Neurosurgery practice最新文献

{"title":"Fluorescence-Guided Surgery Using 5-Aminolevulinic Acid/Protoporphyrin IX in Brain Metastases.","authors":"Anthony Price, Joshua D Bernstock, Nina Truong, Kyle Wu, John Y K Lee, Isaac J Tucker, Florian Gessler, Salvatore DeSena, Gregory Friedman, Pablo A Valdes","doi":"10.1227/neuprac.0000000000000121","DOIUrl":"10.1227/neuprac.0000000000000121","url":null,"abstract":"<p><strong>Background and objectives: </strong>The purpose of this systematic review was to provide a comprehensive overview of the available literature on 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PpIX) fluorescence-guided surgery (FGS) for the resection of brain metastases (BMs).</p><p><strong>Methods: </strong>A comprehensive search of the PubMed database for literature on 5-ALA use in BMs surgery was performed. For inclusion, BMs studies had to have data on the observed intraoperative fluorescence available. Additional data categories included the number of metastatic tumors, 5-ALA dosage and timing, the imaging system (eg, microscope) used, imaging wavelength(s), fluorescence grading (\"simple\" and \"detailed\"), fluorescence consistency (heterogeneous vs homogeneous), intracranial tumor location, metastatic primary tumor location, and extent of resection, among others.</p><p><strong>Results: </strong>Twenty-three articles published between 2007 and 2022 met the inclusion criteria. These studies comprised 1709 total patients; 870 metastatic samples were collected from 855 patients with 377 (43.3%) fluorescence-negative and 493 (56.7%) fluorescence-positive samples. The pooled overall prevalence of fluorescence-positive metastatic lesions was 66% (95% CI 55%-75%; I² = 85%, <i>P</i> < .01). The fluorescence grading was as follows: (a) simple fluorescence (n = 599): 295 (49.3%) fluorescence-negative and 304 (50.8%) fluorescence-positive samples and (b) detailed fluorescence (n = 271): 82 (30.3%) no fluorescence, 107 (39.5%) weak fluorescence, and 82 (30.3%) strong fluorescence. A total of 764 lesions had primary tumor site data available: 702 lesions had fluorescence data with 384 (54.7%) fluorescence-positive samples.</p><p><strong>Conclusion: </strong>FGS using 5-ALA/PpIX in BMs demonstrates varying benefits as an adjunct for maximizing the extent of resection. Thus, preoperative knowledge of the primary tumors' origin may inform surgeons regarding the potential utility of 5-ALA/PpIX for FGS management of BMs.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 4","pages":"e00121"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage in a Tertiary Hospital in Ghana: A Retrospective Analysis.","authors":"Bernice Limann, Kwadwo Darko, Emmanuel Kwadwo Adjei Osei, Nina Dwumfour-Poku, Michael Farid, Samuel Benjamin Nkansah, Abdallah Tikuma Faisal, Kwasi Kyei Ofei, Joseph Danwura Tanlongo, Mina Guirguis, Pearl Ohenewaa Tenkorang, Umaru Barrie, Adams Fuseini, Teddy Totimeh","doi":"10.1227/neuprac.0000000000000120","DOIUrl":"10.1227/neuprac.0000000000000120","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spontaneous intracerebral hemorrhage (sICH) carries a high mortality and morbidity burden, with multiple factors influencing outcomes. The aim of this study was to identify the predictors of in-hospital outcomes for patients with sICH at a tertiary hospital in Ghana.</p><p><strong>Methods: </strong>In this retrospective study, approved by the Institutional Review Board, adult patients with sICH at the University of Ghana Medical Centre between 2021 and 2023 were reviewed to characterize the association between sociodemographics, clinical features, and management strategies to in-hospital outcomes. Based on in-hospital outcomes, patients were categorized into \"mortality\" and \"survival\" groups. Statistical analyses were performed using Wilcoxon rank sum, χ², and logistic and Cox regression to identify predictors of mortality and time to mortality.</p><p><strong>Results: </strong>Among the 168 patients, 71 (42.3%) died, with a male predominance in both groups (60.6% and 70.1%, respectively). Altered level of consciousness was more common in mortality cases (70.4% vs 45.4%, <i>P</i> = .002). The average Glasgow Coma Scale (GCS) score at presentation was lower in the mortality group (8.19 vs 12.5, <i>P</i> < .001). Patients who died had a higher initial systolic blood pressure (SBP) (179 vs 163 mm Hg, <i>P</i> = .004). Imaging showed a mean hematoma volume of (35.2 mL vs 22.7 mL, <i>P</i> = .112). Intraventricular extension was present in (69.7% vs 50.5%, <i>P</i> = .024). Predictors of in-hospital mortality were intraventricular extension (odds ratio: 2.18, 95% CI: 1.13-4.19, <i>P</i> = .019), management complications (OR: 10.76, 95% CI: 3.99-29.06, <i>P</i> < .001), and increasing mean SBP (OR: 1.02, 95% CI: 1.00-1.03, <i>P</i> = .023). Independent predictors of earlier time to mortality were a drop in GCS (hazard ratio: 3.28, 95% CI: 1.86-5.80, <i>P</i> < .001) and increasing ICH score (hazard ratio: 1.51, 95% CI: 1.24-1.85, <i>P</i> < .001).</p><p><strong>Conclusion: </strong>Predictors of in-hospital mortality included intraventricular extension, management complications, changes in GCS, and increasing SBP. Identifying and mitigating these factors, along with implementing rapid intervention protocols, are essential for improving outcomes in patients with sICH.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 4","pages":"e00120"},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual Approach for Basilar Artery Fenestration Aneurysm With Insights From Computational Fluid Dynamics.","authors":"Rafael T Tatit, Vincenzo T R Loly, Rabih G Tawk, Johnny S Sandhu, Lucas O C Guida, Jorge Rios-Zermeno, João S B Lima, Carlos E Baccin","doi":"10.1227/neuprac.0000000000000122","DOIUrl":"10.1227/neuprac.0000000000000122","url":null,"abstract":"<p><strong>Background and importance: </strong>Basilar artery fenestration aneurysms (BAFAs) present significant clinical challenges because of their high rupture risk and complex anatomy. Comprehensive management strategies are required, including thorough vascular assessment and post-treatment surveillance. Integration of complementary analyses such as computational fluid dynamics (CFD) holds promise in facilitating preoperative planning for these intricate lesions.</p><p><strong>Clinical presentation: </strong>A 60-year-old female was diagnosed with a BAFA during evaluation for headaches. Digital subtraction angiography revealed the aneurysm projecting posteriorly with a neck predominantly based on the right limb of the fenestration. After initial treatment with a pipeline embolization device, the aneurysm remained patent, requiring further treatment. A secondary approach with stent-assisted loose-packing coil embolization was then performed, resulting in complete occlusion of the aneurysm. Analysis of pretreatment 3-dimensional rotational angiogram images with CFD provided critical hemodynamic insights. It identified that 38.89% of the aneurysm area was exposed to low wall shear stress (WSS) and 11.5% was exposed to high WSS, indicating a high rupture risk profile with significant areas of both low and high WSS. In addition, low WSS was observed in regions corresponding to daughter sacs, suggesting a higher rupture risk. Streamline analysis indicated increased inflow through the right vertebral artery and the right limb of the fenestration, supporting the initial angiographic impression and guiding the choice of therapeutic strategy.</p><p><strong>Conclusion: </strong>This is the first study to analyze the morphology and pretreatment hemodynamics of a BAFA using CFD, illustrating the potential for future development of individualized therapeutic approach-based CFD in complex aneurysms.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 4","pages":"e00122"},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Management of Progressive Radiosurgery-Treated Brain Metastasis With Resection Followed by Pathology-Informed Management: A Retrospective Study.","authors":"Rohini K Bhatia, Jessica George, Catherine Siu, Emerson Lee, Kristin J Redmond, Brock Baker, Christopher M Jackson, Chetan Bettegowda, Debraj Mukherjee, Robert F Hobbs, Jon Weingart, Michael Lim, Lawrence Kleinberg","doi":"10.1227/neuprac.0000000000000117","DOIUrl":"10.1227/neuprac.0000000000000117","url":null,"abstract":"<p><strong>Background and objectives: </strong>In patients treated with stereotactic radiosurgery (SRS) for brain metastases, follow-up imaging demonstrating progression may result from treatment effect/radionecrosis (RN) or tumor progression. We report long-term outcomes for a cohort of patients who demonstrated radiological progression on serial imaging after initial radiation and who underwent resection, at which point histology informed further management.</p><p><strong>Methods: </strong>A retrospective chart review identified 76 patients with an associated 82 brain lesions between 2009 and 2022, that were initially treated with SRS, and then demonstrated suspicious imaging developing through at least 2 scan time points with either pathologic confirmation of tumor or RN.</p><p><strong>Results: </strong>Of the 82 lesions, 55 lesions (67.1%) were found to be tumor and were treated with repeat radiation and 27 (32.9%) were found to have pathologically confirmed RN and conservatively managed. 14/27 lesions ultimately found to be radionecrotic required steroids preoperatively due to neurological symptoms. None of these lesions required further intervention with median postsurgery follow-up of 24.4 months (range 1-104 months). There were 55 instances (in 51 patients) of confirmed recurrent/progressive tumor who we treated with repeat aggressive radiation with either Cs-131 brachytherapy (12 [21.8%]) or SRS (43 [78.2%]). Among patients treated with reirradiation, the median follow-up to local failure was 15.2 months (95% CI 7.3-26.6 months). The 2-year local control rate was 79.5% (95% CI 68.3%-92.5%).</p><p><strong>Conclusion: </strong>These results support resection of radiosurgery-treated lesions with progression continuing through serial imaging, and this pathology-informed management results in excellent control of both RN and tumor progression after radiosurgery.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 4","pages":"e00117"},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Embolization Through Grafts for Recurrent Giant Complex Internal Carotid Artery Aneurysms After Combined Microsurgical Low-Flow With Subsequent High-Flow Revascularization and Parent Artery Occlusion.","authors":"Chingiz Nurimanov, Karashash Menlibayeva, Iroda Mammadinova, Nurtay Nurakay, Yerbol Makhambetov","doi":"10.1227/neuprac.0000000000000119","DOIUrl":"10.1227/neuprac.0000000000000119","url":null,"abstract":"<p><strong>Background and importance: </strong>The case describes the management of a giant and recurrent aneurysm in a patient. The treatment involved a combination of microsurgical protective low-flow, followed by high-flow revascularization and parent artery occlusion.</p><p><strong>Clinical presentation: </strong>The patient presented with severe headaches and progressive visual impairment. Brain magnetic resonance imaging revealed a giant saccular intracranial aneurysm in the left internal carotid artery. The examination also revealed hypoplasia of the right anterior cerebral artery and a fetal-type left posterior cerebral artery originating from the neck of the aneurysm. Considering the location and size of the aneurysm, a combination of endovascular and microsurgical approaches was applied. A protective low-flow procedure was followed by high-flow revascularization and occlusion of the parent artery. After 12 months, the aneurysm recanalized through the graft. To address the recurrence of giant complex aneurysms, endovascular embolization was performed through the radial artery grafts. These interventions showed positive midterm outcomes for the patient's giant aneurysm.</p><p><strong>Conclusion: </strong>In the treatment of complex giant aneurysms, it is important to consider both endovascular and microsurgical approaches as complementary, rather than mutually exclusive. Endovascular embolization using radial artery grafts may be used when dealing with retrograde recanalization and the challenges associated with accessing the aneurysm.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 4","pages":"e00119"},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumbocaval Shunt for Idiopathic Intracranial Hypertension: A Technical Report and Case Series.","authors":"Nanthiya Sujijantarat, Andrew B Koo, Aladine A Elsamadicy, Joseph P Antonios, Daniela Renedo, Joseph O Haynes, Bushra Fathima, Brianna C Theriault, Miguel M Chavez, Abdelaziz Amllay, Kamil W Nowicki, Matthew Kanzler, Jasmine W Jiang, Apurv H Shekar, Ryan M Hebert, Michael L DiLuna, Charles C Matouk","doi":"10.1227/neuprac.0000000000000113","DOIUrl":"10.1227/neuprac.0000000000000113","url":null,"abstract":"<p><strong>Background and objectives: </strong>Neurosurgical management of idiopathic intracranial hypertension (IIH) can be challenging given high rates of revision associated with cerebrospinal fluid shunting. In this study, we present a technical report and early outcomes for lumbocaval shunt (LCS) placement in difficult-to-manage cases.</p><p><strong>Methods: </strong>A literature search was performed for previous reports of LCS or lumboatrial shunt. Electronic medical records of patients who underwent placement of LCS for the treatment of IIH at a single institution were reviewed. Based on early experience and outcomes, our modified technique for LCS is described.</p><p><strong>Results: </strong>Six patients (4 females, median age 36 years [IQR 31-43]) underwent placement of LCS between October 2023 and April 2024. LCS was completed in all cases without intraoperative complications. The median operative time was 88.5 minutes [IQR 79.5-158.8]. One patient developed low-pressure headaches that resolved after the addition of a shunt-assist device. Five of 6 patients reported improved headache at the last follow-up visit, with 4 of 5 patients reporting that their high-pressure headaches completely resolved (median time to the last follow-up of one month [IQR 1-2 months]). During the study period, one shunt revision was performed because of migration of the lumbar shunt into a suprafascial pocket. This led to modification of the surgical technique, specifically the inclusion of anchoring dips.</p><p><strong>Conclusion: </strong>LCS may represent an alternative shunting technique in difficult-to-manage patients with IIH. Further assessment of long-term outcomes is needed.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 4","pages":"e00113"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nasoseptal Flap Enhancement on Early Postoperative MRI Does Not Predict 3-Month Enhancement nor Postoperative Cerebrospinal Fluid Leak Risk.","authors":"Mehrdad Pahlevani, Artak Mukhaelyan, Keila Angel, Regin Jay Mallari, Chester Griffiths, Daniel F Kelly, Garni Barkhoudarian","doi":"10.1227/neuprac.0000000000000118","DOIUrl":"10.1227/neuprac.0000000000000118","url":null,"abstract":"<p><strong>Background and objectives: </strong>The nasoseptal flap (NSF) has been a versatile reconstructive option for extended endonasal skull base surgery, significantly decreasing postoperative cerebrospinal fluid (CSF) leakage rates. One failure mechanism of concern is NSF necrosis. It has been postulated that immediate postoperative MRI flap enhancement can predict flap necrosis. This retrospective study analyzes NSF enhancement to assess for flap viability and CSF leakage.</p><p><strong>Methods: </strong>Patients from 2012 to 2020 who underwent extended endoscopic endonasal surgery with NSF reconstruction were assessed. Immediate postoperative MRI and delayed 3-month MRI were compared for NSF enhancement. Enhancement was graded as no enhancement, partial, or complete enhancement. Patient demographics, tumor type, intraoperative CSF leak grade, and postoperative CSF leakage were assessed based on flap enhancement patterns.</p><p><strong>Results: </strong>Of 713 patients who underwent endoscopic endonasal surgery, 64 required NSF reconstruction. On the immediate postoperative MRI, 45 patients (70%) had complete flap enhancement, 9 (14%) had partial, and 10 (16%) no enhancement. On the 3-month MRI, 59 patients (92%) had complete flap enhancement and 5 (8%) had partial enhancement. There was significant improvement of flap enhancement between immediate postoperative and 3-month MRI (<i>P</i> = .002). All patients with no initial enhancement had complete enhancement at 3 months. Of those with partial enhancement, 2 remained partial and 7 had complete enhancement at 3 months. Overall, 44 patients (69%) had no change between MRI scans, 17 (27%) improved, and 3 (5%) had decreased enhancement. There was no correlation between intraoperative CSF leak rates and flap enhancement. Four patients had postoperative CSF leaks, 2 having complete immediate enhancement, 1 partial, and 1 without enhancement (<i>P</i> = .85).</p><p><strong>Conclusion: </strong>Overall, immediate postoperative MRI NSF enhancement (or lack thereof) did not predict enhancement at the 3-month MRI and did not correlate with postoperative CSF leakage. Hence, one should not rely solely on postoperative flap enhancement to assess the viability of the dural reconstruction.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 4","pages":"e00118"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BrainPath Tubular Retractor System for Subcortical Hemorrhagic Vascular Lesions: A Case Series of Technique and Outcomes.","authors":"Leonard H Verhey, Andres Restrepo Orozco, Mohamed Abouelleil, Paul Mazaris, Casey J Madura, Michael Bercu, Justin A Singer","doi":"10.1227/neuprac.0000000000000114","DOIUrl":"10.1227/neuprac.0000000000000114","url":null,"abstract":"<p><strong>Background and objectives: </strong>Hemorrhagic subcortical vascular lesions such as cavernous malformations (CM) and arteriovenous malformations (AVM) can be neurologically devastating. Conventional open surgical resection is often associated with additional morbidity. The BrainPath® (NICO Corp.) transsulcal tubular retractor system offers a less-invasive corridor to deep-seated lesions. Our objective was to describe a single-center experience with the resection of subcortical hemorrhagic vascular lesions in adult and pediatric patients using the BrainPath® system.</p><p><strong>Methods: </strong>The departmental database was queried for patients who underwent resection of a hemorrhagic CM, AVM, or cerebral aneurysm through the BrainPath® tubular retractor system between January 2017 and September 2021. All patients underwent either postoperative MRI (for patients with CM) or digital subtraction angiography (for patients with AVM or aneurysm). Demographic and clinical characteristics, preoperative and postoperative imaging features, operative details, and surgical and clinical outcomes were extracted through a retrospective review of the medical records.</p><p><strong>Results: </strong>Fourteen patients (mean [SD] age 32.3 [23.9] years; 7 (50%) female) underwent BrainPath®-based resection of a deeply seated CM (n = 7), AVM (n = 6), or ruptured cerebral aneurysm (n = 1). The mean maximal lesion diameter was 21.5 (12.6) mm. The mean operative time was 134 (53) minutes. Residual lesion was present in 2 patients, both of which underwent repeat BrainPath®-assisted surgery for complete resection. All lesions were completely resected or obliterated on postoperative MRI or digital subtraction angiography. At a mean follow-up of 4.1 (1.1) years, the median modified Rankin Scale score was 1 (range 0-6).</p><p><strong>Conclusion: </strong>In a well-selected cohort, we show the effective use of BrainPath® tubular retractors for resection or obliteration of subcortical hemorrhagic vascular lesions. This report further exemplifies the expanded role of the endoport system beyond that of intracerebral hemorrhage and tumor. Further study will elucidate the impact of this less-invasive brain retraction technique on clinical outcome in patients with vascular lesions.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 4","pages":"e00114"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Combined Microsurgical and Endovascular Approach for Type II Endoleak Embolization Through Direct Puncture of a Lumbar Segmental Artery: A Technical Case Instruction.","authors":"Vincent N Nguyen, Robert C Rennert, Sarah Sternbach, Jonathon Cavaleri, Aidin Abedi, Nadia A Atai, Sukgu Han, Jonathan J Russin","doi":"10.1227/neuprac.0000000000000115","DOIUrl":"10.1227/neuprac.0000000000000115","url":null,"abstract":"<p><strong>Background and importance: </strong>Despite the advances in endovascular aortic repair techniques, type II endoleaks with aneurysm sac expansion remain frequent and challenging problems.</p><p><strong>Clinical presentation: </strong>An elderly gentleman underwent a combined microsurgical and endovascular procedure to address a type 2 endoleak and the growth of a recurrent abdominal aortic aneurysm caused by direct puncture of a lumbar segmental artery. The patient tolerated the procedure well and was discharged without complications. Follow-up imaging revealed no further endoleak and a smaller aneurysm size.</p><p><strong>Conclusion: </strong>This unique case presents a novel multidisciplinary surgical strategy for treating complex, recurrent aortic aneurysms with type II endoleaks. The approach is tailored to the individual patient and has shown effectiveness. Long-term follow-up data will be crucial for assessing the efficacy and durability of this approach.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 4","pages":"e00115"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental Leave in Neurosurgery: A US Cross-Sectional Study.","authors":"Olabisi Sanusi, Richard U Kalu, James Obayashi, Nathan Beird, Theresa Williamson, Mathew Geltzeiler, Brian V Nahed, Maria I Rodriguez","doi":"10.1227/neuprac.0000000000000116","DOIUrl":"10.1227/neuprac.0000000000000116","url":null,"abstract":"<p><strong>Background and objectives: </strong>The Accreditation Council for Graduate Medical Education implemented a minimum of 6 weeks parental leave for residents in July 2022. The implementation and impact have not previously been studied in neurosurgery. Our primary study objectives were to determine whether an institution had a parental leave policy and quantify the Family and Medical Leave Act (FMLA) and total parental leave (TPL) time taken by neurosurgeons.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey (August 2023 to December 2023) of neurosurgeons (residents and faculty) in Accreditation Council for Graduate Medical Education-accredited programs. We elicited demographic information, experience with parental leave, and career satisfaction. Association between continuous variables was evaluated using Pearson's correlation. Data distribution was evaluated using the Shapiro-Wilks test. Central tendency comparison was performed using one-way analysis of variance, Kruskal-Wallis, or Mann-Whitney <i>U</i> tests.</p><p><strong>Results: </strong>There were 147 anonymous survey respondents (response rate 15.7%), with an average age of 41 years. The majority (72.2% and 73%) were female and married. The mean age of first pregnancy was 32 years. On average, female residents and faculty took more TPL (7.7 weeks vs 9.0 weeks) and FMLA (6.0 weeks vs 6.8 weeks) than men (resident TPL:2.0 weeks, FMLA: 1.5 weeks. faculty TPL: 2.1 weeks, FMLA: 1.6 weeks). There was a significant difference between how much parental leave leadership believe residents have vs amount of FMLA (<i>P</i>-value = .004) and TPL (<i>P</i>-value = .001) residents took. There was a correlation between age and the amount of TPL (Pearson's R -0.307, <i>P</i>-value = .009).</p><p><strong>Conclusion: </strong>Our survey demonstrates that neurosurgeons, in general, took less than the minimum suggested leave. Departmental leadership perceived that residents took more leave than they reported. This study highlights an opportunity to increase support for parental leave among neurosurgeons.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 4","pages":"e00116"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}