Journal of neurosurgery最新文献

{"title":"Oral and general health quality of life following a subtemporal preauricular infratemporal approach with condylar fossa osteotomy in surgical skull base tumor resection.","authors":"Seika Taniguchi, Jeremy Kam, Mendel Castle-Kirszbaum, Ryojo Akagami","doi":"10.3171/2024.6.JNS232959","DOIUrl":"https://doi.org/10.3171/2024.6.JNS232959","url":null,"abstract":"<p><strong>Objective: </strong>With the capacity to provide maximal lesion exposure, the subtemporal preauricular infratemporal (SPI) approach with condylar fossa osteotomy is highly utilized in radical resection of skull base tumors. While this approach requires disruption of the temporomandibular joint (TMJ) for access, the effects of this maneuver are poorly appreciated in neurosurgery. The aim of this study was to assess the morbidity of condylar fossa osteotomies by comparing oral health quality of life (OHQOL) and general health quality of life (GHQOL) outcomes after TMJ-involving and TMJ-sparing skull base approaches.</p><p><strong>Methods: </strong>A retrospective review of the medical records of patients who underwent surgery with the SPI approach (TMJ-involving approach) for skull base chondrosarcoma (CS) by a single senior surgeon at Vancouver General Hospital between 2002 and 2022 was performed. Patients undergoing TMJ-sparing anterolateral approaches for trigeminal schwannoma (TS) during the same study period by the same surgeon were included as controls. GHQOL was evaluated using the 36-item Short Form Health Survey from preoperative and postoperative periods. Postoperative OHQOL was evaluated using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I/II screening instrument.</p><p><strong>Results: </strong>Data regarding quality of life were available for 13 of 19 CS patients and 12 of 15 TS patients surgically managed between 2002 and 2022. CS patients demonstrated less jaw dysfunction in all parameters of the DC/TMD Axis I/II components when specifically assessing OHQOL. CS patients had a lower likelihood of temporomandibular disorder (TMD) presence on the TMD pain screener than TS patients (25% vs 45%, p = 0.40). Chronic pain scores were higher in the TS group, with significantly more patients with grade 2 or higher pain (36.4% vs 0%, p = 0.01). The mean Jaw Functional Limitation Scale (JFLS) scores were lower in CS patients than in TS patients. Both CS and TS patients demonstrated lower mean JLFS scores (0.50 and 0.81, respectively) than patients with chronic TMD (1.76), but higher mean JLFS scores than patients without TMD (0.16).</p><p><strong>Conclusions: </strong>The authors report novel findings regarding the impact of the SPI approach with a condylar fossa osteotomy on OHQOL and GHQOL among skull base tumor patients. Anatomical disruption of the TMJ was not associated with significant clinical TMJ dysfunction. Compared with TS patients, CS patients had even lower mean scores in TMJ-related morbidity, and both groups had lower TMJ morbidity than patients diagnosed with chronic TMJ dysfunction. Condylar fossa osteotomies can therefore be considered without concern of significant additional morbidity.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467927","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":"The 2024 Presidential Address. The power of humility.","authors":"Anthony L Asher","doi":"10.3171/2024.7.JNS241653","DOIUrl":"10.3171/2024.7.JNS241653","url":null,"abstract":"<p><p>Physicians generally underestimate their potential to influence social progress, despite substantial precedents for medical professionals leading important societal transformations. The author believes that our times require we challenge the notion that physicians have limited influence beyond clinical settings. Our voice is powerful and important. It needs to be heard. In light of these considerations, the author chose \"What Matters\" as the theme of the 2024 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting held in Chicago on May 3-6. The topic was reflective of his personal conviction that physicians, by virtue of the public respect and goodwill maintained through their dedication to the art and science of medicine, possess unparalleled potential to enhance both individual and societal health and well-being. The 2024 AANS scientific program committee determined to create an unprecedented program that would allow the community of neurosurgery to engage with some of the greatest minds in American medicine, academics, journalism, technology and public life. All contributors were invited to weave their insights regarding what truly matters into a broad, thought-provoking intellectual and spiritual tapestry. Universally resonant themes such as empathy, innovation, resilience, leadership, value, trust and equity framed the cooperative dialogues, emphasizing our shared humanity and the core values uniting us-despite our differences. The objectives for the 2024 Annual Meeting were ambitious: to consider as a professional community themes of utmost importance to our professional and personal lives; to catalyze a profound reevaluation of our collective objectives; to envision an expanded common mission; and to inspire visionary leaders to collaborate on creating lasting value-both for the patients who are the principal focus of our shared devotion, and for society writ large.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467929","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":"Electrocorticography and navigated transcranial magnetic stimulation-tailored supratotal resection for epileptogenic low-grade gliomas.","authors":"Francesca Battista, Giovanni Muscas, Alberto Parenti, Camilla Bonaudo, Davide Gadda, Cristiana Martinelli, Riccardo Carrai, Andrea Amadori, Antonello Grippo, Alessandro Della Puppa","doi":"10.3171/2024.6.JNS24597","DOIUrl":"https://doi.org/10.3171/2024.6.JNS24597","url":null,"abstract":"<p><strong>Objective: </strong>Epilepsy is commonly associated with low-grade gliomas (LGGs), impacting patients' well-being. While resection is the primary treatment, seizures can persist postoperatively in 27%-55% of cases. The authors aimed to evaluate an electrocorticography (ECoG) and navigated transcranial magnetic stimulation (nTMS)-tailored supratotal resection (ETT-SpTR) for LGG in controlling seizures, preserving neurological function, and enhancing treatment effectiveness.</p><p><strong>Methods: </strong>The authors retrospectively analyzed a prospectively enrolled cohort of patients with LGG presenting with epileptic seizures with ictal/interictal activity on electroencephalography (EEG) who underwent resective surgery. The authors performed preoperative nTMS to identify functional cortical areas. ECoG was used to guide the removal of the high-risk epilepsy cortical areas (HREAs). Patients were divided into two groups: group I, the control group, underwent gross-total resection alone, whereas group II patients underwent removal of HREAs identified by ECoG (ETT-SpTR). Resection avoided functionally eloquent areas as identified on nTMS, checked with cortical mapping. Postoperative seizure outcome was assessed using the Engel classification.</p><p><strong>Results: </strong>Fifteen patients who underwent LGG resection between January and July 2023 were included. Among 24 identified nTMS-positive points, none were included in the resection. Overall, 73.3% of patients (11/15) showed positive intraoperative ECoG, with better outcomes in group II (85.7% Engel class IA) than in group I (25% Engel class IA) at the follow-up (p = 0.02, OR 0.5 [95% CI 0.035-7.10], RR 0.19 [95% CI 0.03-1.2]). Seizure control was significantly better in group II, with no notable differences in postoperative transient neurological deficits between the two groups (p = 0.45). No permanent neurological deficits were observed during follow-up. Statistical analysis revealed significant differences between the two groups (p < 0.05).</p><p><strong>Conclusions: </strong>This preliminary study affirms the predictive value of TMS for postoperative neurological status and safety in epileptic patients. Intraoperative ECoG effectively identified peritumoral HREAs. ETT-SpTR significantly improved epileptic outcomes, preserving functions without permanent neurological worsening. Additional resection targets the HREAs in the temporal, frontal, and parietal lobes.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467903","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":"Wartime penetrating traumatic brain injury of the anterior skull base involving the paranasal sinuses: a single-center, first-year experience from Dnipro, Ukraine.","authors":"Andrii Sirko, Connor Berlin, Siny Tsang, Bhiken I Naik, Rocco Armonda","doi":"10.3171/2024.6.JNS24852","DOIUrl":"https://doi.org/10.3171/2024.6.JNS24852","url":null,"abstract":"<p><strong>Objective: </strong>Since February 2022, the number of casualties in the Russian-Ukrainian war have dramatically increased, with a high incidence of penetrating traumatic brain injuries (pTBIs). To date, there has been limited evaluation of pTBI of the anterior skull base involving the paranasal sinuses. The objective of this study was to highlight the authors' experience with this injury pattern and identify specific factors associated with favorable short-term (1-month) outcome and survival.</p><p><strong>Methods: </strong>The authors conducted a single-institution retrospective review of patient data collected from the 1st year of the Russian-Ukrainian war at a frontline civilian Ukrainian hospital. To prevent complications from conservative treatment of pTBI with paranasal sinus injury, a protocol of early primary neurosurgical treatment including debridement/hematoma evacuation, repair of dural defects with vascularized pericranial flaps, and titanium plating of external/skull base defects was implemented. Using 1-month postoperative Glasgow Outcome Scale scores, the authors defined a favorable outcome as good recovery/moderate disability and a poor outcome as severe disability/vegetative state/death. Patient demographics, injury characteristics, imaging findings, and postoperative complications were assessed. Logistic regression models were used to estimate the effect of patient characteristics on unfavorable outcome or survival.</p><p><strong>Results: </strong>From February 2022 to February 2023, there were 141 pTBIs (20%) involving the paranasal sinuses, 134 (95%) due to blast fragmentation. One hundred eighteen patients (84%) had a favorable outcome. Most patients with pTBIs (69%) had other nonbrain-related injuries. While 48 patients (34%) presented with preoperative CSF leak, only 1 patient (0.7%) had persistent postoperative CSF leak, which was managed with lumbar drainage. High admission Glasgow Coma Scale (GCS) score, favorable injury lateralization (single hemisphere involved), and low Injury Severity Score (ISS) were associated with significantly increased odds of favorable short-term outcome, whereas high admission GCS scores and no midline shift were associated with significantly increased odds of survival.</p><p><strong>Conclusions: </strong>This was the largest single-year study on neurosurgical treatment of wartime pTBI involving the paranasal sinuses. Implementation of primary neurosurgical intervention at the time of presentation demonstrated promising early results and a shift away from expectant management of this injury pattern. The association of high admission GCS score, low ISS, favorable injury lateralization, and no midline shift on favorable short-term outcomes or survival has not been previously documented with this injury pattern.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467930","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":"Natural history and management outcomes of patients with ruptured Spetzler-Martin grade IV and V brain arteriovenous malformations.","authors":"Shahab Aldin Sattari, Wuyang Yang, James Feghali, Albert Antar, Alice Hung, Risheng Xu, Rafael J Tamargo, Judy Huang","doi":"10.3171/2024.6.JNS241075","DOIUrl":"https://doi.org/10.3171/2024.6.JNS241075","url":null,"abstract":"<p><strong>Objective: </strong>The natural history of ruptured high Spetzler-Martin grade IV and V brain arteriovenous malformations (bAVMs) is underreported given the scarcity of this pathology, and decision-making for patients with bAVMs remains unclarified. In this study, the authors sought to shed light on this topic.</p><p><strong>Methods: </strong>Patients harboring ruptured high-grade bAVMs were identified from an institutional database spanning from 1990 to 2020. The authors examined outcomes of annual hemorrhagic risk in natural history and after treatment, follow-up hemorrhage rate, bAVM obliteration, follow-up modified Rankin Scale (mRS) score > 2, worsened mRS score, and mortality.</p><p><strong>Results: </strong>After reviewing the charts of 1066 patients without hereditary hemorrhagic telangiectasia, 84 patients with ruptured high-grade bAVMs were included in the study for analysis. For cortical bAVMs, the annual risk of hemorrhage during natural history was 2.68%. Surgery decreased the risk to 0.74%, while radiosurgery increased the risk to 5.35%, and embolization only increased the risk to 16.96%. For deep-seated high-grade bAVMs, the annual risk of hemorrhage during natural history was 8.37%. Radiosurgery decreased the risk to 3.11%, surgery decreased the risk to 5.25%, and embolization only increased the risk to 22.33%. Poisson regression analysis demonstrated that embolization only increased the risk of hemorrhage in cortical bAVMs (rate ratio 4.745, 95% CI 1.365-12.819; p = 0.005) and deep-seated bAVMs (rate ratio 6.290, 95% CI 0.997-21.932; p = 0.013). Logistic regression analysis showed that surgery (OR 52.000, 95% CI 8.083-1046.127; p = 0.004) and radiosurgery (OR 11.142, 95% CI 1.804-217.650; p = 0.029) were predictors of obliteration in cortical and deep-seated bAVMs, respectively. The proportions of patients experiencing a worsened mRS score, a follow-up mRS score > 2, and mortality were similar between conservative and treatment groups.</p><p><strong>Conclusions: </strong>The natural history of cortical ruptured high-grade bAVMs bears a risk similar to that of incidental bAVMs, whereas deep-seated ruptured high-grade bAVMs have an increased risk of hemorrhage. With extremely prudent patient selection, surgery might be a viable option for cortical bAVMs to obliterate the bAVM and reduce hemorrhagic risk, while preserving functional status. Radiosurgery might be beneficial to lower hemorrhagic risk in deep-seated bAVMs. Embolization as a single modality should be avoided as it provides no benefit to reduce hemorrhagic risk.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467915","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":"Chordoma incidence, treatment, and survival in the 21st century: a population-based Ontario cohort study.","authors":"Husain Shakil, Armaan K Malhotra, Ahmad Essa, Alexander P Landry, Suganth Suppiah, Arjun Sahgal, Nicolas Dea, Gelareh Zadeh, Michael G Fehlings, Christopher D Witiw, Jefferson R Wilson","doi":"10.3171/2024.6.JNS24426","DOIUrl":"https://doi.org/10.3171/2024.6.JNS24426","url":null,"abstract":"<p><strong>Objective: </strong>This study estimates the incidence, treatment patterns, and overall survival for patients with chordoma treated in Ontario.</p><p><strong>Methods: </strong>A 17-year (2003-2019) population-based cohort study was conducted, including all patients in the Ontario Cancer Registry with histologically proven chordoma. Primary outcomes of interest were age-standardized annual incidence, overall survival, and rates of radiation therapy, chemotherapy, and open resection.</p><p><strong>Results: </strong>A total of 208 patients were diagnosed with chordoma over the study period: 97 patients with skull base chordoma, 37 with mobile spine chordoma, and 65 with sacropelvic chordoma. A total of 133 patients were treated with either open or endoscopic surgery, of whom 99 were also treated with some form of radiation therapy. Across the 17-year study period, the average annual age-standardized incidence was 12.04 cases per 10 million (95% CI 9.31-14.78 cases per 10 million). There was no significant change in the annual incidence rate over the study period (average annual percent change 2.27, 95% CI -1.74 to 6.44; p = 0.25). The odds of receiving radiation therapy or chemotherapy significantly increased by 8% per year (95% CI 1%-16% per year, p = 0.036) over the study period. The odds of receiving open resection significantly decreased by 14% per year (95% CI 8%-20% per year, p < 0.001). The odds of receiving endoscopic surgery among patients with skull base chordoma increased by 38% per year (95% CI 22%-60% per year, p < 0.001), while the odds of patients receiving biopsy alone did not change significantly over the study period (p = 0.684). After diagnosis of chordoma, the 5-, 10-, and 15-year overall survival probabilities were 0.74 (95% CI 0.69-0.81), 0.58 (95% CI 0.51-0.67), and 0.48 (95% CI 0.40 to 0.59), respectively. There was no significant association between hazard of death and year of diagnosis (p = 0.126) or anatomical location (p = 0.712, skull base vs mobile spine chordoma; p = 0.518 skull base vs sacropelvic chordoma).</p><p><strong>Conclusions: </strong>Chordoma is a rare disease with no significant change in the average annual incidence rate between 2003 to 2019. During this time, treatment with less invasive modalities increased, particularly for skull base chordoma. Overall survival exceeds 10 years for many patients, with no change in the hazard of death across the study period.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467902","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":"Defining ideal middle cerebral artery bifurcation aneurysm size for Woven EndoBridge embolization.","authors":"Nimer Adeeb, Basel Musmar, Hamza Adel Salim, Assala Aslan, Anika Alla, Nicole M Cancelliere, Rachel M McLellan, Oktay Algin, Sherief Ghozy, Mahmoud Dibas, Sovann V Lay, Adrien Guenego, Leonardo Renieri, Joseph Carnevale, Guillaume Saliou, Panagiotis Mastorakos, Kareem El Naamani, Eimad Shotar, Kevin Premat, Markus Möhlenbruch, Michael Kral, Omer Doron, Charlotte Chung, Mohamed M Salem, Ivan Lylyk, Paul M Foreman, Jay A Vachhani, Hamza Shaikh, Vedran Župančić, Muhammad U Hafeez, Joshua S Catapano, Muhammad Waqas, Vincent M Tutino, Mohamed K Ibrahim, Marwa A Mohammed, M Ozgur Ozates, Giyas Ayberk, James D Rabinov, Yifan Ren, Clemens M Schirmer, Mariangela Piano, Anna L Kühn, Caterina Michelozzi, Stéphanie Elens, Robert M Starke, Ameer Hassan, Mark Ogilvie, Anh Nguyen, Jesse Jones, Waleed Brinjikji, Marie T Nawka, Marios Psychogios, Christian Ulfert, Jose Danilo Bengzon Diestro, Bryan Pukenas, Jan-Karl Burkhardt, Ricardo A Domingo, Thien Huynh, Juan Carlos Martinez-Gutierrez, Muhammed Amir Essibayi, Sunil A Sheth, Gary Spiegel, Rabih G Tawk, Boris Lubicz, Pietro Panni, Ajit S Puri, Guglielmo Pero, Erez Nossek, Eytan Raz, Monika Killer-Oberfalzer, Christoph J Griessenauer, Hamed Asadi, Adnan Siddiqui, Allan L Brook, David Altschul, Andrew F Ducruet, Felipe C Albuquerque, Robert W Regenhardt, Christopher J Stapleton, Peter Kan, Vladimir Kalousek, Pedro Lylyk, Srikanth Boddu, Jared Knopman, Mohammad A Aziz-Sultan, Stavropoula I Tjoumakaris, Frédéric Clarençon, Nicola Limbucci, Hugo H Cuellar-Saenz, Pascal M Jabbour, Vitor Mendes Pereira, Aman B Patel, Adam A Dmytriw","doi":"10.3171/2024.5.JNS232204","DOIUrl":"https://doi.org/10.3171/2024.5.JNS232204","url":null,"abstract":"<p><strong>Objective: </strong>The Woven EndoBridge (WEB) device was approved to treat wide-necked bifurcation aneurysms. The device is designed as an intrasaccular flow disruptor covering aneurysm widths up to 10 mm. Although prior studies combined all aneurysm sizes, it is known that aneurysms behave differently in response to endovascular treatment based on their size. Therefore, the authors' objective was to identify ideal middle cerebral artery (MCA) aneurysm width and neck sizes most suitable for WEB treatment.</p><p><strong>Methods: </strong>The WorldWideWEB consortium is a large multicenter retrospective database that analyzes intracranial aneurysms treated with the WEB device. In this study, all unruptured MCA bifurcation aneurysms with available measurements were included. Cutoff values based on aneurysm width and neck in relation to aneurysm occlusion status were measured using the receiver operating characteristic (ROC) curve. Propensity score matching (PSM) was then used to compare treatment outcomes between aneurysms smaller and larger than the cutoff value for both width and neck size.</p><p><strong>Results: </strong>The ideal cutoff values for MCA bifurcation aneurysm width and neck were 6.1 mm and 4.6 mm, respectively. On PSM, 87 matched pairs were compared based on width size (≤ 6.1 mm and > 6.1 mm), and 77 matched pairs were compared based on neck size (≤ 4.6 mm and > 4.6 mm). There was a significant difference in adequate aneurysm occlusion between aneurysms smaller and larger than those cutoff values for both widths (93% vs 76%, p = 0.0017) and neck sizes (90% vs 70%, p = 0.0026). The retreatment rate was also significantly higher for larger aneurysms in both parameters.</p><p><strong>Conclusions: </strong>This study shows that MCA bifurcation aneurysms ≤ 6.1 mm in width and ≤ 4.6 mm in neck size are significantly better candidates for WEB treatment, leading to improved occlusion status and reduced retreatment rate, which are important considerations when using WEB devices.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406443","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":"Creating and validating a neurosurgical intervention rule-out tool for patients with mild traumatic brain injury and isolated subdural hematoma: a 5-year, six-center retrospective cohort study.","authors":"Alessandro Orlando, Ripul R Panchal, Glenda Quan, Timbre Backen, Jeffrey Gordon, Lane Mellor, Laxmi Dhakal, David Hamilton, Carlos H Palacio, Justin Kerby, Dave Acuna, Gina M Berg, Andrew Stewart Levy, Benjamin Rubin, Josef Coresh, David Bar-Or","doi":"10.3171/2024.5.JNS232478","DOIUrl":"https://doi.org/10.3171/2024.5.JNS232478","url":null,"abstract":"<p><strong>Objective: </strong>Because there is no reliable method on admission to predict whether a patient will require neurosurgical intervention in the future, the general approach remains to treat each patient with mild traumatic brain injury (mTBI) and subdural hematoma (SDH) as if they will require such an intervention. Consequently, there is a growing population of patients with mTBI and SDH that is overtriaged despite having a low probability of needing neurosurgical intervention. This study aimed to train and validate a predictive rule-out tool for neurosurgical intervention in patients with mTBI and SDH.</p><p><strong>Methods: </strong>This was a retrospective cohort study of all trauma patients admitted to six level I trauma centers in three states. Patients were included if they met the following criteria: admitted between 2016 and 2020, ≥ 18 years of age, ICD-10 diagnosis of isolated SDH, initial head imaging available, initial Glasgow Coma Scale score of 13-15, and arrived within 48 hours of injury. Exclusion criteria included skull fracture, intracranial hemorrhage other than an SDH, and no neurosurgical consultation. Prediction variables included 34 demographic, clinical, and radiographic variables. The study outcome was neurosurgical intervention within 48 hours of hospital admission. Seventy-five percent of the data were used for training, and 25% for testing. Multivariable logistic regression with fivefold cross-validation was used on the training set to identify covariates with the highest specificity while holding sensitivity at 100%. Results were validated on the testing set.</p><p><strong>Results: </strong>In total, 1000 patients were in the training set and 333 in the testing set. The overall neurosurgical intervention rate was 8.8%. For the fivefold cross-validation process, three variables were selected that maximized specificity while holding sensitivity at 100%: maximum hematoma thickness, initial Glasgow Coma Scale score, and preinjury antithrombotic use (sensitivity 100%, specificity 56%, area under the receiver operating characteristic curve 0.94). With a cutoff probability of neurosurgical intervention set at 1.88%, the final model was validated to predict neurosurgical intervention with a sensitivity of 100% (95% CI 88.4%-100%) and specificity of 55.1% (95% CI 49.3%-60.8%).</p><p><strong>Conclusions: </strong>In this study, the largest of its kind to date, the authors successfully developed and validated a new tool for ruling out the necessity of neurosurgical intervention in patients with mTBI and isolated SDH. By successfully identifying more than half of patients who are unlikely to require neurosurgery within the first 2 days of admission, this tool can be used to improve treatment efficiency and provide patients and clinicians with valuable prognostic information.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406442","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":"Extended transcavernous posterior clinoidectomy in endoscopic endonasal surgery.","authors":"Yuanzhi Xu, Christine K Lee, Jonathan Rychen, Muhammad Reza Arifianto, Maximiliano Alberto Nunez, Aaron A Cohen-Gadol, Juan C Fernandez-Miranda","doi":"10.3171/2024.6.JNS24606","DOIUrl":"https://doi.org/10.3171/2024.6.JNS24606","url":null,"abstract":"<p><strong>Objective: </strong>Mastery of the posterior clinoidectomy technique is of utmost importance for neurosurgeons who specialize in endoscopic endonasal approaches, because the posterior clinoid process (PCP) is commonly involved in chondroid tumor resection. Three main techniques for posterior clinoidectomy have been developed: intradural, extradural, and transcavernous interdural. The authors introduce here a novel technical variant in which the transcavernous approach is extended to the dorsal clinoidal space after transection of the caroticoclinoid ligament, and they elaborate on its clinical application on the basis of anatomical dissections and radiological studies.</p><p><strong>Methods: </strong>The authors reviewed CT angiography images and 3D reconstruction of the PCP in 50 adults to analyze the height and presence of ossified ligament attachments. In addition, endoscopic endonasal posterior clinoidectomy was performed in 20 lightly embalmed postmortem human heads. Three techniques, including extradural, transcavernous, and extended transcavernous posterior clinoidectomy, were performed sequentially, and anatomical landmarks and areas exposed with each technique were investigated and compared.</p><p><strong>Results: </strong>Using radiological studies, the authors categorized the PCPs as 1 of 2 types: 1) normal, defined as less than or equal to 8 mm high with no ossified ligament attachments; or 2) complex, defined as greater than 8 mm high with or without an ossified ligament attachment. Compared with extradural (exposed PCP height 4.7 ± 0.5 mm) and transcavernous (exposed PCP height 7.3 ± 0.8 mm) posterior clinoidectomies, the extended transcavernous posterior clinoidectomy provided the maximally exposed PCP height (9.6 ± 0.4 mm; p < 0.0001).</p><p><strong>Conclusions: </strong>This report details the extended transcavernous posterior clinoidectomy as a novel technical variant for achieving maximal exposure of the PCP in endoscopic endonasal surgery. In addition, the positive results establish the importance of preoperative skull base imaging for surgical planning.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406456","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":"Conservative management of brain arteriovenous malformations: results of the prospective observation registry of a pragmatic trial.","authors":"Tim E Darsaut, Jean-Christophe Gentric, Jonathan Heppner, Camille Lopez, Roland Jabre, Daniela Iancu, Daniel Roy, Alain Weill, Michel W Bojanowski, Chiraz Chaalala, Pierre-Olivier Comby, David Roberge, Christophe Cognard, Anne-Christine Januel, Jean-Francois Sabatier, Hubert Desal, Vincent Roualdes, Jean-Christophe Ferre, Quentin Alias, Chrysanthi Papagiannaki, Stéphane Derrey, Stanislas Smajda, Sorin Aldea, Thomas Gaberel, Charlotte Barbier, Xavier Barreau, Gaultier Marnat, Vincent Jecko, Rene Anxionnat, Isabelle Merlot, Thanh N Nguyen, Mohamad Abdalkader, Chloe Dumot, Roberto Riva, Thomas Graillon, Lucas Troude, Basile Kerleroux, Irene Ollivier, Remy Beaujeux, Grégoire Boulouis, Alexia Planty-Bonjour, Laurent Spelle, Vanessa Chalumeau, Olivier Naggara, Pierre-Henri Lefevre, Marine Le Corre, Eimad Shotar, Andrew P Carlson, Alessandra Biondi, Laurent Thines, Rabih G Tawk, Thien Huynh, Robert Fahed, J Max Findlay, Emmanuel Chabert, Justine Zehr, Guylaine Gevry, Ruby Klink, Geraldine Viard, Elsa Magro, Jean Raymond","doi":"10.3171/2024.5.JNS24623","DOIUrl":"https://doi.org/10.3171/2024.5.JNS24623","url":null,"abstract":"<p><strong>Objective: </strong>Many patients recruited in the Treatment of Brain Arteriovenous Malformations Study (TOBAS) are managed conservatively. The aim of this study was to monitor what happened to those patients.</p><p><strong>Methods: </strong>TOBAS comprises two randomized controlled trials and multiple prospective registries. All patients with brain arteriovenous malformations (AVMs) can participate. This report concerns patients selected for conservative management. The primary trial outcome measure is related death or dependency (modified Rankin Scale [mRS] score > 2) at 10 years. Secondary outcomes include intracranial hemorrhages, nonhemorrhagic neurological events, and serious adverse events (SAEs). For this report, outcome results are presented using patient-years, Kaplan-Meier survival curves, and Cox log-rank tests. There was no blinding.</p><p><strong>Results: </strong>From June 2014 to May 2021, 1010 patients were recruited, of whom 498 (49%) were proposed the prospective observation registry. After exclusions, 434 (87%) patients remained for analysis. The majority of patients had unruptured AVMs (378/434 [87%]), of which 195 (52%) were low grade (Spetzler-Martin grade I or II). During a mean follow-up period of 3.2 years (total 1368 patient-years), the primary outcome occurred in 23 of 434 (5%) patients, corresponding to an incidence of 1.7 (95% CI 1.1-2.5) per 100 patient-years. For unruptured AVMs the incidence was 1.1 (95% CI 0.7-1.9) per 100 patient-years, and for low-grade unruptured AVMs it was 0.6 (95% CI 0.2-1.7) per 100 patient-years. Poor outcomes were more frequent in patients with a history of rupture (HR 5.6 [95% CI 2.4-13.0], p < 0.001), infratentorial AVMs (HR 2.9 [95% CI 1.1-7.3], p = 0.027), and age ≥ 55 years (HR 3.2 [95% CI 1.4-7.6], p = 0.007). Major intracranial hemorrhage occurred in 35 of 434 (8%) patients (incidence of 2.6 [95% CI 1.9-3.6] per 100 patient-years; 2.0 [95% CI 1.3-2.9] per 100 patient-years for unruptured AVMs and 1.3 [95% CI 0.6-2.6] per 100 patient-years for low-grade unruptured AVMs). Major AVM hemorrhages were more frequent in ruptured (HR 4.4 [95% CI 2.1-8.9], p < 0.001), large (HR 2.6 [95% CI 1.1-6.6], p = 0.039), and high-grade (HR 2.5 [95% CI 1.2-5.3], p = 0.013) AVMs and those with deep venous drainage (HR 2.1 [95% CI 1.1-4.2], p = 0.032). SAEs occurred in 48 of 434 (11%) patients (incidence of 3.6 [95% CI 2.7-4.8] per 100 patient-years). For unruptured AVMs the incidence was 2.8 (95% CI 2.0-4.0) per 100 patient-years, and for low-grade unruptured AVMs it was 1.8 (95% CI 1.0-3.2) per 100 patient-years.</p><p><strong>Conclusions: </strong>Nearly half of TOBAS participants were observed. Rates of untoward neurological events were within expected boundaries.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406441","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}