina Navarria, and Piero Picozzi
doi : 10.3171/2020.4.JNS20558
Page Range:228–236
The goal of this study was to assess the safety and efficacy of stereotactic central lateral thalamotomy with Gamma Knife radiosurgery in patients with neuropathic pain.
Earlier radiosurgery leads to better pain relief and less medication usage for trigeminal neuralgia patients: an international multicenter study
Monica Mureb, Danielle Golub, Carolina Benjamin, Jason Gurewitz, Ben A. Strickland, Gabriel Zada, Eric Chang, Du?an Urgo??k, Roman Li???k, Ronald E. Warnick, Herwin Speckter, Skyler Eastman, Anthony M. Kaufmann, Samir Patel, Caleb E. Feliciano, Carlos H. Carbini, David Mathieu, William Leduc, DCS, Sean J. Nagel, Yusuke S. Hori, Yi-Chieh Hung, Akiyoshi Ogino, Andrew Faramand, Hideyuki Kano, L. Dade Lunsford, Jason Sheehan, and Douglas Kondziolka
doi : 10.3171/2020.4.JNS192780
Page Range:237–244
Trigeminal neuralgia (TN) is a chronic pain condition that is difficult to control with conservative management. Furthermore, disabling medication-related side effects are common. This study examined how stereotactic radiosurgery (SRS) affects pain outcomes and medication dependence based on the latency period between diagnosis and radiosurgery.
Oblique trajectory angles in robotic stereo-electroencephalography
Patrick S. Rollo, Matthew J. Rollo, Ping Zhu, Oscar Woolnough, and Nitin Tandon
doi : 10.3171/2020.5.JNS20975
Page Range:245–254
Traditional stereo-electroencephalography (sEEG) entails the use of orthogonal trajectories guided by seizure semiology and arteriography. Advances in robotic stereotaxy and computerized neuronavigation have made oblique trajectories more feasible and easier to implement without formal arteriography. Such trajectories provide access to components of seizure networks not readily sampled using orthogonal trajectories. However, the dogma regarding the relative safety and predictability of orthogonal and azimuth-based trajectories persists, given the absence of data regarding the safety and efficacy of oblique sEEG trajectories. In this study, the authors evaluated the relative accuracy and efficacy of both orthogonal and oblique trajectories during robotic implantation of sEEG electrodes to sample seizure networks.
Orbitofrontal epilepsy: distinct neuronal networks underlying electroclinical subtypes and surgical outcomes
Baotian Zhao, Chao Zhang, Xiu Wang, Yao Wang, Jiajie Mo, Zhong Zheng, Lin Ai, Kai Zhang, Jianguo Zhang, Xiao-qiu Shao, and Wenhan Hu
doi : 10.3171/2020.5.JNS20477
Page Range:255–265
The aim of this study was to characterize the clinical and electrophysiological findings of epilepsy originating from the orbitofrontal cortex (OFC) as well as its surgical outcomes.
Sulcus-centered resection for focal cortical dysplasia type II: surgical techniques and outcomes
Baotian Zhao, Chao Zhang, Xiu Wang, Yao Wang, Chang Liu, Jiajie Mo, Zhong Zheng, Kai Zhang, Xiao-qiu Shao, Wenhan Hu, and Jianguo Zhang
doi : 10.3171/2020.5.JNS20751
Page Range:266–272
Focal cortical dysplasia type II (FCD II) is a common histopathological substrate of epilepsy surgery. Here, the authors propose a sulcus-centered resection strategy for this malformation, provide technical details, and assess the efficacy and safety of this technique. The main purpose of the sulcus-centered resection is to remove the folded gray matter surrounding a dysplastic sulcus, particularly that at the bottom of the sulcus. The authors also retrospectively reviewed the records of 88 consecutive patients with FCD II treated with resective surgery between January 2015 and December 2018. The demographics, clinical characteristics, electrophysiological recordings, neuroimaging studies, histopathological findings, surgical outcomes, and complications were collected. After the exclusion of diffusely distributed and gyrus-based lesions, 71 patients (30 females, 41 males) who had undergone sulcus-centered resection were included in this study. The mean (± standard deviation) age of the cohort was 17.78 ± 10.54 years (38 pediatric patients, 33 adults). Thirty-five lesions (49%) were demonstrated on MRI; 42 patients (59%) underwent stereo-EEG monitoring before resective surgery; and 37 (52%) and 34 (48%) lesions were histopathologically proven to be FCD IIa and IIb, respectively. At a mean follow-up of 3.34 ± 1.17 years, 64 patients (90%) remained seizure free, and 7 (10%) had permanent neurological deficits including motor weakness, sensory deficits, and visual field deficits. The study findings showed that in carefully selected FCD II cases, sulcus-centered resection is an effective and safe surgical strategy.
Cost-effectiveness analysis of MR-guided focused ultrasound thalamotomy for tremor-dominant Parkinson’s disease
Ying Meng, Christopher B. Pople, Suneil K. Kalia, Lorraine V. Kalia, Benjamin Davidson, Luca Bigioni, Daniel Zhengze Li, Suganth Suppiah, Karim Mithani, Nadia Scantlebury, Michael L. Schwartz, Clement Hamani, and Nir Lipsman
doi : 10.3171/2020.5.JNS20692
Page Range:273–278
The development of transcranial MR-guided focused ultrasound (MRgFUS) has revitalized the practice of lesioning procedures in functional neurosurgery. Previous health economic analysis found MRgFUS thalamotomy to be a cost-effective treatment for patients with essential tremor, supporting its reimbursement. With the publication of level I evidence in support of MRgFUS thalamotomy for patients with tremor-dominant Parkinson’s disease (TDPD), the authors performed a health economic comparison between MRgFUS, deep brain stimulation (DBS), and medical therapy.
Incidence and risk factors for seizures associated with deep brain stimulation surgery
Travis J. Atchley, Galal A. Elsayed, Blake Sowers, Harrison C. Walker, Gustavo Chagoya, Matthew C. Davis, Joshua D. Bernstock, Nidal B. Omar, Daxa M. Patel, and Barton L. Guthrie
doi : 10.3171/2020.5.JNS20125
Page Range:279–283
The objective of this study was to determine the incidence of seizures following deep brain stimulation (DBS) electrode implantation and to evaluate factors associated with postoperative seizures.
Motoric impairment versus iron deposition gradient in the subthalamic nucleus in Parkinson’s disease
Weiyuan Huang, Richard Ogbuji, Liangdong Zhou, Lingfei Guo, Yi Wang, and Brian H. Kopell
doi : 10.3171/2020.5.JNS201163
Page Range:284–290
The objective of this study was to investigate the correlation between the quantitative susceptibility mapping (QSM) signal gradient of the subthalamic nucleus (STN) and motor impairment in patients with Parkinson’s disease (PD).
Technical and radiographic considerations for magnetic resonance imaging–guided focused ultrasound capsulotomy
Benjamin Davidson, Karim Mithani, Yuexi Huang, Ryan M. Jones, Maged Goubran, Ying Meng, John Snell, Kullervo Hynynen, Clement Hamani, and Nir Lipsman
doi : 10.3171/2020.6.JNS201302
Page Range:291–299
Magnetic resonance imaging–guided focused ultrasound (MRgFUS) is an emerging treatment modality that enables incisionless ablative neurosurgical procedures. Bilateral MRgFUS capsulotomy has recently been demonstrated to be safe and effective in treating obsessive-compulsive disorder (OCD) and major depressive disorder (MDD). Preliminary evidence has suggested that bilateral MRgFUS capsulotomy can present increased difficulties in reaching lesional temperatures as compared to unilateral thalamotomy. The authors of this article aimed to study the parameters associated with successful MRgFUS capsulotomy lesioning and to present longitudinal radiographic findings following MRgFUS capsulotomy.
Acute low-pressure hydrocephalus: a case series and systematic review of 195 patients
Michael B. Keough, Albert M. Isaacs, Geberth Urbaneja, Jarred Dronyk, Andrew P. Lapointe, and Mark G. Hamilton
doi : 10.3171/2020.4.JNS20476
Page Range:300–308
Acute low-pressure hydrocephalus (ALPH) is characterized by clinical manifestations of an apparent raised intracranial pressure (ICP) and ventriculomegaly despite measured ICP that is below the expected range (i.e., typically ? 5 cm H2O). ALPH is often refractory to standard hydrocephalus intervention protocols and the ICP paradox commonly leads to delayed diagnosis. The aim of this study was to characterize ALPH and develop an algorithm to facilitate diagnosis and management for patients with ALPH.
A light on the dark side: in vivo endoscopic anatomy of the posterior third ventricle and its variations in hydrocephalus
Alberto Feletti, Alessandro Fiorindi, Vincenzo Lavecchia, Rafael Boscolo-Berto, Elisabetta Marton, Veronica Macchi, Raffaele De Caro, Pierluigi Longatti, Andrea Porzionato, and Giacomo Pavesi
doi : 10.3171/2020.4.JNS20493
Page Range:309–317
Despite the technological advancements of neurosurgery, the posterior part of the third ventricle has always been the “dark side” of the ventricle. However, flexible endoscopy offers the opportunity for a direct, in vivo inspection and detailed description of the posterior third ventricle in physiological and pathological conditions. The purposes of this study were to describe the posterior wall of the third ventricle, detailing its normal anatomy and surgical landmarks, and to assess the effect of chronic hydrocephalus on the anatomy of this hidden region.
Endoscopic bimanual sharp dissection technique for gross-total resection of colloid cysts: technical note
Sascha Marx and Henry W. S. Schroeder
doi : 10.3171/2020.5.JNS201583
Page Range:318–326
Neuroendoscopic resection of colloid cysts has gained tremendous popularity over the last 2 decades because of good clinical outcomes and a low complication profile. However, in comparison to microsurgical resections, endoscopic resection has a lower rate of gross-total resection, which leaves the patient at risk for cyst recurrence. At present, there is still ongoing debate as to the best surgical approach for colloid cysts. Endoscopic resection as a technique has to compete with the good outcomes of microsurgical resections with respect to a long-term recurrence-free outcome. It is the authors’ belief that gross-total resection should be the aim of endoscopic cyst resection. In this technical note, they describe their surgical technique for achieving safe gross-total resection of colloid cysts by using a ventriculoscopic system. The surgical technique includes a far anterolateral entry point, navigational guidance, bimanual sharp dissection, use of the endoscopic sheath as a retractor, the small-chamber irrigation technique, and the dry-field technique for hemostasis.
Erratum. Corticotroph hyperplasia and Cushing disease: diagnostic features and surgical management
Michael P. Catalino
doi : 10.3171/2020.9.JNS201514a
Page Range:327
Letter to the Editor. Pain outcomes for trigeminal neuralgia
Luigi Albano, Lina Raffaella Barzaghi, and Pietro Mortini
doi : 10.3171/2020.7.JNS202729
Page Range:328–329
Letter to the Editor. Earlier radiosurgery is related to better outcome in trigeminal neuralgia
Alfio Spina, Nicola Boari, and Pietro Mortini
doi : 10.3171/2020.9.JNS203342
Page Range:329–330
Letter to the Editor. Zero complications in SEEG: a goal to pursue
Michele Rizzi, Laura Castana, Piergiorgio d’Orio, and Francesco Cardinale
doi : 10.3171/2020.9.JNS203440
Page Range:330–331
Letter to the Editor. The importance of orthogonal implantation in SEEG: historical considerations
Jorge A. Gonzalez-Martinez and Patrick Y. Chauvel
doi : 10.3171/2020.10.JNS203393
Page Range:332–333
Letter to the Editor. Validating the 5-factor modified frailty index
Michael T. C. Poon
doi : 10.3171/2020.8.JNS203241
Page Range:334
Letter to the Editor. Multidisciplinary meetings for neuro-oncology services
José P. Lavrador, Graeme Pang, Francesco Vergani, Ranjeev Bhangoo, Richard Gullan, and Keyoumars Ashkan
doi : 10.3171/2020.12.JNS204247
Page Range: 335–336
Letter to the Editor. Neurosurgical residency abroad: chasing a dream in unknown lands
Juan Maiguel-Lapeira, Ivan Lozada-Martinez, Daniela Torres-Llin?s, and Luis Moscote-Salazar
doi : 10.3171/2020.11.JNS204112
Page Range: 337–338
