Journal of neurosurgery最新文献

{"title":"Letter to the Editor. Endoscopic transorbital approaches: the lateral orbital rim trade-off.","authors":"Sergio Corvino","doi":"10.3171/2024.10.JNS242554","DOIUrl":"https://doi.org/10.3171/2024.10.JNS242554","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575861","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":"Predictors of dural venous sinus pressure gradient in patients with idiopathic intracranial hypertension.","authors":"Arbaz A Momin, Basel Musmar, Kareem El Naamani, Nikolaos Mouchtouris, Dwight Mitchell Self, Matthews Lan, Keenan Piper, Caitlin Ritz, Stavropoula I Tjoumakaris, Pascal M Jabbour, M Reid Gooch","doi":"10.3171/2024.10.JNS241749","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241749","url":null,"abstract":"<p><strong>Objective: </strong>Growing evidence suggests that venous outflow obstruction from venous sinus stenosis (VSS) may lead to increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH). There is a paucity of evidence examining clinical predictors of elevated cerebral venous pressure gradient (CVPG) from VSS in patients with IIH. In this study, the authors examined predictors of elevated CVPG, determined the sensitivity and specificity of common presenting symptoms of IIH, and identified the optimal opening pressure threshold on lumbar puncture (LP) to determine which patients should undergo venous manometry (VM).</p><p><strong>Methods: </strong>Patient demographics, presenting symptoms, complications, and opening pressure on LP were collected. Venous pressure gradient across a stenotic dural venous sinus and maximum venous pressure values were recorded from cerebral venograms. VM was considered positive when the CVPG was ≥ 8 mm Hg between two contiguous segments of a dural venous sinus. Sensitivity, specificity, and multivariable logistic regression analysis was performed.</p><p><strong>Results: </strong>The predominant patient population was young (mean age 38.9 years), obese (BMI ≥ 30; 83.8%), and female (95.0%). Sensitivity and specificity for papilledema were 74% and 70% (area under the curve [AUC] 0.71, 95% CI 0.63-0.80), and 70% and 63% (AUC 0.66, 95% CI 0.57-0.75) for pulsatile tinnitus. Vision changes demonstrated a sensitivity of 80% and specificity of 50% (AUC 0.63, 95% CI 0.54-0.72). VSS seen on magnetic resonance venography (MRV) demonstrated a sensitivity of 90% and specificity of 53% (AUC 0.71, 95% CI 0.63-0.79). Youden's index analysis identified an opening pressure ≥ 25 cm H2O on LP (AUC 0.72, 95% CI 0.60-0.83) as an optimal threshold for predicting elevated CVPG.</p><p><strong>Conclusions: </strong>Predictors of elevated CVPG on VM include childbearing age, African American race, papilledema, pulsatile tinnitus, obesity (BMI ≥ 30), focal VSS with unilateral dominance in venous drainage seen on MRV, or an opening pressure on LP ≥ 25 cm H2O.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575879","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":"Letter to the Editor. A revision of the classic high-, moderate-, and low-contact sport categorization of risk for head and neck injuries.","authors":"Scott L Zuckerman, Grant H Rigney, Jacob Jo, Allen K Sills, David O Okonkwo, Nicholas Theodore, Gavin A Davis","doi":"10.3171/2024.12.JNS242524","DOIUrl":"https://doi.org/10.3171/2024.12.JNS242524","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575860","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":"Deep learning-based segmentation of the trigeminal nerve and surrounding vasculature in trigeminal neuralgia.","authors":"Kyra M Halbert-Elliott, Michael E Xie, Bryan Dong, Oishika Das, Xihang Wang, Christopher M Jackson, Michael Lim, Judy Huang, Vivek S Yedavalli, Chetan Bettegowda, Risheng Xu","doi":"10.3171/2024.10.JNS241060","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241060","url":null,"abstract":"<p><strong>Objective: </strong>Preoperative workup of trigeminal neuralgia (TN) consists of identification of neurovascular features on MRI. In this study, the authors apply and evaluate the performance of deep learning models for segmentation of the trigeminal nerve and surrounding vasculature to quantify anatomical features of the nerve and vessels.</p><p><strong>Methods: </strong>Six U-Net-based neural networks, each with a different encoder backbone, were trained to label constructive interference in steady-state MRI voxels as nerve, vasculature, or background. A retrospective dataset of 50 TN patients at the authors' institution who underwent preoperative high-resolution MRI in 2022 was utilized to train and test the models. Performance was measured by the Dice coefficient and intersection over union (IoU) metrics. Anatomical characteristics, such as surface area of neurovascular contact and distance to the contact point, were computed and compared between the predicted and ground truth segmentations.</p><p><strong>Results: </strong>Of the evaluated models, the best performing was U-Net with an SE-ResNet50 backbone (Dice score = 0.775 ± 0.015, IoU score = 0.681 ± 0.015). When the SE-ResNet50 backbone was used, the average surface area of neurovascular contact in the testing dataset was 6.90 mm2, which was not significantly different from the surface area calculated from manual segmentation (p = 0.83). The average calculated distance from the brainstem to the contact point was 4.34 mm, which was also not significantly different from manual segmentation (p = 0.29).</p><p><strong>Conclusions: </strong>U-Net-based neural networks perform well for segmenting trigeminal nerve and vessels from preoperative MRI volumes. This technology enables the development of quantitative and objective metrics for radiographic evaluation of TN.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575852","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":"Effect of deep brain stimulation on nonmotor symptoms in essential tremor.","authors":"Anthony E Bishay, Alexander T Lyons, Daniel R S Habib, Natasha C Hughes, Isabel Long, Michael Zargari, Helen Qian, Danika Paulo, Jessica E Summers, Rui Li, Steven Bishay, Douglas P Terry, Benoit M Dawant, Tyler J Ball, Peter E Konrad, Dario J Englot, Kaltra Dhima, Sarah K Bick","doi":"10.3171/2024.11.JNS241990","DOIUrl":"https://doi.org/10.3171/2024.11.JNS241990","url":null,"abstract":"<p><strong>Objective: </strong>Essential tremor (ET) is a prevalent movement disorder that also includes nonmotor symptoms such as anxiety, depression, and cognitive impairment. Deep brain stimulation (DBS) is an established treatment for ET, yet its impact on nonmotor symptoms remains unclear. This study aims to describe neuropsychological outcomes following ventral intermediate nucleus (VIM) DBS in a large cohort of patients with ET and identify factors associated with changes in depression and cognitive function.</p><p><strong>Methods: </strong>A retrospective cohort study of patients who had undergone VIM DBS was performed. Inclusion criteria were ET diagnosis, surgery between October 2007 and March 2020, and available pre- and post-DBS neuropsychological testing results. Neuropsychological measures included the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and cognitive measures assessing attention, executive function, language, memory, and visuospatial function. Post-DBS tremor improvement was graded, and active electrode coordinates and stimulation parameters were identified. Statistical analyses included descriptive statistics, t-tests to compare pre- and postoperative scores at the group level, and one-way analysis of variance to compare variables among patients who improved, were stable, or worsened in psychiatric and cognitive characteristics after DBS.</p><p><strong>Results: </strong>One hundred thirty-nine patients met the study inclusion criteria. BDI-II scores significantly decreased postoperatively (9.82 ± 6.77 vs 8.29 ± 6.18, p < 0.001, Cohen's d = 0.176), whereas BAI scores remained unchanged. Both language (p = 0.003, Cohen's d = 0.259) and memory (p < 0.001, Cohen's d = 0.336) domains showed statistically significant small-magnitude declines following surgery, whereas attention, executive function, and visuospatial function were unchanged. Patients with improved depression (14.3%) following VIM DBS had significantly higher BDI-II scores preoperatively (p < 0.001, ω2 = 0.226). Patients with worsened language (18.7%) had higher preoperative language scores (p < 0.001, ω2 = 0.058). Patients with worsened memory (15.1%) had higher BAI scores preoperatively (p = 0.002, ω2 = 0.079). Preoperative scores were similar between patients with improved and worsened overall cognition postsurgery. Patients with improved overall cognition had improvements in attention, language, and visuospatial function.</p><p><strong>Conclusions: </strong>VIM DBS for ET did not result in large-magnitude neuropsychological changes. There were statistically significant, though likely not clinically meaningful, small-magnitude improvements in depression and worsening in language and memory scores. Associations were found between multiple preoperative mood and cognitive scores and post-DBS neuropsychological changes. These findings can help inform clinical decision-making and patient counseling for DBS.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-15"},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575854","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":"Letter to the Editor. The minipterional craniotomy: a versatile approach for interpeduncular lesions.","authors":"Saul Almeida da Silva, Carlos Gilberto Carlotti, Eberval Gadelha Figueiredo","doi":"10.3171/2024.11.JNS242880","DOIUrl":"https://doi.org/10.3171/2024.11.JNS242880","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575874","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":"Letter to the Editor. Coagulopathy in TBI: the emerging role of biomarkers.","authors":"Marios G Lampros, George A Alexiou, Spyridon Voulgaris","doi":"10.3171/2024.11.JNS242747","DOIUrl":"https://doi.org/10.3171/2024.11.JNS242747","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527844","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":"Involved but not essential: cognitive activity in periventricular nodules and neuropsychological outcomes following their ablation.","authors":"Yosefa A Modiano, Oscar Woolnough, Ryan M McCormack, Kathryn Snyder, Ellery Wheeler, Samden D Lhatoo, Nuria Lacuey, Sandipan Pati, Katherine Harris, Jay Gavvala, Jessica A Johnson, Nitin Tandon","doi":"10.3171/2024.10.JNS241541","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241541","url":null,"abstract":"<p><strong>Objective: </strong>Periventricular nodular heterotopia (PVNH) is a malformation of cortical development with high rates of epilepsy. The extent to which nodules participate in normal cerebral functions in addition to pathological processes is unclear. The authors assessed the functional utility (i.e., cognitive impacts) of surgically ablated epileptogenic PVNH tissue via comprehensive neuropsychological testing.</p><p><strong>Methods: </strong>The sample included 32 patients with PVNH who underwent presurgical neuropsychological evaluation and a subsample of 16 patients who underwent MR-guided laser interstitial thermal therapy (MRgLITT) of nodules, with postsurgical neuropsychological testing. In 11 patients in whom intracranial recordings were performed, reading and naming tasks were tested to determine if there was task-related activation within the nodules. Postoperative changes were assessed at the domain level and across individual tests by using reliable change indices, with consideration of spatial distribution and hemisphere of surgery as potential modifiers of postoperative change.</p><p><strong>Results: </strong>Task-related activation during reading or naming was seen in 53% of electrodes localized within nodules that were later ablated; however, no related postsurgical language impacts were observed. No significant declines occurred following MRgLITT in any domain level z-scores. For single tests, the authors found substantial evidence in favor of the null hypothesis in 18/21 tests. Significant decline was seen only in spatial learning. A substantial association with laterality was identified in the perceptual reasoning index.</p><p><strong>Conclusions: </strong>The functionality of PVNH tissue was evaluated by direct recordings and changes in cognitive assessments following MRgLITT ablation of epileptogenic nodules. Despite language-related activity seen in these nodules, no pattern of change was observed within any cognitive domain. The only significant decline observed was in spatial learning, whereas perceptual reasoning improved for individuals with surgery in the nondominant hemisphere. These results offer strong evidence against the role of epileptogenic PVNH in cognitive functions. This work speaks to the need for caution in assigning causality to activations seen in functional imaging without evidence from lesional methods.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":3.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527841","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":"Safe and efficacious therapeutic outcomes with salvage endonasal transsphenoidal surgery for pituitary adenoma progression following stereotactic radiosurgery.","authors":"Yuki Shinya, Sukwoo Hong, Christoph Wipplinger, Hirotaka Hasegawa, Dana Erickson, Irina Bancos, Justine S Herndon, Tamara M Wipplinger, Sandhya R Palit, Masahiro Shin, Michael J Link, Bruce E Pollock, John L D Atkinson, Nobuhito Saito, Jamie J Van Gompel","doi":"10.3171/2024.10.JNS241682","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241682","url":null,"abstract":"<p><strong>Objective: </strong>Stereotactic radiosurgery (SRS) offers excellent tumor control for pituitary adenoma (PA); however, treatment failure occasionally necessitates salvage surgery. Comprehensive studies on salvage surgical outcomes for recurrent PA after SRS remain scarce. This study aimed to elucidate the outcomes of salvage endonasal transsphenoidal surgery (sETS) for progressive PA failing SRS.</p><p><strong>Methods: </strong>This retrospective, two institution-based cohort study analyzed data from patients who underwent sETS for progressive PA failing SRS. Progression-free survival (PFS), disease-specific survival (DSS), and neurological and endocrinological outcomes in the sETS group were analyzed and compared with those in the primary ETS (pETS) group after propensity score matching using the following variables: age at surgery, maximum tumor diameter, highest Knosp-Steiner classification, and tumor type.</p><p><strong>Results: </strong>Thirteen sETS patients (8 males [62%], median age at surgery of 56 years) with 5 nonfunctioning (39%), 6 corticotropic (46%), and 2 other functioning (15%) PAs who received median (range) follow-up of 125 ( 23-169) months were included. None of the patients experienced new neurological deficits or death after sETS. The median (range) tumor resection rate was 90% (80%-100%). The 5-year PFS and DSS rates were 55% and 77%, respectively. All 4 patients (31%) who experienced recurrence after sETS had corticotropic tumors. In the matched cohort analysis between the sETS group with 12 patients and the pETS group with 12 patients, no significant differences were observed in surgical outcomes. PFS rates were marginally higher in the sETS group than in the pETS group (80% vs 49% at 3 years, p = 0.216, log-rank test), and DSS was similar between the two groups (p = 0.543, log-rank test).</p><p><strong>Conclusions: </strong>The authors' results indicate that ETS can be safely performed as a salvage treatment after failed SRS with low complication rates and satisfactory tumor control in treatment-resistant PA.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527848","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":"Long-term safety and efficacy of the FRED X flow diverter for intracranial aneurysms: a multicenter study of 154 patients.","authors":"Joanna M Roy, Kareem El Naamani, Cheritesh Amaravadi, Shyam Majmundar, Nikolaos Mouchtouris, Alexandra R Paul, Nicholas C Field, Yi Zhang, Jan-Karl Burkhardt, Anna Luisa Kühn, Ajit Puri, Elad Levy, M Reid Gooch, Pascal Jabbour, Robert H Rosenwasser, Stavropoula I Tjoumakaris","doi":"10.3171/2024.10.JNS241233","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241233","url":null,"abstract":"<p><strong>Objective: </strong>The Flow-Redirection Endoluminal Device X (FRED X) is a newer generation flow diverter with surface modifications aimed at minimizing thrombogenicity. At present, data on its long-term efficacy are limited. This multicenter study presents the largest series within the United States describing the device's efficacy, safety, and long-term outcomes in treating cerebral aneurysms of varying morphology.</p><p><strong>Methods: </strong>Patients treated with the FRED X for a cerebral aneurysm between February 2022 and February 2024 at 6 high-volume centers across the United States were included. Data were collected regarding demographics, clinical presentation, and procedural efficacy. Angiographic and clinical follow-up outcomes were assessed at 6 and 12 months.</p><p><strong>Results: </strong>A total of 154 patients with 162 aneurysms were treated with 164 FRED X devices over the study period. Overall, 81.8% of the cohort was female with a mean age of 56.8 years. The authors observed satisfactory rates (≥ 99.3%) of device deployment and good wall apposition and neck coverage. One hundred forty-seven (95.5%) patients were functionally independent at discharge (modified Rankin Scale scores 0-2). Rates of adequate occlusion (Raymond-Roy Occlusion Scale score I or II) increased from 84.2% at 6 months to 83.5% at the 12-month follow-up, while rates of in-stent stenosis decreased. All patients (100%) who underwent follow-up were functionally independent at 6 months, and 95.9% were functionally independent at 12 months.</p><p><strong>Conclusions: </strong>This multicenter cohort study demonstrates the ease of FRED X deployment with an adequate safety profile, with low rates of procedural complications and favorable outcomes on follow-up. Rates of aneurysm occlusion increased over time, with a subsequent decrease in stent-associated complications.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527846","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}