Neurosurgical focus最新文献

{"title":"Accuracy of cervical pedicle screw placement with a robotic guidance system via the open midline approach.","authors":"Yuki Yamamoto, Takashi Fujishiro, Fumiya Adachi, Hiromichi Hirai, Sachio Hayama, Yoshiharu Nakaya, Yoshitada Usami, Masashi Neo, Shuhei Otsuki","doi":"10.3171/2024.9.FOCUS24431","DOIUrl":"10.3171/2024.9.FOCUS24431","url":null,"abstract":"<p><strong>Objective: </strong>An increasing number of studies have shown that a robotic guidance system (RGS) can provide accurate cervical pedicle screw (CPS) placement. The accuracy of CPS placement with an RGS has mostly been evaluated according to the magnitude of pedicular cortical violation. However, an RGS assists in pedicle screw (PS) placement by directly indicating the preplanned trajectory in the operative field. Therefore, investigating how accurately the planned trajectory is executed is essential to determine the accuracy of CPS placement using an RGS, in addition to evaluating the clinical accuracy. Hence, this study aimed to evaluate the accuracy of CPS placement using an RGS by comparing the executed trajectory with the planned trajectory.</p><p><strong>Methods: </strong>This prospective study analyzed 174 CPSs placed between C2 and C6 in 39 consecutive patients who underwent cervical fusion surgery using an RGS. The deviation of the executed CPS trajectory from the planned trajectory was measured at the entry point and at a depth of 20 mm in both the axial and sagittal planes on CT images. Additionally, its direction was noted (lateral or medial in the axial plane and cephalad or caudal in the sagittal plane). These measurements were analyzed according to spinal levels (C2 and C3-C6), laterality (right and left sides), and registration material (preoperative and intraoperative CT images). Furthermore, clinical accuracy was assessed using the Neo classification (grades 0-3).</p><p><strong>Results: </strong>Overall, the mean (± SD) deviations from the planned trajectory at the entry point and at a depth of 20 mm were 0.79 ± 0.65 mm and 0.86 ± 0.69 mm in the axial plane and 0.88 ± 0.81 mm and 0.82 ± 0.79 mm in the sagittal plane, respectively. When separately examining the deviations according to spinal level, laterality, and registration material, the mean deviations were < 1 mm at any point. Analysis of the deviation direction showed that the CPSs were placed divergently from the planned trajectory in the axial plane. In the sagittal plane, the CPSs were likely to be inserted parallel to the planned trajectory. However, at C2 the CPSs were placed in the caudal direction relative to the planned trajectory. Regarding clinical accuracy, the acceptable rates (grades 0 and 1) were 97.7% and 97.1% in the axial and sagittal planes, respectively, without any CPS-related complications.</p><p><strong>Conclusions: </strong>This study suggests that an RGS can reliably execute planned trajectories, aiding accurate CPS placement in clinical settings.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 6","pages":"E13"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770745","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":"Comparison between robot-assisted and navigation-guided minimally invasive transforaminal lumbar interbody fusion: a multicenter study.","authors":"Dennis Chen Heath, Hsuan-Kan Chang, Chih-Chang Chang, Hao-Chien Yang, Tsung-Hsi Tu, Bing-Hung Hsu, Ming-Chin Lin, Jau-Ching Wu, Chien-Min Lin, Wen-Cheng Huang, Heng-Wei Liu","doi":"10.3171/2024.9.FOCUS24521","DOIUrl":"10.3171/2024.9.FOCUS24521","url":null,"abstract":"<p><strong>Objective: </strong>Both robot and computer navigation have significantly improved the accuracy and safety of percutaneous pedicle screw placement compared with a freehand fluoroscopy-guided technique. However, how the two new technologies compare with each other is unknown. The aim of this study was to investigate the accuracy and safety of robot-assisted and navigation-guided percutaneous pedicle screw placement in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).</p><p><strong>Methods: </strong>A multicenter, retrospective study was conducted with patients who underwent 1- to 3-level MIS-TLIF from 2019 to 2022. The surgical indication was symptomatic spinal stenosis and spondylolisthesis that failed conservative management. Screw accuracy and safety were compared between robot and computer navigation systems by obtaining postoperative CT images in all patients. The screw accuracy was determined by the Gertzbein and Robbins classification.</p><p><strong>Results: </strong>A total of 100 patients were divided into robot-assisted (RA; n = 42) and O-arm navigation (ON; n = 58) groups, with 514 percutaneous pedicle screws placed. Clinically satisfactory accuracy was achieved in 100% of the RA group and 92.1% of the ON group (p < 0.001). There were no medial breaches or revision surgeries for screw malposition in either group. The RA group showed similar overall operation time to the ON group (263.54 ± 114.33 vs 243.4 ± 68.96 minutes, p = 0.2821). Subgroup analyses showed that there was no difference in 1-level MIS-TLIF, but the RA group had significantly more operative time for 2-level MIS-TLIF than the ON group (324.67 ± 101.25 vs 266.4 ± 66.38 minutes, p = 0.0264).</p><p><strong>Conclusions: </strong>Screw accuracy was significantly better in the RA group, with slightly more operation time, compared with the navigation group. Neither group required revision surgery or reoperation for screw malposition.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 6","pages":"E12"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770747","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":"Robotic carotid artery stenting: a multicenter, propensity score-matched analysis of clinical outcomes and cost-effectiveness.","authors":"Shray A Patel, Joanna M Roy, Basel Musmar, Advith Sarikonda, Kyle Scott, Rawad Abbas, Antony A Fuleihan, Ahilan Sivaganesan, Stavropoula I Tjoumakaris, M Reid Gooch, Robert Rosenwasser, Visish M Srinivasan, Jan-Karl Burkhardt, Pascal M Jabbour","doi":"10.3171/2024.9.FOCUS24479","DOIUrl":"10.3171/2024.9.FOCUS24479","url":null,"abstract":"<p><strong>Objective: </strong>Preclinical studies suggest that robotic carotid artery stenting (CAS) could be superior to manual CAS. However, very limited comparative data exist for patients who have undergone robotic versus manual CAS. In addition, no data exist comparing the costs of manual and robotic CAS.</p><p><strong>Methods: </strong>All robotic CAS cases at two academic neurosurgery centers were retrospectively reviewed and 1:1 propensity matched with manual CAS cases. Personnel costs, supply costs, and total procedure costs were collected in collaboration with hospital administration by using time-driven activity-based cost analysis.</p><p><strong>Results: </strong>A total of 24 robotic CAS operations were performed between 2019 and 2023. Comorbidities and baseline procedural characteristics were well matched between robotic and manual cases. Unplanned manual conversion was observed in only 1 robotic case (4.2%). Robotic CAS complications and outcomes were comparable to manual. Robotic CAS was associated with a significantly increased fluoroscopy time (29.0 vs 19.2 minutes; p < 0.001). Robotic procedure time (88.9 ± 18.2 minutes) was significantly (p = 0.003) longer than manual time (68.72 ± 22.4 minutes). Health personnel costs ($1589.71 ± $176.92 vs $1375.99 ± $233.39, p = 0.005); supply costs ($3918.25 ± $421.20 vs $2152.74 ± $1030.26, p < 0.001); and total procedure costs ($5306.11 ± $608.95 vs $3437.56 ± $1165.67, p < 0.001) were greater for robotic CAS.</p><p><strong>Conclusions: </strong>In the first multicenter study and largest sample to date, the authors show that robotic CAS, with a low rate of procedural failure and postoperative complications, is safe and feasible. In addition, robotic CAS achieves comparable clinical outcomes to manual CAS. Robotic CAS was associated with increased fluoroscopy time, but fluoroscopy time decreased as operators gained familiarity with the CorPath GRX system. Robotic CAS was associated with a greater procedural cost, which was driven by greater personnel and supply costs. Robotic CAS failed to show superiority to manual CAS. These findings set a foundation for randomized controlled trials of robotic CAS, and also highlight the need for further studies to optimize robotic CAS and reduce its associated costs.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 6","pages":"E10"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770779","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 cost of admission for robot-assisted pedicle screw placement.","authors":"Patrick Kramer, Kelly Jiang, Carly Weber-Levine, Ritvik Jillala, Maria Rain Jennings, Antony A Fuleihan, Andrew M Hersh, Meghana Bhimreddy, Arjun K Menta, A Daniel Davidar, Daniel Lubelski, Nicholas Theodore","doi":"10.3171/2024.9.FOCUS24531","DOIUrl":"10.3171/2024.9.FOCUS24531","url":null,"abstract":"<p><strong>Objective: </strong>The authors investigated the predictors of cost of admission (CoA) for robot-assisted pedicle screw placement to assess the value of robotic systems in spine operations.</p><p><strong>Methods: </strong>Demographic, operative, and postoperative variables were retrospectively collected from 506 patients undergoing robot-assisted spine surgery utilizing the ExcelsiusGPS robot at two high-volume tertiary care centers from 2017 to 2023. Perioperative parameters were evaluated against total hospital admission cost utilizing the Kruskal-Wallis and Wilcoxon rank-sum tests followed by multivariable linear regression.</p><p><strong>Results: </strong>The majority of patients were female (53.6%), 50-80 years of age (77.7%), and White (73.9%); had at least 1 comorbidity (58.1%); and presented with an average functional preoperative Frankel grade (57.5%). The mean CoA was $69,458 ± $47,910. On univariable analysis, demographic data including sex, age, race, and Frankel grade were not associated with CoA. The presence of a comorbidity, however, was associated with increased CoA (p < 0.001). Intraoperatively, one-third of the operations (31.8%) were revisions from prior operations and were subsequently associated with increased CoA (p = 0.021). Thoracic-level operations constituted roughly one-quarter of the cohort (24.1%) and were also associated with increased CoA (p < 0.001). Intraoperative durotomies occurred in 7.7% of patients, leading to increased CoA (p = 0.003). Extended surgical durations also demonstrated elevated CoA (p < 0.001). Postoperatively, the median length of stay (LOS) was 3 days, and an LOS of greater than 3 days was one of the primary drivers of cost (p < 0.001). Postoperative complications occurred in just 6.3% of the cohort but were also associated with increased CoA (p < 0.001). On multivariable analysis, LOS, number of screws placed, operative duration, and postoperative complications were the primary predictors of increased CoA.</p><p><strong>Conclusions: </strong>Understanding the drivers of cost in robot-assisted pedicle screw placement is crucial to elucidate the value associated with the use of robotic systems in spine surgery. These results indicate that patient and surgical complexity influence cost and that robotic systems may augment management in spine surgery. Further investigation is warranted to determine the long-term benefits and cost-effectiveness of new technologies compared with traditional techniques in spine surgery.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 6","pages":"E15"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770777","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":"Neuro-oncology application of next-generation, optically tracked robotic stereotaxis with intraoperative computed tomography: a pilot experience.","authors":"Carlin Chuck, Rohaid Ali, Christine K Lee, Athar N Malik, Konstantina A Svokos, Deus Cielo, Curtis E Doberstein, Harry J Rosenberg, Jerrold L Boxerman, Joseph Rajasekaran, Wael F Asaad, Ziya Gokaslan, Prakash Sampath, Clark C Chen","doi":"10.3171/2024.9.FOCUS24532","DOIUrl":"10.3171/2024.9.FOCUS24532","url":null,"abstract":"<p><strong>Objective: </strong>Innovations in robotics continue to reshape the landscape of neurosurgery. Here, the authors evaluated the safety and efficacy of the ExcelsiusGPS robot in the treatment of neuro-oncological, intracranial lesions.</p><p><strong>Methods: </strong>The authors conducted a retrospective analysis of 19 consecutive adult patients with a neuro-oncological diagnosis who underwent intracranial biopsy and/or laser interstitial thermal therapy (LITT) with the assistance of the ExcelsiusGPS robot and intraoperative CT. Demographic and clinical data were collected from the electronic medical record and the robot software.</p><p><strong>Results: </strong>All 19 patients harbored lesions that were deep seated, involving the eloquent cortex, or subcentimeter. Definitive tissue diagnosis was achieved in all cases involving stereotactic biopsy (n = 16), with glioblastoma as the most common diagnosis. The mean ± SD time for setting up the robotic stereotaxis system was 57.4 ± 10.7 minutes. The mean procedural time after that was 71.6 ± 41.0 minutes for stereotactic needle biopsy and 188.4 ± 61.2 minutes for procedures involving LITT. The mean radial errors of the actual trajectory relative to the planned trajectory at the entry and target points were 0.625 ± 0.443 mm and 0.745 ± 0.472 mm, respectively. There were no procedural complications or new postoperative deficits, although routine postoperative CT showed new hyperdensity at the target site in 3/19 patients (15.7%). All patients who underwent elective procedures were discharged by postoperative day 3 (mean 1.38 ± 0.619 days). There were two 30-day readmissions (pulmonary embolus and general weakness), and neither was attributable to the surgical procedure.</p><p><strong>Conclusions: </strong>The authors' pilot experience with the ExcelsiusGPS robot in neuro-oncology procedures indicates a favorable efficacy and safety profile.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 6","pages":"E4"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770776","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 propensity score-matched cost-effectiveness analysis of magnetic resonance-guided laser interstitial thermal therapy versus craniotomy for brain tumor radiation necrosis.","authors":"Jia-Shu Chen, Alexander F Haddad, Jason E Chung, Oliver Y Tang, Winson S Ho, Shawn L Hervey-Jumper, Manish K Aghi","doi":"10.3171/2024.8.FOCUS24417","DOIUrl":"10.3171/2024.8.FOCUS24417","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Radiation necrosis is becoming an increasingly prevalent complication in patients with brain tumors given the growing utility of stereotactic radiosurgery in modern treatment paradigms. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a new minimally invasive modality that has exhibited an efficacy comparable to craniotomy in treating radiation necrosis. No studies to date have compared their cost-effectiveness despite the significant additional expenses associated with MRgLITT use. This study aimed to evaluate the cost-effectiveness of MRgLITT versus craniotomy in patients with comparable presentations of radiation necrosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The National Inpatient Sample (NIS) was queried from 2011 to 2020 for patients with radiation necrosis and treated using craniotomy or MRgLITT. Admission charges and costs were inflation adjusted to 2020 $US. Surgical cohorts were propensity score-matched according to demographic, clinical, and admission characteristics. Multivariable linear and logistic regression analyses identified associations between type of intervention and outcomes. A semi-Markov model was created to simulate treatment with craniotomy versus MRgLITT. Cost, transition probabilities, and health state utilities were derived from the NIS, individual patient outcomes from multiple institutions, and prospectively collected quality-of-life data from a single institution and verified against other studies. Monte Carlo simulation and probabilistic sensitivity analysis were used to evaluate the cost-effectiveness between the two modalities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the designated study period, 2869 patients had been admitted with brain tumor radiation necrosis and were managed with neurosurgical intervention. After propensity score matching, MRgLITT, relative to craniotomy, was independently associated with a shorter length of stay (LOS; β = -1.81, p = 0.002), lower odds of complications (OR 0.18, p = 0.033), and higher odds of home discharge (OR 3.05, p = 0.041), but there was no difference in total admission costs between the two modalities (β = $6229, p = 0.081). On Monte Carlo simulation, patients treated with MRgLITT had a lower probability of disease (radiation necrosis or tumor) recurrence (13.5% vs 22.0%, p &lt; 0.001) but an equivalent mortality risk (22.8% vs 22.3%, p = 0.429) compared to the patients treated with craniotomy at the 1-year follow-up. Over a 4-year time horizon, MRgLITT had an incremental cost of -$25,685 and incremental effectiveness of 0.14 quality-adjusted life-year (QALY), resulting in an incremental cost-effectiveness ratio of -$183,464 per QALY relative to craniotomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;MRgLITT was a more cost-effective treatment strategy than craniotomy in the management of patients with brain tumor radiation necrosis. The cost-effectiveness of MRgLITT may be attributed to a shorter LOS, lower complication odds, and hig","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 5","pages":"E2"},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a murine laser interstitial thermotherapy system.","authors":"Matthew Frain, Nagheme Thomas, Sandra C Yan, Aida Karachi, Farhad Dastmalchi, Ghaidaa Ebrahim, Didier Rajon, Richard Tyc, Catherine Flores, Anjali Chauhan, Elias Sayour, Duane A Mitchell, Frank J Bova, Maryam Rahman","doi":"10.3171/2024.8.FOCUS24452","DOIUrl":"10.3171/2024.8.FOCUS24452","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to develop a murine system for the delivery of laser interstitial thermotherapy (LITT) with probe-based thermometry as a model for human glioblastoma treatment to investigate thermal diffusion in heterogeneous brain tissue.</p><p><strong>Methods: </strong>First, the tissue heating properties were characterized using a diode-pumped solid-state near-infrared laser in a homogeneous tissue model. The laser was adapted for use with a repurposed stereotactic surgery frame utilizing a micro laser probe and Hamilton syringe. The authors designed and manufactured a stereotactic frame attachment to work as a temperature probe stabilizer. Application of this novel design was used as a precise method for real-time thermometry at known distances from the thermal ablative center mass during murine LITT studies.</p><p><strong>Results: </strong>Temperature measurements were achieved during LITT that verified the direct thermometry capability of the system without the need for MR-based thermal monitoring. Application of multiple stereotactic design iterations led to an accurately reproducible surgical laser ablation procedure. Histological staining confirmed precise thermal ablation and controllable lesion size based on time and temperature control. Treatment of a syngeneic intracranial glioma model highly resistant to conventional therapy resulted in a modest survival benefit.</p><p><strong>Conclusions: </strong>The authors have successfully developed a murine model system of LITT with direct in situ thermometry for investigation into the effects of thermal ablation and combinatorial treatments in murine brain tumor models.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 5","pages":"E10"},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562490","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":"Indication-based analysis of laser interstitial thermal therapy: a propensity score-matched comparison of outcomes for brain tumor versus epilepsy indications.","authors":"Andrew M Miller, Shane Shahrestani, Michelot Michel, John S Yu, Adam Mamelak","doi":"10.3171/2024.8.FOCUS24441","DOIUrl":"10.3171/2024.8.FOCUS24441","url":null,"abstract":"<p><strong>Objective: </strong>Laser interstitial thermal therapy (LITT) is a minimally invasive procedure used to ablate abnormal tissue in a targeted fashion. It is most commonly used to treat epileptic foci, brain tumors, and radiation necrosis. This study aimed to compare immediate postoperative outcomes between these indications.</p><p><strong>Methods: </strong>This study analyzed clinical data from the Nationwide Readmissions Database (NRD) from 2016 to 2019 and identified 2234 patients who underwent LITT procedures using ICD-10 codes. The authors analyzed patient demographics, complications, discharge disposition, readmission rates, and mortality. Following propensity score matching, 317 patients treated for epilepsy and 323 patients treated for brain tumors were compared.</p><p><strong>Results: </strong>The mean ages were similar (epilepsy: 45.7 vs tumor: 49.0 years, p = 0.55), as were the proportions of female patients (epilepsy: 45.4% vs tumor: 52.9%, p = 0.83), all-payer costs (p = 0.81), income quartiles (p = 0.58), insurance types (p = 0.70), frailty rates (p = 0.85), and comorbid disease burdens as assessed by ECI score (p = 0.73). No significant differences were observed in rates of hemorrhage (p = 0.1), pulmonary embolism (p = 0.32), or infection (p = 0.16). However, the tumor cohort had higher rates of deep vein thrombosis (3.4% vs < 3.15%, p = 0.045), nonroutine discharge (26.6% vs 16.4%, p = 0.04), and 1-year hospital readmission (32.5% vs 18.6%, p = 0.006). One-year mortality rates were similar (tumor: 3.4% vs epilepsy: < 3.15%, p = 0.08).</p><p><strong>Conclusions: </strong>While postoperative complications and 1-year mortality rates were similar among patients undergoing LITT for epilepsy and brain tumors, the tumor cohort experienced higher rates of deep vein thrombosis, nonroutine discharge, and 1-year hospital readmission.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 5","pages":"E8"},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562496","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":"An analysis of functional outcomes following laser interstitial thermal therapy for recurrent high-grade glioma.","authors":"Bradley Wilhelmy, Riccardo Serra, Chixiang Chen, Mark Mishra, Dario Rodrigues, Neeraj Badjatia, Melissa Motta, Alexander Ksendzovsky, Graeme F Woodworth","doi":"10.3171/2024.8.FOCUS24460","DOIUrl":"10.3171/2024.8.FOCUS24460","url":null,"abstract":"<p><strong>Objective: </strong>Laser interstitial thermal therapy (LITT) is an emerging tool for treating a variety of focal brain lesions, including recurrent high-grade glioma (HGG). While the efficacy and uses of LITT have been well studied, the impact of this treatment on patient functional outcomes has not been analyzed in detail. This study sought to better define the role of LITT in treating patients with recurrent HGG, examining which patients exhibit good functional outcomes after LITT, and to determine risk factors for worsening neurological function.</p><p><strong>Methods: </strong>The medical records of patients treated with LITT for recurrent HGG at a single tertiary care center were retrospectively reviewed. Functional status was assessed using the Karnofsky Performance Scale (KPS). Demographic, clinical, and radiological data were examined for associations with change in KPS score assessed 4-6 weeks following surgery.</p><p><strong>Results: </strong>Forty-seven patients were included in the study with histopathologically confirmed recurrent HGG. The mean age was 57 years, and 21 (45%) patients were female. The pre-LITT KPS scores were as follows: 100 in 4 (9%) patients, 90 in 15 (32%) patients, 80 in 10 (21%) patients, 70 in 13 (28%) patients, and 60 in 5 (11%) patients. Overall, 59% of patients showed a stable or improved KPS score after undergoing LITT. Tumor volume was the sole predictor of decreased KPS score after LITT. Notably, tumor location including eloquent location, preoperative KPS score, and other comorbidities were not independently associated with change in functional status.</p><p><strong>Conclusions: </strong>The majority of patients undergoing LITT for recurrent HGG had a favorable functional outcome at the initial follow-up visit. The treated tumor volume was inversely and independently associated with post-LITT functional outcome. This information may help guide patient selection and treatment optimization in the setting of LITT-based approaches for recurrent HGG.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 5","pages":"E4"},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562486","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":"Introduction. Calibrating the utility of laser interstitial thermal therapy in neurosurgery: a once-novel surgical treatment finds it place in the armamentarium.","authors":"Robert J Bollo, Winson S Ho, Ido Strauss, Sherise D Ferguson, Sarah T Menacho","doi":"10.3171/2024.9.FOCUS23741","DOIUrl":"https://doi.org/10.3171/2024.9.FOCUS23741","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"57 5","pages":"E1"},"PeriodicalIF":3.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562500","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}