Journal of neurosurgery最新文献

{"title":"The impact of intracranial pressure monitoring in severe traumatic brain injury: results from the National Trauma Registry.","authors":"Anton Peled, Gil Kimchi, Adi Givon, Raquel C Gardner, Nachshon Knoller, Eldad Katorza, Irit Cohen-Manheim","doi":"10.3171/2024.10.JNS24502","DOIUrl":"https://doi.org/10.3171/2024.10.JNS24502","url":null,"abstract":"<p><strong>Objective: </strong>Intracranial pressure monitoring (ICPM) is a cornerstone procedure in the management of severe traumatic brain injury (TBI). Yet, its implementation is low and the impact on outcomes debated. The authors' objective was to determine the association between ICPM and 1-year mortality in severe TBI.</p><p><strong>Methods: </strong>The authors performed a retrospective cohort study utilizing data from the Israel National Trauma Registry (INTR) of severe TBI patients admitted to level I trauma centers from 2015 to 2021. Multivariable logistic regressions were performed to calculate the odds ratio (OR) of 1-year mortality, adjusted for age, Glasgow Coma Scale (GCS) score, other severe injuries (nonhead Abbreviated Injury Scale [AIS] score ≥ 4), hypotension, and surgical decompression. The main outcome was 1-year mortality.</p><p><strong>Results: </strong>Of 2202 patients, 36.8% underwent insertion of ICPM. ICPM patients had a lower 1-year mortality rate (28.12% vs 33.60%, p = 0.015). Compared with ICPM, the adjusted odds of 1-year mortality of no ICPM were increased 1.2-fold (OR 1.21, 95% CI 0.96-1.54). The effect size was greater among patients with head AIS score 5-6 and age 18-64 years (OR 1.57, 95% CI 1.13-2.20) and age ≥ 65 years (OR 1.92, 95% CI 1.04-3.55); the effect size of no ICPM in those with head AIS score 3-4 was decreased (OR 0.49, 95% CI 0.26-0.93).</p><p><strong>Conclusions: </strong>A significant association between ICPM and lower 1-year mortality in the most severe TBI patients (head AIS score 5-6) who were ≥ 18 years of age was observed. The authors' study supports the use of ICPM in severe TBI. The authors recommend more detailed reporting to best inform quality improvement programs on a national scale. This research contributes to the academic dialogue on TBI and the considerations for enhancing patient care.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416690","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":"Treatment of low-pressure hydrocephalus using a novel shunt valve technique: applying Bernoulli's equation to fluid statics. Technical note.","authors":"Diego A Carrera, Hengameh B Pajer, Daxa Patel, Ariana S Barkley, James A Botros, Heather S Spader","doi":"10.3171/2024.10.JNS232782","DOIUrl":"https://doi.org/10.3171/2024.10.JNS232782","url":null,"abstract":"<p><p>Low-pressure hydrocephalus (LPH) is the presence of persistent ventriculomegaly with low to normal intracranial pressure. Patients with LPH respond to subzero drainage, which consists of external ventricular drainage at levels below the external auditory meatus. Multiple treatment modalities have been described in the literature, but due to low intracranial pressures, weaning the external ventricular drain can take weeks to even months. This poses a relevant gap in the knowledge of treatment for LPH. The authors describe a new technique of placing a programmable differential pressure valve below the clavicle as an effective and feasible way to treat LPH. The authors present their experience with 3 patients with LPH who required prolonged subzero drainage and had a shunt valve placed below the clavicle as an effective treatment for LPH. Three patients were diagnosed with LPH and underwent subzero drainage, and drain weaning trials were unsuccessful. All 3 patients received a programmable valve below the clavicle that enabled an expedited discharge with return to baseline. A shunt valve placed caudal to the clavicle is a feasible and effective long-term treatment option for LPH.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416697","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":"Factors affecting outcomes following burr hole drainage of chronic subdural hematoma: a single-center retrospective study.","authors":"Ardalan Zolnourian, Susruta Manivannan, Ben Edwards, Anne Chua, Mukul Arora, Taiwo Akhigbe, Andrew Durnford, Jonathan Hempenstall, Ali Nader-Sepahi, Diederik Bulters, Ahmed-Ramadan Sadek","doi":"10.3171/2024.9.JNS24370","DOIUrl":"https://doi.org/10.3171/2024.9.JNS24370","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Chronic subdural hematoma (CSDH) is among the most common neurosurgical conditions. Patient selection for surgical intervention is often complex and multifactorial. The objective of this study was to examine the predictors of clinical outcomes, complications, and hospital length of stay (LOS) in patients with burr hole drainage of CSDH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective electronic neurosurgical database search was performed between January 2009 and January 2020 at a single tertiary referral unit. Adult patients treated with burr hole evacuation of CSDH and with extractable outcome data at discharge were eligible for inclusion. Variables including preoperative clinical status, antithrombotic use, surgical factors, clinical outcome, hospital LOS, discharge destination, and complications were extracted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1226 patients were eligible for inclusion, with a median age of 79 years (IQR 71-85 years) and predominantly male (n = 885, 72.2%). Most patients were independent at baseline (n = 1019, 83.1%) with a median Karnofsky Performance Status score of 80 (IQR 70-90). The majority of patients underwent unilateral burr hole drainage (n = 1001, 81.6%) with two burr holes (n = 1177, 96.0%) and subdural drain insertion (n = 1087, 88.7%). The majority of patients had favorable outcomes at discharge (Glasgow Outcome Scale scores 4 and 5; n = 975, 79.5%) with a median hospital LOS of 6 days (IQR 4-9 days). Recurrence was observed in 122 patients (10.0%) with an overall postoperative complication rate of 27.2% (n = 334). Age &lt; 80 years, preadmission independence, preoperative Glasgow Coma Scale motor (GCS-M) score of 6, &lt; 5 regular medications, and American Society of Anesthesiologists (ASA) grades I and II were associated with significantly increased odds of a favorable outcome and being discharged home, decreased odds of postoperative complications, and decreased risk of prolonged hospital LOS. Surgical factors including laterality and number of burr holes were not associated with the tested outcomes. The use of a subdural drain was associated with increased odds of favorable outcome and being discharged home but not recurrence or complications. Long-term mortality analysis (n = 1222) demonstrated a median survival of 93 months (95% CI 84-105 months) with a median follow-up of 57 months (IQR 31-88 months). Nonmodifiable baseline variables (age, preadmission independence, GCS-M score, and ASA grade) demonstrated significant differences (p &lt; 0.001) in survival distribution, while surgical factors (drain insertion, symptomatic recurrence, and number of days of bed rest) did not.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In the largest single-center study of patients managed with burr hole drainage of CSDH, the authors highlight several preoperative factors that may influence short-term outcome. Their findings offer robust criteria for counseling patients and families in situations in wh","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416820","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":"Quantity versus quality: analysis of research publications in the 2023 neurosurgery match.","authors":"Alexander F Wang, Ethan A Wetzel, Timothy R West, Logan Muzyka, Andreas C Runde, Ali M Nasser, Uyanga Batsaikhan, Ganesh M Shankar, Bryan D Choi, Brian V Nahed","doi":"10.3171/2024.10.JNS242070","DOIUrl":"https://doi.org/10.3171/2024.10.JNS242070","url":null,"abstract":"<p><strong>Objective: </strong>Prematch research productivity is a heavily utilized metric in evaluating neurosurgery residency applicants. With the rise in research output by successfully matched candidates and the so-called publication arms race, there is a growing interest in understanding the quality and impact of the research conducted by medical students who secure neurosurgery residency positions. This study aimed to characterize the research output of medical students who matched into neurosurgery in 2023, identify predictors of research productivity, and explore the implications of research output on match outcomes.</p><p><strong>Methods: </strong>First-year neurosurgery residents from the 2023 match were identified via program websites. Research output data were collected from the PubMed and Scopus databases, excluding publications released after the 2023 National Resident Matching Program deadline. Predictive analyses were conducted using multiple linear regression models.</p><p><strong>Results: </strong>Data were obtained for 242 1st-year neurosurgery residents and 2519 PubMed-indexed publications. The median numbers of total and first author publications were 7 (range 0-73) and 2 (range 0-25), respectively. The median number of citations was 28 (range 0-1010), with a median impact factor of 3.1 (range 0-30.43). Most publications represented retrospective clinical research (n = 839). Of the neurosurgery-related publications, spine-related research was most common (n = 410), while peripheral nerve research was the least common (n = 20). Factors associated with higher publication output included attending a top 20-ranked U.S. News & World Report medical school (p = 0.00044), international medical graduate status (p = 1.95e-6), and obtaining a doctor of philosophy degree (p = 0.00582). Applicants who published more than 30 papers averaged 4.16 citations per paper, whereas residents who published fewer than 30 papers averaged 8.34 citations per paper (p = 0.0006).</p><p><strong>Conclusions: </strong>This study characterizes the research output of successfully matched neurosurgery applicants and identifies medical school ranking and degree status as predictors of research productivity. Interestingly, only the rank of the medical school attended predicted better match outcomes despite an overall shift to utilizing research as a metric of merit in residency applications in reaction to an increase in pass/fail medical school curriculums and changes in United States Medical Licensing Examination Step 1 grading systems. These findings also demonstrate that residents who published the most papers published the lowest-impact research, which aligns with the notion that there is an increased emphasis on publication quantity rather than publication quality.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416677","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":"Microsurgical clipping for intracranial aneurysms in elderly patients: outcomes comparable to those in younger cohorts.","authors":"Joanna M Roy, Basel Musmar, Matthews Lan, Shyam Majmundar, Cheritesh Amaravadi, Sarah Winiker, Charles Morse, Erica Sais, Shray Patel, Kareem El Naamani, Stavropoula I Tjoumakaris, M Reid Gooch, Robert H Rosenwasser, Pascal M Jabbour","doi":"10.3171/2024.10.JNS242494","DOIUrl":"https://doi.org/10.3171/2024.10.JNS242494","url":null,"abstract":"<p><strong>Objective: </strong>In recent years, there has been a shift toward the endovascular treatment of intracranial aneurysms, particularly among elderly patients, that is, those aged 70 years and older. However, microsurgical clipping remains the preferred modality for aneurysms of a certain morphology and location. The authors of this study aimed to compare the outcomes of clipping on the basis of age.</p><p><strong>Methods: </strong>This was a retrospective single-center study of patients who had undergone microsurgical clipping of an intracranial aneurysm between February 2016 and November 2022. Propensity scores were estimated using the 1:2 nearest neighbor method. Outcomes of interest were intraoperative and postoperative complications, length of stay (LOS), nonhome discharge (NHD), functional dependence on discharge, and mortality.</p><p><strong>Results: </strong>After propensity score matching, 50 patients older than 70 years were matched with 100 patients younger than 70 years of age. Aneurysm location, morphology, and rupture status were comparable between the matched cohorts. There was no significant difference in complications (14.0% for age ≥ 70 vs 13.0% for age < 70, p > 0.99), extended LOS (30% vs 19%, respectively, p = 0.129), NHD (38.0% vs 26.0%, respectively, p = 0.131), functional dependence on discharge (22% vs 17%, respectively, p = 0.509), or mortality (8.0% vs 2.0%, respectively, p = 0.077).</p><p><strong>Conclusions: </strong>The study results demonstrated rates of complications, LOS, NHD, functional dependence, and mortality in elderly patients comparable to those in younger patients. The authors acknowledge the importance of patient selection and encourage further studies to assess the safety of clipping in the elderly.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416757","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":"Connectomic-guided stereotactic radiosurgery thalamotomy for tremor: a patient-specific approach to enhance outcomes.","authors":"Erik H Middlebrooks, Vishal Patel, Richard A Popple, Harrison C Walker, Evan M Thomas, Sarah A Brinkerhoff, Ashley R Anderson, Hrishikesh D Deshpande, Benjamin A McCullough, Natividad P Stover, Victor W Sung, Anthony P Nicholas, David G Standaert, Talene Yacoubian, Marissa N Dean, Jaimie A Roper, Sanjeet S Grewal, Marshall T Holland, J Nicole Bentley, Barton L Guthrie, Markus Bredel","doi":"10.3171/2024.10.JNS24753","DOIUrl":"https://doi.org/10.3171/2024.10.JNS24753","url":null,"abstract":"<p><strong>Objective: </strong>Stereotactic radiosurgery (SRS) is an effective treatment for refractory tremor. However, the lack of reliable patient-specific targeting biomarkers leads to varying outcomes. Although connectomic-based targeting is commonly used in deep brain stimulation, its application in SRS is limited. This study aimed to develop a new targeting approach by using patient-specific structural connectivity to improve outcomes after SRS.</p><p><strong>Methods: </strong>The authors performed a retrospective study of patients in a prospective trial for frameless virtual-cone SRS on a linear accelerator for essential tremor or tremor-dominant Parkinson disease. The primary endpoint was percentage improvement in Fahn-Tolosa-Marin tremor rating scale scores contralateral to the treatment side. Probabilistic tractography assessed connectivity from each thalamic voxel to the primary motor cortex (M1), primary sensory cortex (S1), and supplemental motor area/premotor cortex (SMA/PMC). Group-level comparisons were conducted to evaluate the relationship between the sweet spot for maximum contralateral tremor improvement and areas maximally connected to M1, S1, and SMA/PMC. Multiple regression analysis assessed the relationship between the lesion centerpoint coordinates and the maximally connected voxel to M1, S1, and SMA/PMC at the individual level.</p><p><strong>Results: </strong>The analysis included 27 patients with a mean follow-up of 17.9 ± 11.1 months. The sweet spot for maximal contralateral tremor improvement at the group level was in the region most connected to M1 cortex. Smaller y-distances (anterior-posterior) from the lesion center to the M1 maximally connected voxel significantly correlated with tremor improvement at the single-subject level (p < 0.001). However, the authors found no significant correlation between the lesion y-coordinate and the maximally connected voxel to SMA/PMC and S1, nor between the x-distances from the lesions to the SMA/PMC, M1, and S1 voxels (p > 0.07).</p><p><strong>Conclusions: </strong>This study demonstrates that patient-specific connectivity between the treatment target and M1 correlates with treatment outcomes. The authors' approach provides a practical targeting method for SRS thalamotomy for tremor.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416818","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":"Sex-specific differences in DNA methylation defining prognostically relevant subgroups in glioblastoma.","authors":"Barbara Kiesel, Martin Borkovec, Julia Furtner, Thomas Roetzer-Pejrimovsky, Karl-Heinz Nenning, Lisa Greutter, Yelyzaveta Miller-Michlits, Georg Widhalm, Adelheid Woehrer","doi":"10.3171/2024.9.JNS24665","DOIUrl":"https://doi.org/10.3171/2024.9.JNS24665","url":null,"abstract":"<p><strong>Objective: </strong>Glioblastoma is an aggressive brain tumor that is more common and has a worse outcome in males. Recently, the observed sex differences have been linked to tumor biology, prominently highlighting fundamental differences in gene expression programs. Here, the authors advance this concept to epigenome-based DNA methylation patterns across primary and recurring glioblastoma.</p><p><strong>Methods: </strong>The authors leveraged their 614 publicly available DNA methylation datasets comprising 252 female and 362 male patients with glioblastoma. They applied a joint and individual variation explained analysis to explore clusters among tumors in males and females in an unsupervised way. Their prognostic association was explored using Kaplan-Meier analysis and a Cox proportional hazards model. Their findings were validated using The Cancer Genome Atlas (TCGA) dataset.</p><p><strong>Results: </strong>Clustering of the individual, sex-specific components yielded two distinct clusters in males and females, which were predictive of overall survival in males (p = 0.0098). Among differentially regulated genes in males, the 20 most consistently altered genes resulted in a targeted panel, which predicted overall survival in males and females at the first surgery (p < 0.0001 and p = 0.013) but not at recurrence (p = 0.3 and p = 0.85, respectively). These findings were validated in TCGA dataset. The authors translated the observed differences in survival to networked pathways prominently highlighting protein metabolism in males and oxidative phosphorylation in females.</p><p><strong>Conclusions: </strong>In summary, the authors report sex-specific differences in DNA methylation patterns among male and female cases of glioblastoma that converge on a set of 20 genes that have a prognostic impact in both sexes at the first surgery. Sex-specific networks of pathways suggest prominent roles for protein processing and antigen presentation in males and metabolism in females. The study findings provide new insights in sex-specific tumor biology to further improve individual gender-based patient management and estimation of disease prognosis.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416687","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":"Perforating artery injury as a critical factor besides cortical dysfunction in motor deficit after peri-rolandic epilepsy surgery.","authors":"Atsuhiko Ninomiya, Shin-Ichiro Osawa, Kyoko Suzuki, Kazuo Kakinuma, Kazushi Ukishiro, Yoshiteru Shimoda, Kazutaka Jin, Mitsugu Uematsu, Shiho Sato, Shunji Mugikura, Hiroyoshi Suzuki, Hajime Miyata, Shingo Kayano, Nobukazu Nakasato, Hidenori Endo","doi":"10.3171/2024.10.JNS24878","DOIUrl":"https://doi.org/10.3171/2024.10.JNS24878","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Surgery for peri-rolandic epilepsy requires appropriate consideration to balance the functional risk of postoperative motor deficit and seizure outcome. Based on voxel-based morphometric analysis, the authors hypothesized that cortical damage and ischemic subcortical damage related to surgery could affect postoperative motor deterioration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Sixteen patients with peri-rolandic epilepsy who underwent resective surgery at a single institution were retrospectively investigated. Their imaging findings, postoperative seizure outcomes, and postoperative neurological deteriorations in motor function, as well as duration, were analyzed. Using the standardized MRI data of each case, the authors examined the surgically resected area on high-resolution 3D MR images and the high-intensity area on diffusion-weighted images, which were converted to voxel data. These voxel data were superimposed on a standard brain image for neuroimaging assessment. Postoperative motor deterioration of the orofacial region, upper limb, or lower limb was noted as no, transient, or permanent deterioration and analyzed in relation to the surgically resected area and subcortical damage. Univariate analysis of the clinical factors was conducted between cases with permanent upper- and/or lower-limb motor deterioration and those with no or transient deterioration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean follow-up period was 28 months. Ten patients (62.5%) achieved Engel class I. Fourteen patients (87.5%) experienced postoperative motor deteriorations in the following areas (no/transient/permanent): orofacial (11/5/0), upper limb (9/5/2), and lower limb (9/3/4). All cases with orofacial motor deterioration underwent cortical resection of the inferior third of the peri-rolandic cortex. Cortical resection of the precentral gyrus only, in contrast to both the precentral and postcentral gyri, was not associated with permanent upper- and/or lower-limb motor deterioration. Cortical resection involving the postcentral gyrus was significantly associated with permanent upper- and/or lower-limb motor deterioration in 4 cases (25.0%). Surgically related perforating artery injury caused ischemic subcortical damage, which was significantly associated with postoperative transient or permanent motor deterioration by extending to the corticospinal tract (CST).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Postoperative motor deterioration for peri-rolandic epilepsy was related to both the resected cortex and ischemic subcortical damage. In peri-rolandic epilepsy, cortical resection of the precentral gyrus might not necessarily cause permanent upper- and/or lower-limb motor deterioration because of the functional reserve in other peri-rolandic areas outside the epileptic focus. On the other hand, cortical resection of the postcentral gyrus could cause permanent upper- and/or lower-limb motor deterioration because of injury to the vasculature, which is","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416839","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 influence of prestroke disability on outcome in patients with a low Alberta Stroke Program Early CT Score who underwent endovascular thrombectomy.","authors":"Hidetoshi Matsukawa, Kazutaka Uchida, Sameh Samir Elawady, Conor Cunningham, Mohammad-Mahdi Sowlat, Ilko Maier, Pascal Jabbour, Joon-Tae Kim, Stacey Quintero Wolfe, Ansaar Rai, Robert M Starke, Marios-Nikos Psychogios, Edgar A Samaniego, Adam S Arthur, Shinichi Yoshimura, Hugo Cuellar-Saenz, Jonathan A Grossberg, Ali Alawieh, Daniele G Romano, Omar Tanweer, Justin Mascitelli, Isabel Fragata, Adam Polifka, Joshua Osbun, Roberto Crosa, Charles Matouk, Min S Park, Michael R Levitt, Waleed Brinjikji, Mark Moss, Richard Williamson, Pedro Navia, Peter Kan, Reade De Leacy, Shakeel Chowdhry, Mohamad Ezzeldin, Alejandro M Spiotta","doi":"10.3171/2024.10.JNS24888","DOIUrl":"https://doi.org/10.3171/2024.10.JNS24888","url":null,"abstract":"<p><strong>Objective: </strong>The definitive influence of prestroke disability on outcomes in patients with a low Alberta Stroke Program Early CT Score (ASPECTS) treated with endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) remains unknown. This study aimed to investigate the impact of prestroke disability on outcomes in this specific population.</p><p><strong>Methods: </strong>Data from 32 international centers for AIS-LVO patients with a low ASPECTS who underwent EVT between January 2013 and December 2022 were analyzed retrospectively. Low ASPECTS and prestroke disability were defined as ASPECTS values of 2-5 and prestroke modified Rankin Scale (mRS) score ≥ 2. The primary outcome was a return to the prestroke mRS score at 90 days. Secondary outcomes were independent ambulation (mRS scores of 0-3) or a return to the prestroke mRS score at 90 days, good functional outcome (mRS scores of 0-2) or a return to the prestroke mRS score at 90 days, successful recanalization, and 90-day mortality. Safety outcomes were any intracranial hemorrhage or symptomatic intracranial hemorrhage. A symptomatic intracranial hemorrhage was defined as an intracranial hemorrhage with an associated worsening of ≥ 4 points in the National Institutes of Health Stroke Scale score. Outcomes were compared between patients with and without prestroke disability.</p><p><strong>Results: </strong>Of 293 patients, 50 (17.1%) had a prestroke disability. Of 50 patients, 20 (40.0%), 24 (48.0%), and 6 (12.0%) had prestroke mRS scores of 2, 3, and 4, respectively. The primary outcome showed no significant difference between the two groups. Compared with patients without prestroke disability, those with prestroke disability had a significantly smaller proportion of independent ambulation or return to prestroke mRS score (adjusted OR 0.13, 95% CI 0.03-0.53) and good functional outcome or return to prestroke mRS score (adjusted OR 0.21, 95% CI 0.05-0.91). Other secondary and safety outcomes showed no significant difference between the two groups.</p><p><strong>Conclusions: </strong>The present study indicated that prestroke disability was not associated with a return to the prestroke mRS score at 90 days or intracranial hemorrhage. Physicians should not routinely exclude AIS-LVO patients with a low ASPECTS who have prestroke disability from EVT based on prestroke disability alone.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370844","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":"Effects of the length of preoperative conservative management on postoperative outcomes after primary microvascular decompression for trigeminal neuralgia.","authors":"Anita L Kalluri, Emeka Ejimogu, Sai Chandan Reddy, Sumil K Nair, Hussain Alkhars, Collin Kilgore, Mostafa Abdulrahim, Vivek Yedavalli, Michael Lim, Christopher M Jackson, Judy Huang, Chetan Bettegowda, Risheng Xu","doi":"10.3171/2024.9.JNS241436","DOIUrl":"https://doi.org/10.3171/2024.9.JNS241436","url":null,"abstract":"<p><strong>Objective: </strong>Although trigeminal neuralgia (TN) is initially managed conservatively, approximately half of all patients will eventually undergo surgery. Despite this outcome, there is limited understanding of the relationship between preoperative length of conservative management and pain outcomes after microvascular decompression (MVD). In this study, the authors aimed to describe the relationship between the duration of preoperative conservative management and postoperative outcomes in patients undergoing MVD for TN.</p><p><strong>Methods: </strong>The electronic medical records of 381 patients with TN who underwent primary MVD at the authors' institution between 2007 and 2023 were reviewed. Patients were dichotomized based on whether the duration of conservative management, defined as the duration of anticonvulsant use, was greater than, or less than or equal to, the median duration of conservative management for the entire cohort. For adjusted analysis, duration of conservative management was also assessed as a continuous variable. Demographic information, comorbidities, clinical TN characteristics, pain recurrence, and pre- and postoperative modified Barrow Neurological Institute (BNI) pain and numbness scale scores were recorded and compared between groups. Differences in pain outcomes were assessed via multivariate ordinal regression, Kaplan-Meier analysis, and Cox proportional hazards analysis.</p><p><strong>Results: </strong>The median preoperative duration of conservative management was 1.74 years. Patients with a prolonged duration of conservative management were significantly more likely to be male (p = 0.028) and less likely to preoperatively use opioids (p = 0.037). At final follow-up, those with a prolonged duration of conservative management had significantly higher reported BNI pain scores (p = 0.021) and higher rates of pain recurrence (p = 0.021). On multivariable ordinal regression analysis, younger age (p < 0.001) and prolonged duration of conservative management, which was assessed as both a dichotomized (p = 0.002) and continuous variable (p = 0.011), were associated with higher BNI pain scores at final follow-up. Patients with a longer duration of conservative management also had a significantly shorter time to pain recurrence, as assessed by Kaplan-Meier survival analysis (p = 0.0037) as well as Cox proportional hazards analysis (p = 0.001, dichotomized; p = 0.008, continuous).</p><p><strong>Conclusions: </strong>In the setting of primary MVD for patients with TN, a longer duration of preoperative conservative management was associated with higher postoperative BNI pain scores and increased risk of pain recurrence. These findings suggest a potential beneficial role for early surgical intervention.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370697","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}