Journal of neurosurgery最新文献

{"title":"Indications and outcomes of the extended endoscopic endonasal approach for the removal of \"unconventional\" suprasellar pituitary neuroendocrine tumors.","authors":"Domenico Solari, Elena d'Avella, Garni Barkhoudarian, Matteo Zoli, Stephanie Cheok, Ilaria Bove, Gianluca Lorenzo Fabozzi, Gabriel Zada, Diego Mazzatenta, Daniel F Kelly, Paolo Cappabianca, Luigi Maria Cavallo","doi":"10.3171/2024.11.JNS242484","DOIUrl":"https://doi.org/10.3171/2024.11.JNS242484","url":null,"abstract":"<p><strong>Objective: </strong>Pituitary neuroendocrine tumors (PitNETs) rarely harbor \"unconventional\" inner features such as wide intracranial extension, fibrous consistency, irregular shape, vessel encasement, and subarachnoid space invasion that increase surgical complexity, as they are not suitable for the standard transsphenoidal route. Among this subset of difficult adenomas, PitNETs harboring an unconventional suprasellar extension present peculiar surgical considerations and challenges. Herein, the authors present an international multicentric study, intending to analyze the indications and outcomes of the endoscopic endonasal transtuberculum-transplanum approach (ETTA) for the removal of these so-called unconventional PitNETs in a large cohort of patients.</p><p><strong>Methods: </strong>PitNETs removed via an endoscopic endonasal approach (EEA) between January 2000 and December 2023 at 4 primary referral centers were retrospectively reviewed. Tumors removed via the ETTA and harboring one or more of the following unconventional suprasellar features, regardless of size and/or cavernous sinus invasion, were included in the study: irregular shape, vessel encasement, subarachnoid invasion at the supradiaphragmatic space, and firm or fibrous consistency. Clinical, radiological, surgical findings, and outcomes were reviewed.</p><p><strong>Results: </strong>Of a total of 5138 patients with PitNETs, 257 patients underwent an ETTA (5%). Nonfunctioning PitNETs were the most common (65.4%). The most common presenting symptoms were visual field restriction (64.6%), decreased visual acuity (51%), anterior pituitary deficiency (44.8%), and endocrine hyperproduction syndromes (20.6%). All PitNETs harbored prominent suprasellar extension: 33.1% were giant and 30.7% were fibrous; the majority were multilobular (43.6%) and Knosp grade ≥ 3 (54.1%). Overall, 51.8% of patients had undergone previous treatment. The gross-total resection (GTR) rate was 49.8%. Visual field and visual acuity improved in 67.5% and 82.4% of cases, respectively. The postoperative complication rate was 19.1%. Previous treatment, vessel encasement, and Knosp grade ≥ 3 were independent risk factors affecting extent of resection. A suprasellar tumor remnant was the only significant risk factor for vascular complications, and tumor GTR the only protecting factor.</p><p><strong>Conclusions: </strong>This is the largest series in the literature describing indications and outcome expectations of the ETTA for the removal of unconventional suprasellar PitNETs. Tumor size, shape, and consistency did not represent a limitation to favorable surgical outcomes. The difficulty in achieving total removal of unconventional PitNETs, especially in the presence of vessel encasement and recurrent lesions, should raise the awareness of the increased risk of suprasellar tumor remnant apoplexy and arterial vasospasm, particularly in tumors with subarachnoid invasion.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of the glymphatic system in the pathogenesis of normal pressure hydrocephalus: an illustrated scoping review.","authors":"Matias L Costa, Daniel Casanova-Martinez, Huanwen Chen, Marco Colasurdo, Peter Kan","doi":"10.3171/2024.12.JNS2420","DOIUrl":"https://doi.org/10.3171/2024.12.JNS2420","url":null,"abstract":"<p><p>Idiopathic normal pressure hydrocephalus (iNPH) is characterized by the clinical triad of cognitive impairment, gait disturbances, and urinary incontinence, coupled with ventricular enlargement on brain imaging. The pathophysiology of iNPH remains complex, with varied patient responses to CSF diversion and a generally progressive nature of the disease. This scoping review aimed to provide an overview of the glymphatic system (GS) and its role in the development of iNPH. The review highlights the crucial function of the GS in maintaining brain homeostasis by clearing waste products from the interstitial space. Dysfunction in this system leads to impaired CSF clearance, resulting in the accumulation of neurotoxic substances that contribute to the symptoms of iNPH. Additionally, potential shared pathophysiological pathways between iNPH and other conditions affecting the GS such as aging, diabetes mellitus, hypertension, and sleep disorders are discussed. The findings suggest that GS dysfunction is a key factor in iNPH pathogenesis and may also be linked to the disease's poor responsiveness to shunt treatment. By enhancing understanding of these mechanisms, there is potential to develop targeted therapies aimed at restoring glymphatic function, thereby improving outcomes for patients with iNPH.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement in multiple cognitive domains via combined revascularization by 6 months' follow-up: a new potential surgical indication in moyamoya disease.","authors":"Ziqi Liu, Xiaokuan Hao, Chaoran Shen, Shihao He, Jing Gu, Junze Zhang, Yanru Wang, Xilong Wang, Zhenyu Zhou, Ning Ma, Ran Duan, Weitao Jin, Xin Lou, Xinlin Zhou, Tao Yu, Yongbo Yang, Rong Wang","doi":"10.3171/2024.11.JNS241932","DOIUrl":"https://doi.org/10.3171/2024.11.JNS241932","url":null,"abstract":"<p><strong>Objective: </strong>Moyamoya disease (MMD) is a cerebrovascular condition characterized by progressive stenosis of the main branches of the cerebral artery. Patients with MMD are prone to cognitive decline due to chronic hypoperfusion. Whether revascularization surgery can reverse cognitive dysfunction by improving cerebral blood flow perfusion and what types and levels of cognitive dysfunction can benefit most from the surgery remain unclear.</p><p><strong>Methods: </strong>Between July 31, 2022, and May 15, 2024, a total of 155 patients were prospectively enrolled in this trial and underwent combined or indirect revascularization with an average 6-month follow-up. Eleven types of cognitive domains were tested. Subgroup analysis was used to compare the postoperative benefits of different surgical procedures and preoperative cognitive levels.</p><p><strong>Results: </strong>Choice reaction time (adjusted p = 0.032), verbal working memory (adjusted p = 0.006), mental rotation (adjusted p = 0.002), complex subtraction (adjusted p < 0.001), and word memory (adjusted p < 0.001) improved significantly after surgery. Combined revascularization led to improvement in more cognitive domains (choice reaction time, p < 0.001; mental rotation, p < 0.001; word memory, p < 0.001; executive inhibition in the same direction, p = 0.016; complex subtraction, p = 0.001; and verbal working memory in reverse order, p = 0.001) than indirect revascularization (word memory, p = 0.023; and complex subtraction, p = 0.007).</p><p><strong>Conclusions: </strong>Revascularization can selectively reverse cognitive dysfunction by improving cerebral blood flow perfusion in adults with MMD. Combined revascularization may allow more definite hemodynamic improvement than indirect revascularization, leading to more frequent and greater potential improvement in more cognitive domains; however, more studies are needed to confirm this. A population with lower preoperative cognition and good postoperative collateral formation may benefit more from the surgery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a machine learning model based on laboratory parameters for preoperative prediction of Ki-67 expression in gliomas.","authors":"Jinlan Huang, Shoupeng Ding, Lijin Lin, Guiyang Zhong, Zhou Yu, Qingwen Luo, Dongmei Chen, Yazhi Chen, Shouzhao Zheng, Shihao Zheng","doi":"10.3171/2024.11.JNS241673","DOIUrl":"https://doi.org/10.3171/2024.11.JNS241673","url":null,"abstract":"<p><strong>Objective: </strong>Glioma is the most common form of brain tumor and has high mortality. The Ki-67 proliferation index, a vital marker of cell proliferation, has been demonstrated to predict tumor classification and prognosis. The aim of this study was to develop and validate a noninvasive model based on machine learning (ML) and routine laboratory parameters to preoperatively predict the level of Ki-67 in gliomas.</p><p><strong>Methods: </strong>A total of 506 patients with pathological confirmation of glioma from 2 medical centers (January 2020 to December 2023) were retrospectively enrolled and divided into training (n = 352), internal validation (n = 88), and external validation (n = 66) cohorts. According to the Ki-67 proliferation index, patients were classified into low Ki-67 (index < 10%) and high Ki-67 (index ≥ 10%) groups. Laboratory parameters were obtained within 1 week before surgery from the Laboratory Information System. The potential features associated with Ki-67 levels were screened using extreme gradient boosting (XGBoost), support vector machine (SVM), and least absolute shrinkage and selection operator (LASSO). Then, 10 ML classifiers, including SVM, XGBoost, logistic regression (LR), random forest, adaptive boosting (AdaBoost), gradient boosting machine, partitioning around medoids, naive Bayes, neural network, and bagged classification and regression trees (CART), were trained. The performance of these models was evaluated on internal and external validation sets using the area under the receiver operating characteristic curve (AUC). Calibration curve, decision curve, and clinical impact curve analyses were used for validation.</p><p><strong>Results: </strong>Fifteen laboratory parameters that met the requirements of XGBoost, SVM, and LASSO were selected. Among all tested ML models, the LR model had superior performance with relatively high AUC, accuracy, sensitivity, and specificity. The LR model achieved AUCs of 0.838 in the training set, 0.800 (with the highest accuracy [0.782] and optimal sensitivity [0.845]) in the internal validation set, and 0.757 in the external validation set. Finally, the LR model was visualized as a nomogram based on the top 6 laboratory parameters (age, anion gap, apolipoprotein A-1, apolipoprotein B, calcium, creatinine) to individually predict the Ki-67 proliferation index in patients with gliomas.</p><p><strong>Conclusions: </strong>The authors successfully constructed an LR model based on routine laboratory parameters, with relatively high sensitivity and specificity, to preoperatively predict the level of Ki-67 in patients with gliomas, which might be helpful for prognostic evaluation and clinical decision-making.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hormone outcomes following endoscopic endonasal resection of nonfunctional pituitary adenomas.","authors":"Evan D Bander, Abhinav Pandey, Carson Gundlach, Ying Li, Miguel Tusa Lavieri, Paul J Christos, Georgiana Dobri, Theodore H Schwartz","doi":"10.3171/2024.11.JNS241242","DOIUrl":"https://doi.org/10.3171/2024.11.JNS241242","url":null,"abstract":"<p><strong>Objective: </strong>Resection of nonfunctional pituitary adenomas (NFPAs) can precipitate transient, or in some cases, permanent hormone deficits requiring replacement. Predicting the risk of permanent hormone dysfunction and the possibility of improvement postsurgery is crucial for patient counseling. This study analyzed a large cohort of patients with NFPA to assess predictors of postoperative hormone function and to help both surgeons and patients better predict outcomes.</p><p><strong>Methods: </strong>The authors conducted a retrospective single-institution study on a series of patients treated for NFPAs at Weill Cornell Medicine between 2006 and 2023. Data including demographics, preoperative hormone status, laboratory values, pathological and radiographic tumor characteristics, and postoperative transient and permanent hormone replacement were collected. Multivariable logistic regression analysis was used to identify predictors of hormone deterioration and improvement.</p><p><strong>Results: </strong>A cohort of 372 patients were included in this study, 56% of whom presented with preoperative hormone deficiency of at least one axis. A total of 79% of patients underwent gross-total or near-total resection. Postoperatively, 178 (48%) required permanent hormone replacement for at least one hormonal axis: thyroid (34%), cortisol (23%), gonadotropin (15%), and antidiuretic hormone (7%). In patients with no preoperative endocrinopathy, 30.8% needed new hormone replacement therapy. Apoplexy and tumor size were strong predictors. If the tumor was < 2 cm, 23.5% needed new hormone replacement, and if the tumor was > 3 cm, 54.5% needed new hormone replacement. On the other hand, 39.5% of patients with a preoperative hormone deficiency did not require any long-term replacement. If the tumor was < 2 cm, 53.3% improved, and if the tumor was > 3 cm, 32.7% improved. Factors significantly associated with permanent hormone replacement and improvement besides tumor size and the presence of preoperative hormone deficiencies included hemorrhage on MRI, age, and sex, but these associated factors differed for each axis.</p><p><strong>Conclusions: </strong>This study highlights the relatively high but balanced rates of hormone loss and improvement after surgical removal of nonhormone-producing adenomas. The size of the tumor, apoplexy, and the patient's preoperative hormone status are strong predictors of outcome and can be used to estimate hormone function after surgery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancement of gait improvement in Parkinson disease with anterior subthalamic nucleus deep brain stimulation.","authors":"Jacqueline R Zak, Kelvin L Chou, Parag G Patil, Karlo A Malaga","doi":"10.3171/2024.10.JNS241470","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241470","url":null,"abstract":"<p><strong>Objective: </strong>Subthalamic nucleus (STN) deep brain stimulation (DBS) alleviates the motor symptoms of Parkinson disease (PD). However, a generalized targeting approach may lead to suboptimal outcomes for patients with diverse symptoms. Volume of tissue activation (VTA) modeling can be used to compute the spatial extent of stimulation relative to specific neural structures to assess clinical outcomes. Better outcomes for gait disturbances may be obtained by stimulating regions within or around the STN. This study aimed to determine the optimal stimulation region within or around the STN to improve gait disturbances in PD.</p><p><strong>Methods: </strong>Forty PD patients who underwent bilateral STN DBS were analyzed retrospectively. The therapeutic VTA of 72 implants was calculated to quantify STN and external (non-STN) activation in different regions. Stepwise regression was used to evaluate associations between stimulation location and gait symptom improvement (based on the Movement Disorder Society-Unified Parkinson's Disease Rating Scale). Implants grouped by stimulation location were compared according to symptom improvement using the Kruskal-Wallis test. Electrode position (relative to the STN) was examined for comparison.</p><p><strong>Results: </strong>Significant positive associations between anterior STN activation and gait (p = 0.03) and total gait improvement (p = 0.01) were found. Significant differences in freezing of gait (FoG) (p = 0.03) and total gait (p = 0.02) were also found when the majority anterior and majority posterior STN activation groups were compared. For external activation, a significant positive association between anterior external activation and FoG (p = 0.02) was found. No significant relationship between electrode position and gait symptoms was found.</p><p><strong>Conclusions: </strong>More anterior STN DBS may benefit patients whose primary symptoms include gait disturbances. This study demonstrates the utility of VTA modeling and highlights the importance of patient- and symptom-specific targeting.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of shorter time to surgery with improved overall survival for atypical intracranial meningiomas: an analysis using the National Cancer Database.","authors":"Linda Tang, Sachiv Chakravarti, Rohan Venkatdas, Emre Derin, A Karim Ahmed, Debraj Mukherjee","doi":"10.3171/2024.11.JNS241896","DOIUrl":"https://doi.org/10.3171/2024.11.JNS241896","url":null,"abstract":"<p><strong>Objective: </strong>Atypical intracranial meningiomas are characterized by brain invasion and faster growth than lower-grade counterparts. Surgery improves survival for patients with atypical meningiomas, and this study assesses the association between the timing of surgery and survival.</p><p><strong>Methods: </strong>Patients > 18 years of age with intracranial atypical meningiomas resected (2004-2019) and cataloged in the National Cancer Database were included. Descriptive statistics of sociodemographic and clinical characteristics were generated. Kaplan-Meier survival curves for each variable were generated. Cox proportional hazards models were developed to assess the association of time between diagnosis and surgery with overall survival, while controlling for age, sex, race, ethnicity, facility type, tumor size, comorbidity, resection type, adjuvant radiotherapy, and systemic therapy.</p><p><strong>Results: </strong>A total of 5452 patients were included; 17.81% of the patients were between 18 and 50 years, 66.89% were between 51 and 75 years, and 15.30% were > 75 years. Among the cohort, 55.98% of patients were female. The average time between diagnosis and surgery was 0.8 months; 63.33% of the patients underwent gross-total resection, 28.28% received adjuvant radiotherapy, and 0.92% received systemic therapy. Overall, 21.39% of the patients died during the study period, and the average follow-up time after surgery was 50.9 months. Bivariate analysis showed that the risk of patient mortality over the entire study period increased significantly for every additional month between diagnosis and surgery (hazard ratio [HR] 1.03, 95% CI 1.01-1.06; p = 0.01). On multivariable analysis, a longer time between diagnosis and surgery (HR 1.03, 95% CI 1.00-1.05; p = 0.02) remained a significant predictor of mortality after adjusting for age, sex, race, ethnicity, treatment facility type, tumor size, frailty, resection type, adjuvant radiotherapy, and systemic therapy. On subgroup analysis, delayed time to surgery was associated with increased mortality for those who received subtotal resection (HR 1.04, 95% CI 1.01-1.07; p = 0.01), but not for those who received gross-total resection (HR 1.02, 95% CI 0.97-1.06; p = 0.43). Patients who were female, Asian, treated at an academic program, and received radiotherapy were associated with significantly decreased mortality, whereas patients who were male, African American, had a tumor size > 60 mm, had more comorbidities, and underwent subtotal resection experienced increased mortality.</p><p><strong>Conclusions: </strong>Additional time between diagnosis and surgery is associated with an increased risk of mortality after adjusting for confounders. The authors recommend surgery as soon as safely possible after diagnosis for patients with intracranial meningiomas with signs of atypia.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional anterior temporal lobectomy for temporal lobe epilepsy: from anatomical resection to functional disconnection.","authors":"Yong Liu, Qiang Meng, Yutao Ren, Hao Wu, Huanfa Li, Hui Li, Anqing Li, Haohao Cui, Xiaobo Ye, Shan Dong, Xiaofang Liu, Changwang Du, Hua Zhang","doi":"10.3171/2024.10.JNS241152","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241152","url":null,"abstract":"<p><strong>Objective: </strong>Although anterior temporal lobectomy (ATL) has the highest efficacy for temporal lobe epilepsy (TLE), there is currently a trend toward performing minimally invasive surgery (MIS) for TLE. However, the MIS methods, such as laser thermocoagulation, have been used at the expense of efficacy. Functional ATL (FATL), which involves functional disconnection instead of anatomical resection and was designed by the authors, resolves this problem. This study aimed to evaluate seizure outcomes of FATL as an MIS for TLE.</p><p><strong>Methods: </strong>A consecutive case series of FATLs for ATL was conducted between 2020 and 2022. FATL was scheduled after standard presurgical evaluations of TLE and applied the same criteria as standard ATL. Seizure outcomes were categorized by Engel classifications, with at least 2 years of follow-up.</p><p><strong>Results: </strong>Forty-nine patients with TLE who underwent FATL were included in the case series. The mean follow-up duration was 31.9 (range 24-42) months. Freedom from disabling seizures (Engel class I) occurred in 36 patients (73.5%) and significant improvement (Engel class I-II) occurred in 44 (89.8%) after surgery. The rate of complete freedom from all seizures (Engel class Ia) was 77.6% at 1 year after surgery and 69.4% at 2 years. No deaths or permanent morbidities after FATL were recorded. The complication rate was 2.0%.</p><p><strong>Conclusions: </strong>FATL incorporates a change from anatomical resection to functional disconnection without brain shift. As a keyhole surgery, the FATL incision is barely visible, with a better cosmetic appearance than ATL. FATL has the MIS quality as well as excellent seizure outcomes similar to those of ATL.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes and prognostic factors in patients with primary Meige syndrome undergoing subthalamic nucleus deep brain stimulation: a retrospective study of 65 cases.","authors":"Zhebin Feng, Bin Liu, Junpeng Xu, Yanyang Zhang, Zhipei Ling, Xin Xu, Zhiguo Ma, Xinguang Yu, Zhiqi Mao","doi":"10.3171/2024.12.JNS241739","DOIUrl":"https://doi.org/10.3171/2024.12.JNS241739","url":null,"abstract":"<p><strong>Objective: </strong>Subthalamic nucleus deep brain stimulation (STN-DBS) for primary Meige syndrome has been increasingly reported in recent years. Despite the potential of this therapeutic approach, only a limited number of studies have evaluated its clinical benefits. Moreover, the efficacy of STN-DBS varies among patients with Meige syndrome, and stable prognostic predictors are scarce. In this study, the authors assessed the therapeutic effect of STN-DBS for Meige syndrome and explored reliable prognostic indicators to facilitate patient selection and postoperative programming.</p><p><strong>Methods: </strong>The authors enrolled 65 consecutive patients with Meige syndrome who underwent bilateral STN-DBS at their institution. Preoperative and postoperative motor symptoms were assessed using the Burke-Fahn-Marsden Dystonia Rating Scale movement (BFMDRS-M) and disability (BFMDRS-D) subscales. Leads were reconstructed in the standard space by using the Lead-DBS toolbox, and the volume of tissue activated (VTA) was calculated for each lead. Group comparisons and multivariate logistic regression analyses were conducted to evaluate clinical and demographic factors influencing the improvement rates in BFMDRS-M scores.</p><p><strong>Results: </strong>Significant postoperative improvements in the BFMDRS-M score (59.17% ± 28.0%, p < 0.001) and in the BFMDRS-D score (65.05% ± 38.9%, p < 0.001) were observed. Group comparisons indicated that the y-axis value of active contacts, the overlapping volume between VTAs and the STN sensorimotor region, as well as the distance from the center of active contacts to the surface of the STN sensorimotor region were significantly associated with the improvement rate of BFMDRS-M scores. Multivariate logistic regression analyses revealed that both the overlapping volume between VTAs and bilateral STN sensorimotor regions-along with the involvement of the left STN limbic region-emerged as independent prognostic indicators for the improvement in BFMDRS-M scores.</p><p><strong>Conclusions: </strong>Bilateral STN-DBS proved to be a safe and effective treatment for Meige syndrome, and the STN sensorimotor region tended to be a desirable target. This study provided deeper insights into the clinical efficacy, patient selection, and targeting precision of STN-DBS treatment for Meige syndrome.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain surgery with safe intraoperative 3-T MRI and neuromonitoring.","authors":"Lindsey A Crowe, Colette Boëx, Orane Lorton, Nadia Bérard, Sana Boudabbous, Jean-Paul Vallée, Karl Schaller, Philippe Bijlenga, Rares Salomir","doi":"10.3171/2024.11.JNS241382","DOIUrl":"https://doi.org/10.3171/2024.11.JNS241382","url":null,"abstract":"<p><strong>Objective: </strong>The aim in glioma or glioblastoma neurosurgery is maximal safe resection, knowing patient survival is strongly linked to resection extension. Deliberately leaving scalp subdermal neuromonitoring needle electrodes in place during intraoperative MRI is highly desirable for continued surgery after MRI but raises concerns for safety and image quality. Preclinical tests were performed to determine safe neuromonitoring electrodes and imaging protocols. The first implementations in a consecutive patient series are reported.</p><p><strong>Methods: </strong>Electromagnetic coupling between electrodes and MR radiofrequency pulses was measured for 5 different electrode lengths via local changes in the B1 field and temperature elevation around the electrode needle. Once the electrode length was selected, specific absorption rate (SAR) thresholds were determined and applied in the first 12 patients who gave consent. All subdermal scalp needle electrodes required for motor, somatosensory, or brainstem auditory or visual evoked potentials were carefully located perpendicular to the B0 field axis and remained in place. Electrode wires were kept in an axial position as close as possible along the center of the MR magnet tunnel to avoid any loops or crossing.</p><p><strong>Results: </strong>The temperature elevation (mean ± SD 0.49°C ± 0.02°C), coupling (2.25 AngularDegree2.cm2), and minimum wire length for accessing the neuromonitoring head box determined the electrode length (1360 mm). Five to 9 scalp electrodes were kept in place during MRI. Among 12 patients, 6 did not require further SAR limitation below the standard regulation of 2 W/kg. The SAR limit of 1.0 W/kg was safe. Lesion resection was continued after MRI in 3 patients; motor monitoring was reinstalled in 1 patient (frontal glioblastoma). Neither redness nor any sign of burns or complaints were detected. Neither radiofrequency spikes nor significant susceptibility artifacts were observed.</p><p><strong>Conclusions: </strong>This protocol, which included a semiempirical physical model, in situ thermometry, B1 mapping, and cutoff SAR thresholding for controlled electrode length and positioning, was safe for intraoperative 3-T MRI in brain surgical procedures in routine clinical practice.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}