Journal of neurosurgery最新文献

{"title":"Letter to the Editor. Mixed reality for the patient's brain: what about the surgeon's brain?","authors":"Ziyu Qi","doi":"10.3171/2024.9.JNS242122","DOIUrl":"https://doi.org/10.3171/2024.9.JNS242122","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":3.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822189","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":"A proposed new classification system of hypothalamic hamartomas in the era of stereotactic ablation surgery.","authors":"Hiroshi Shirozu, Hiroshi Masuda, Shigeki Kameyama","doi":"10.3171/2024.7.JNS24560","DOIUrl":"https://doi.org/10.3171/2024.7.JNS24560","url":null,"abstract":"<p><strong>Objective: </strong>Since the recent development of stereotactic ablation surgery, which can provide good seizure outcomes without limitations in size or location, conventional classification systems have become unsuitable for surgical guidance. The present study aimed to evaluate the validity of a newly proposed classification system focusing on the attachment pattern.</p><p><strong>Methods: </strong>This retrospective study investigated 218 patients with hypothalamic hamartomas who underwent MRI-guided stereotactic radiofrequency thermocoagulation and were followed for at least 1 year after their last surgery. Hypothalamic hamartomas were classified by their attachments into six subtypes: parahypothalamic-unilateral (PU), parahypothalamic-bilateral (PB), intrahypothalamic-unilateral (IU), intrahypothalamic-bilateral (IB), mixed-unilateral (MU), and mixed-bilateral (MB) types. Clinical features, surgical factors, scales of surgical procedures including numbers of trajectories and coagulations, requirement for a trans-third ventricular approach, reoperation rates, and complication rates were investigated. Seizure outcomes were evaluated separately for gelastic seizures (GSs) and non-GSs.</p><p><strong>Results: </strong>In 218 patients (131 [60.1%] males, median age at surgery 7.2 [range 1.8-51] years), the hypothalamic hamartomas were classified as PU type in 10 (4.6%), PB type in 11 (5.0%), IU type in 41 (18.8%), IB type in 17 (7.8%), MU type in 40 (18.3%), and MB type in 99 (45.4%) patients. Patients with MB type were significantly younger at GS onset (p < 0.001) and surgery (p = 0.005). The numbers of trajectories and coagulations were significantly greater in MB type (p < 0.001) and the trans-third ventricular approach was more often required in the PB type (5/6, 83.3%, p < 0.001). Seizure outcomes were not different among subtypes. The rate of transient complications was not different among subtypes, but hyperthermia (p = 0.002) and hyponatremia (p < 0.001) were more frequently found in patients with PB and MB types. Prolonged or persistent neurological complications were also not different and were only found in bilateral subtypes.</p><p><strong>Conclusions: </strong>The new classification predicts clinical features, as well as surgical complexity and complications. Although seizure outcomes were not different among subtypes because the authors' surgical strategy is consistently based on complete disconnection at the border, the new classification could improve seizure outcomes and would be helpful in the appropriate guidance for surgery of hypothalamic hamartomas to provide consistently good outcomes regardless of surgical procedures.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822143","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. Bypass in neurosurgery: a dying microsurgical procedure?","authors":"Leonardo O Brenner, Maria Fernanda Santana, Rafael Reis, Gustavo J S Sanchez, Taiane B Araújo, Raphael Bertani","doi":"10.3171/2024.8.JNS241958","DOIUrl":"https://doi.org/10.3171/2024.8.JNS241958","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822187","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":"Cost-minimizing thresholds and recurrence rates in surgical evacuation with adjunctive middle meningeal artery embolization versus evacuation alone.","authors":"Matthew C Findlay, Matthew Holdaway, Diwas Gautam, Sawyer Z Bauer, Gurpreet Gandhoke, Ramesh Grandhi","doi":"10.3171/2024.7.JNS24200","DOIUrl":"https://doi.org/10.3171/2024.7.JNS24200","url":null,"abstract":"<p><strong>Objective: </strong>Cost-minimization approaches for the treatment of patients with chronic subdural hematoma (cSDH) are important given the increasing incidence of this pathology, particularly among elderly patients receiving antiplatelet and anticoagulation medications. The use of middle meningeal artery embolization (MMAE) as an adjunct to surgical evacuation has shown promise in reducing surgical recurrence; however, additional costs are involved with this procedure. Using their institutional experience, the authors identified thresholds for cost and the cSDH surgical recurrence rate that could influence treatment decisions in patients requiring surgical evacuation for cSDH.</p><p><strong>Methods: </strong>All patients who underwent cSDH evacuation surgery (ES) with concomitant MMAE or ES alone from January 2019 through August 2023 were identified. The authors collected hospital-related costs for the initial admission and any subsequent admissions to address surgical recurrence (rescue surgery [RS]) and conducted cost-minimization analyses. Base-case scenario calculations were supplemented with 1- and 2-way sensitivity analyses to study cost-minimizing variables.</p><p><strong>Results: </strong>Demographic characteristics, comorbidities, and presenting symptoms did not significantly differ between patients who received ES/MMAE (n = 44) and those who received ES (n = 100). ES/MMAE procedures required a mean ± SD 79.3 ± 34.8 minutes whereas ES alone required 54.3 ± 25.9 minutes (p < 0.01), and patients who underwent ES/MMAE had a greater immediate postoperative hemorrhage volume reduction (-62.5% ± 22.1% vs -54.3% ± 21.3%, p = 0.04). No differences in the rates of 30-day complications, readmissions, or mortality were observed (all p > 0.05), but the ES/MMAE cohort had no reoperations after initial surgery whereas 14% in the ES-alone cohort required RS (p < 0.01). The base-case calculations indicated that ES alone minimizes costs more than ES/MMAE when there is no RS. Two-way sensitivity analyses revealed that, given a 14% probability of RS for the ES-alone group and 0% for the ES/MMAE cohort, ES/MMAE becomes cost-minimizing when the costs for ES/MMAE are kept below $21,000. With these same failure rates and cost of ES/MMAE, if ES costs exceed $32,000, ES/MMAE becomes cost-minimizing.</p><p><strong>Conclusions: </strong>Although ES/MMAE is more efficacious for the prevention of surgical recurrence in patients requiring surgical evacuation of cSDH than ES alone, ES alone remains the cost-minimizing option. However, in select situations, as with a low RS rate and low cost for ES/MMAE or a high RS rate and high cost for ES alone, then ES/MMAE also becomes the cost-minimizing option. These thresholds can be used in combination with institutional costs and RS rates to help guide clinical and economic decision-making.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822183","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 impact of cerebrovascular steno-occlusive disease subtype on surgical and clinical outcomes after direct STA-MCA bypass surgery.","authors":"Danielle Golub, Joshua D McBriar, Shyle H Mehta, Harshal A Shah, Justin Turpin, Timothy G White, Eric T Quach, Andrew B Koo, Christian Ferreira, Alexander F Küffer, Thomas W Link, Athos Patsalides, David J Langer, Amir R Dehdashti","doi":"10.3171/2024.7.JNS24321","DOIUrl":"https://doi.org/10.3171/2024.7.JNS24321","url":null,"abstract":"<p><strong>Objective: </strong>Although well-established in moyamoya disease (MMD), the role of direct superficial temporal artery (STA) to middle cerebral artery (MCA) bypass in non-MMD (N-MMD) cerebrovascular steno-occlusive syndromes remains controversial. Nonetheless, the recurrent stroke risk in patients with N-MMD, despite best medical management, remains exceedingly high-especially for those suffering from hypoperfusion-related ischemia. The study objective was to determine the relative safety and efficacy profiles of direct STA-MCA bypass surgery for MMD and N-MMD patients in a large contemporary cohort.</p><p><strong>Methods: </strong>The authors conducted a retrospective review of all direct STA-MCA bypass cases performed between 2014 and 2023 at a high-volume center, which yielded 139 cases. Cases were excluded if they involved double-barrel bypass, an interposition graft, or if the surgical indication was not cerebral hypoperfusion. Direct bypass graft patency was serially assessed on follow-up vessel imaging.</p><p><strong>Results: </strong>Of the 139 included cases, 88 (63.3%) were MMD and 51 (36.7%) were N-MMD cases. The mean patient age was 49.2 years and 60.4% were female. The mean follow-up duration was 18.5 months. The perioperative stroke risk within 30 days of revascularization was 6.5% for the overall cohort, with no significant difference (p = 0.725) observed between MMD (5.7%) and N-MMD (7.8%) cases. The overall postoperative ipsilateral hemispheric and MCA distribution stroke rates at last follow-up were 11.5% and 9.4%, respectively. Despite a greater medical comorbidity burden, N-MMD cases demonstrated comparable rates of direct bypass graft occlusion (21.6% N-MMD vs 28.4% MMD, p = 0.426), MCA-distribution ischemic stroke (11.8% N-MMD vs 7.9% MMD, p = 0.549), and ipsilateral ischemic stroke (15.7% N-MMD vs 9.1% MMD, p = 0.276) to patients with MMD at last follow-up. Higher preoperative total hemispheric flow on noninvasive optimal vessel analysis (NOVA) imaging was the only variable associated with prolonged direct bypass graft patency (hazard ratio [HR] 0.39, p = 0.036). Postoperative stroke-free survival was improved by performing dural synangiosis (HR 0.31, p = 0.033) and, in multivariate analysis, was reduced with direct bypass graft occlusion (HR 4.58, p = 0.009) and a preoperative diffusion-weighted imaging-Alberta Stroke Program Early CT Score (DWI-ASPECTS) < 8 (HR 3.90, p = 0.024).</p><p><strong>Conclusions: </strong>This robust cohort of MMD and N-MMD STA-MCA bypass cases highlights the safety and efficacy of a technically sound direct bypass across all subtypes of cerebrovascular steno-occlusive disease. Careful attention to preoperative MRI parameters, including hemispheric flow rates on NOVA imaging, may improve surgical risk stratification. Further examination of the benefits of adjunctive indirect bypass or dural synangiosis, especially for patients with N-MMD, remains warranted.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789622","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":"Efficacy and safety of intraoperative MRI in glioma surgery: a systematic review and meta-analysis of prospective randomized controlled trials.","authors":"Johannes Wach, Martin Vychopen, Alim Emre Basaran, Agi Güresir, Clemens Seidel, Andreas Kühnapfel, Erdem Güresir","doi":"10.3171/2024.7.JNS241102","DOIUrl":"https://doi.org/10.3171/2024.7.JNS241102","url":null,"abstract":"<p><strong>Objective: </strong>Maximum extent of resection in glioma yields enhanced survival outcomes. The contemporary literature presents contradictory results regarding the benefit of intraoperative MRI (iMRI). This meta-analysis aimed to investigate the efficacy and safety of iMRI-guided surgery.</p><p><strong>Methods: </strong>The authors searched the PubMed, Embase, and Cochrane Reviews databases for eligible prospective randomized controlled trials through the end of February 2024. Endpoints were extent of resection, progression-free survival (PFS), overall survival, neurological functioning, and surgical complications. Individual patient data regarding PFS were reconstructed using the R package IPDfromKM.</p><p><strong>Results: </strong>From 1923 identified results, 3 randomized controlled trials with 384 patients met the inclusion criteria. Extended resections after iMRI were performed in 29.2% of the iMRI cases. Intraoperative MRI-guided glioma surgery (OR 5.40, 95% CI 3.25-8.98; p < 0.00001) outperformed conventional navigation-guided surgery in attaining gross-total resection (GTR). In patients in whom a GTR was achieved, the median time to progression was 16.0 months (95% CI 12.3-19.7 months), while the median PFS in patients with a subtotal resection was 9.7 months (95% CI 6.9-12.5 months) (p < 0.001). Despite increased GTR rates, postoperative neurological deterioration was equal among the iMRI and control groups (OR 1.0, 95% CI 0.6-1.7; p = 0.91, I2 = 0%). Intraoperative MRI use prolongs surgery by 42 minutes on average (95% CI 3.3-80.7 minutes; p = 0.03, I2 = 56%). The risk of postoperative intracranial hemorrhage (OR 1.9, 95% CI 0.2-16.9; p = 0.55, I2 = 0%) was not increased, while in one study significantly increased infections were observed in the iMRI arm.</p><p><strong>Conclusions: </strong>Intraoperative MRI outperforms conventional surgery in achieving complete glioma resections of all contrast-enhancing tumor portions, enhancing PFS without added risk. Intraoperative MRI is a tool that facilitates these aims without reducing safety in terms of neurological deficits and surgical complications.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789618","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":"A novel robot-assisted method for implanting intracortical sensorimotor devices for brain-computer interface studies: principles, surgical techniques, and challenges.","authors":"Naoki Ikegaya, Arka N Mallela, Peter C Warnke, Nicolas G Kunigk, Fang Liu, Hunter R Schone, Ceci Verbaarschot, Nicholas G Hatsopoulos, John E Downey, Michael L Boninger, Robert Gaunt, Jennifer L Collinger, Jorge A Gonzalez-Martinez","doi":"10.3171/2024.7.JNS241296","DOIUrl":"https://doi.org/10.3171/2024.7.JNS241296","url":null,"abstract":"<p><p>Precise anatomical implantation of a microelectrode array is fundamental for successful brain-computer interface (BCI) surgery, ensuring high-quality, robust signal communication between the brain and the computer interface. Robotic neurosurgery can contribute to this goal, but its application in BCI surgery has been underexplored. Here, the authors present a novel robot-assisted surgical technique to implant rigid intracortical microelectrode arrays for the BCI. Using this technique, the authors performed surgery in a 31-year-old male with tetraplegia due to a traumatic C4 spinal cord injury that occurred a decade earlier. Each of the arrays was embedded into the parenchyma with a single insertion without complication. Postoperative imaging verified that the devices were placed as intended. With the motor cortex arrays, the participant successfully accomplished 2D control of a virtual arm and hand, with a success rate of 20 of 20 attempts, and recording quality was maintained at 100 and 200 days postimplantation. Intracortical microstimulation of the somatosensory cortex arrays elicited sensations in the fingers and palm. A robotic neurosurgery technique was successfully translated into BCI device implantation as part of an early feasibility trial with the long-term goal of restoring upper-limb function. The technique was demonstrated to be accurate and subsequently contributed to high-quality signal communication.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789598","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":"Local control and patient survival after stereotactic radiosurgery for esophageal cancer brain metastases: an international multicenter analysis.","authors":"Othman Bin-Alamer, Hussam Abou-Al-Shaar, Raj Singh, Greg Bowden, David Mathieu, Haley K Perlow, Joshua D Palmer, Shahed Elhamdani, Matthew Shepard, Yun Liang, Ahmed M Nabeel, Wael A Reda, Sameh R Tawadros, Khaled Abdel Karim, Amr M N El-Shehaby, Reem Emad Eldin, Ahmed Hesham Elazzazi, Ronald E Warnick, Yair M Gozal, Megan Daly, Brendan McShane, Marcel Addis-Jackson, Gokul Karthikeyan, Sian Smith, Piero Picozzi, Andrea Franzini, Tehila Kaisman-Elbaz, Huai-Che Yang, Judith Hess, Kelsey Templeton, Zhishuo Wei, Stylianos Pikis, Georgios Mantziaris, Gabriela Simonova, Roman Liscak, Selcuk Peker, Yavuz Samanci, Veronica Chiang, Cheng-Chia Lee, Daniel M Trifiletti, Ajay Niranjan, L Dade Lunsford, Jason P Sheehan","doi":"10.3171/2024.7.JNS24920","DOIUrl":"https://doi.org/10.3171/2024.7.JNS24920","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate local control (LC) of tumors, patient overall survival (OS), and the safety of stereotactic radiosurgery (SRS) for esophageal cancer brain metastases (EBMs).</p><p><strong>Methods: </strong>This retrospective cohort study used data from 15 International Radiosurgery Research Foundation facilities encompassing 67 patients with 185 EBMs managed using SRS between January 2000 and May 2022. The median patient age was 63 years, with a male predominance (92.5%). Most patients (64.2%) had a single brain metastasis, while 7.5% had more than 5 metastases. The median tumor volume was 0.9 cm3, and the median margin dose delivered to the tumor was 20 Gy.</p><p><strong>Results: </strong>The median OS post-SRS was 15.2 months, with 1- and 2-year OS rates of 65.7% and 32.3%, respectively. A significant inverse correlation was found between the number of EBMs and OS in the univariable analysis. LC rates at 1 and 2 years were 89% and 76%, respectively. Adverse radiation effects (AREs) were observed in 17.9% of patients, with 13.4% being mild and transient and 4.5% severely symptomatic (Common Terminology Criteria for Adverse Events grade 3). New intracranial disease developed in 58.2% of patients, with 1- and 2-year rates of 58% and 73%, respectively.</p><p><strong>Conclusions: </strong>SRS for EBMs demonstrated high survival rates and effective tumor control, with a low incidence of severe AREs. These findings highlight the potential role of SRS in the multidisciplinary multimodality management paradigm of EBM.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789621","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":"Identification of the optimal thresholds for the hypoperfusion intensity ratio in moyamoya disease.","authors":"Liuxian Wang, Dongshan Han, Ming Liao, Jing Zha, Lei Li, Huagang Fan, Wenfeng Wei, Xiaoqian Ji, Anming Xie","doi":"10.3171/2024.9.JNS241300","DOIUrl":"https://doi.org/10.3171/2024.9.JNS241300","url":null,"abstract":"<p><strong>Objective: </strong>The authors' objective was to retrospectively compare two methods for defining the hypoperfusion intensity ratio (HIR) in moyamoya disease (MMD) by using hypoperfused volumes calculated from time to maximum of the residue function (Tmax) thresholds of 10 seconds/4 seconds and 10 seconds/6 seconds.</p><p><strong>Methods: </strong>All hemispheres were categorized into normal, ischemic, and hemorrhagic groups. Hypoperfused volumes were calculated using Tmax thresholds of 10 seconds, 6 seconds, and 4 seconds. HIR was computed as Tmax > 10 seconds/Tmax > 4 seconds (HIR10/4) and Tmax > 10 seconds/Tmax > 6 seconds (HIR10/6). Angiographic collaterals were assessed using CT perfusion (CTP)-sourced images (CTP-sis). The 3-month clinical follow-up included primary outcomes (survival or death) and secondary outcomes (modified Rankin Scale [mRS] and Katz activities of daily living [ADL] scale scores). Multivariate logistic regression and correlation analyses were conducted.</p><p><strong>Results: </strong>Thirty patients (54 hemispheres) were included. Patients with poor primary outcomes exhibited higher rates of hypertension (p = 0.015), larger hypoperfused volumes, and elevated HIR10/4 and HIR10/6 (p < 0.001). The regression model with HIR10/4 outperformed that with HIR10/6 for predicting primary outcomes (Z = 2.02, p = 0.044). Both HIR10/4 and HIR10/6 correlated with mRS and ADL scores (p < 0.05). Although there was no correlation between HIR and CTP-sis when all hemispheres were included, a significant association was found between HIR10/4 and CTP-sis when hemispheres with hemorrhagic lesions were excluded (p = 0.013).</p><p><strong>Conclusions: </strong>HIR10/4 exhibited a superior predictive value for primary outcomes in MMD compared to HIR10/6. Additionally, HIR10/4 showed a significant association with angiographic collaterals, particularly in ischemic MMD cases. This study suggested that HIR defined as Tmax > 10 seconds/Tmax > 4 seconds may be more suitable than Tmax > 10 seconds/Tmax > 6 seconds in MMD.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789619","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. Mapping and monitoring: considerations on optimizing neurophysiological monitoring parameters.","authors":"Giuseppe Maria Della Pepa, Michele Di Domenico, Salvatore Marino","doi":"10.3171/2024.8.JNS242032","DOIUrl":"https://doi.org/10.3171/2024.8.JNS242032","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789620","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}