Neurosurgery practice最新文献

{"title":"Brain Circuitry of Consciousness: A Review of Current Models and a Novel Synergistic Model With Clinical Application.","authors":"Theresa C Gammel,&nbsp;Leor N Alkadaa,&nbsp;Jordan R Saadon,&nbsp;Sabir Saluja,&nbsp;John Servider,&nbsp;Nathaniel A Cleri,&nbsp;Michael Egnor,&nbsp;Raphael P Davis,&nbsp;Chuan Huang,&nbsp;Yuri B Saalmann,&nbsp;Sima Mofakham,&nbsp;Charles B Mikell","doi":"10.1227/neuprac.0000000000000031","DOIUrl":"https://doi.org/10.1227/neuprac.0000000000000031","url":null,"abstract":"<p><p>How consciousness arises in the brain has important implications for clinical decision-making. We summarize recent findings in consciousness studies to provide a toolkit for clinicians to assess deficits in consciousness and predict outcomes after brain injury. Commonly encountered disorders of consciousness are highlighted, followed by the clinical scales currently used to diagnose them. We review recent evidence describing the roles of the thalamocortical system and brainstem arousal nuclei in supporting awareness and arousal and discuss the utility of various neuroimaging studies in evaluating disorders of consciousness. We explore recent theoretical progress in mechanistic models of consciousness, focusing on 2 major models, the global neuronal workspace and integrated information theory, and review areas of controversy. Finally, we consider the potential implications of recent research for the day-to-day decision-making of clinical neurosurgeons and propose a simple \"three-strikes\" model to infer the integrity of the thalamocortical system, which can guide prognosticating return to consciousness.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 2","pages":"e00031"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/01/75/neuopen-4-e00031a.PMC10193831.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9502772","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":"Diffusely Infiltrating Gliomas With Poor Prognosis, <i>TERT</i> Promotor Mutations, and Histological Anaplastic Pleomorphic Xanthoastrocytoma-Like Appearance Classify as Mesenchymal Type of Glioblastoma, IDH-wildtype by Methylation Analysis.","authors":"Yoshihiro Tsukamoto, Manabu Natsumeda, Haruhiko Takahashi, Jotaro On, Hiroki Seto, Taiki Saito, Kohei Shibuya, Ryosuke Ogura, Junko Ito, Masayasu Okada, Makoto Oishi, Hiroshi Shimizu, Kouichirou Okamoto, Akiyoshi Kakita, Yukihiko Fujii","doi":"10.1227/neuprac.0000000000000040","DOIUrl":"10.1227/neuprac.0000000000000040","url":null,"abstract":"<p><strong>Background: </strong>Pleomorphic xanthoastrocytoma (PXA) (World Health Organization grade II) is classified as a relatively benign and circumscribed glioma; however, anaplastic PXA (APXA, World Health Organization grade III) has a poorer prognosis, and differentiating from glioblastoma can be difficult both histologically and molecularly.</p><p><strong>Objective: </strong>To describe the clinical, pathological, and molecular characteristics of diffusely infiltrating gliomas with histological APXA-like features.</p><p><strong>Methods: </strong>Four diffusely infiltrating gliomas in adult patients histologically diagnosed as APXAs at a single institute were retrospectively reviewed. We analyzed their clinical, radiological, pathological, genetic, epigenetic, and prognostic characteristics.</p><p><strong>Results: </strong>All tumors histologically showed classical characteristic PXA-like appearance with <i>BRAF</i> wildtype, mitotic figure, necrosis, and an increased mindbomb E3 ubiquitin-protein ligase 1 labeling index and were initially diagnosed as APXAs; moreover, they underwent high-grade glioma treatment. Three patients with <i>TERT</i> promotor mutations died within 18 months. These patients' MRIs showed widespread infiltrating fluid-attenuated inversion recovery hyperintense lesions and Gd-enhancing lesions in the bilateral cerebral hemispheres in 2 of the patients. Contrastingly, a patient with the wildtype <i>TERT</i> promotor has survived for 2.5 years without recurrence. MRI revealed an unilateral fluid-attenuated inversion recovery hyperintense and Gd-enhancing lesion. By methylation classifier analysis, all 4 cases clustered toward GBM, IDH-wildtype, mesenchymal type, although one was deemed unclassifiable due to a low calibrated score.</p><p><strong>Conclusion: </strong>In diffusely infiltrating gliomas showing histological characteristics of APXA, methylation classification should be performed as these tumors may be difficult to differentiate between glioblastoma, IDH-wildtype by histological or genetic analysis. The aggressive nature of these tumors should be expected, especially in cases that are <i>BRAF</i>-wildtype and <i>TERT</i> promotor mutant.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 2","pages":"e00040"},"PeriodicalIF":0.0,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434463","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":"Initial Patient Satisfaction With Telemedicine in Neurosurgery Outpatient Clinic During the Early COVID-19 Pandemic.","authors":"Olivia A Kozel, Archit B Baskaran, Anusha Manjunath, Chirag Goel, Michael R Jones, William Gibson, Babak S Jahromi, Matthew C Tate, Nader S Dahdaleh, Joshua M Rosenow","doi":"10.1227/neuprac.0000000000000039","DOIUrl":"10.1227/neuprac.0000000000000039","url":null,"abstract":"<p><strong>Background: </strong>Throughout the COVID-19 pandemic, the medical community has been saturated by the necessity for telemedicine, or \"telehealth\", appointments. With limited prior exposure, the many challenges that accompany telehealth visits have affected how physicians conduct daily tasks and how patients perceive healthcare experiences. In the early stages of the COVID-19 pandemic, telemedicine was new to most neurosurgical patients. This study seeks to evaluate the overall neurosurgical patient experience with telemedicine.</p><p><strong>Objective: </strong>To assess overall neurosurgical patient satisfaction with telemedicine to build an understanding of the effectiveness of these encounters for future planning.</p><p><strong>Methods: </strong>After a telemedicine appointment, patients received an electronic survey. Survey questions focused on demographic information, encounter type, medical history questions, and overall satisfaction with telemedicine. Responses for the survey questions were formulated using a 5-point Likert scale.</p><p><strong>Results: </strong>Two hundred seventy patients were seen via telemedicine by 1 of 4 providers included in this study. 43 patients returned the surveys, with a completion rate of 16%. Patients indicated higher scores for overall satisfaction and quality of appointment. Of note, 23% of participants responded that they would be willing to pay out of pocket for a telemedicine appointment, while 77% responded they would not be willing to pay out of pocket.</p><p><strong>Conclusion: </strong>Our survey results show patients felt comfortable discussing healthcare issues using telehealth, that appropriate levels of care were received, and they would be willing to use telehealth again. Future efforts will be necessary to educate providers and patients about the utilization of technological devices, ensure patient access to telehealth, and standardize ethical guidelines.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 2","pages":"e00039"},"PeriodicalIF":0.0,"publicationDate":"2023-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434473","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":"The \"Canopy Approach\": Case Series Using Immersive Virtual Reality for Bottom-Up Target-Based Preoperative Planning in Pediatric Neurosurgery.","authors":"Grace Y Lai, Ryan R L Phelps, Nilika S Singhal, Joseph E Sullivan, Adam L Numis, Kurtis I Auguste","doi":"10.1227/neuprac.0000000000000038","DOIUrl":"10.1227/neuprac.0000000000000038","url":null,"abstract":"<p><strong>Background: </strong>Virtual reality (VR) is increasingly used for trajectory planning in neurosurgery.</p><p><strong>Objective: </strong>To describe a case series showing the application of immersive VR involving both \"top-down\" from skull to lesion and \"bottom-up\" from lesion to skull approaches for trajectory planning in pediatric neurosurgical patients.</p><p><strong>Methods: </strong>We detail the preoperative and intraoperative application of VR and clinical courses of 5 children (aged 7-14 years) with anatomically challenging intraparenchymal lesions that posed operative risks to nearby vascular anatomy and fiber tracts. Preoperative planning consisted of standard presurgical evaluation with computed tomography and magnetic resonance imaging used to render 3-dimensional models that could be viewed and manipulated using desktop software and immersive VR headsets and hand controllers by the surgeon and family. Patient satisfaction was evaluated by survey. Surgical outcomes were degree of seizure control or extent of resection.</p><p><strong>Results: </strong>Three patients underwent lesion resection and 2 laser ablation. Modifications to 2-dimensional and \"top-down\" VR trajectory plans were made after \"bottom-up\" navigation in all cases. All families reported that the VR enhanced their understanding of the procedure. There were no complications, and no patients suffered permanent neurological deficits postoperatively. Gross total resection was achieved in all lesional cases, and patients with epilepsy achieved seizure freedom at 2 years postoperatively.</p><p><strong>Conclusion: </strong>Immersive VR allows operative corridors to be virtually traveled and viewed from a \"top-down\" and \"bottom-up\" perspective, as if looking up from under a forest canopy of overlying anatomy, for optimal trajectory planning and improvement of family understanding in pediatric neurosurgery.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 2","pages":"e00038"},"PeriodicalIF":0.0,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434511","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":"The History and Current State of Neurosurgery in Albania.","authors":"Elsa Nico, Mirel Grada, Artur Xhumari, Arsen Seferi, Gail Rosseau, Mentor Petrela","doi":"10.1227/neuprac.0000000000000037","DOIUrl":"10.1227/neuprac.0000000000000037","url":null,"abstract":"<p><p>Up to one-third of the global burden of disease involves surgical conditions; however, 5 in 7 people across the world do not have access to timely, affordable surgical care. Low- and middle-income countries account for the majority of the inequities in access to timely surgical care, where the availability of specialty surgical services such as neurosurgery is limited or unavailable. Albania, situated in the Western Balkan region, was once one of the poorest countries in Europe. It is now an upper-middle-income country, and an example of the impact of democratic regime changes in Europe after 1990. This article provides the first-ever examination of the history and current state of neurosurgery in this country. We set the stage with a brief historical background on Albania, including its neurosurgical history. Then, we describe the current state of neurosurgical activity and infrastructure in Albania. Finally, we conclude with suggestions on future neurosurgical efforts for the development of neurosurgery in small countries with variable economic resources.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 2","pages":"e00037"},"PeriodicalIF":0.0,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434513","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 New Complication of Spinal Fusion Surgery for Neuromuscular Scoliosis-Posterior Mediastinal Hematoma: Case Report.","authors":"Anthony K Allam, Alex R Flores, Darrell S Hanson, David F Bauer","doi":"10.1227/neuprac.0000000000000034","DOIUrl":"10.1227/neuprac.0000000000000034","url":null,"abstract":"<p><strong>Background and importance: </strong>Neuromuscular scoliosis surgery is affiliated with a high risk of perioperative and postoperative complications. We present the case of a never-before-reported complication: a posterior mediastinal hematoma.</p><p><strong>Clinical presentation: </strong>We present the case of a 17-year-old female patient with cerebral palsy and neuromuscular scoliosis with a progressive thoracic kyphosis to 85° and levoscoliosis to 13.5° who presented for spinal fusion surgery. Postoperatively, the patient developed persistent tachycardia despite initial resuscitation, anxiolysis, and analgesia. A computed tomography scan was obtained revealing a posterior mediastinal hematoma. The patient was managed with supportive care and recovered well.</p><p><strong>Conclusion: </strong>This case highlights a never-before-reported complication of spinal fusion surgery: a posterior mediastinal hematoma. Although unlikely symptomatic, a posterior mediastinal hematoma should be on the differential diagnosis for postoperative tachycardia. This case entreats us to elucidate the true incidence rate of this complication in the population.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 2","pages":"e00034"},"PeriodicalIF":0.0,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434449","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":"Modified Transanterior Perforated Substance Approach Using the Medial Territory to Thalamomesencephalic Cavernous Malformations: A Case Report.","authors":"Yunjia Ni, Zhiyu Wang, Zhongshuai Zhang, Hongchan Li, Lianping Gu, Qiangyi Zhou, Jian Yin, Yaohua Liu, Meiqing Lou","doi":"10.1227/neuprac.0000000000000035","DOIUrl":"10.1227/neuprac.0000000000000035","url":null,"abstract":"<p><strong>Background and importance: </strong>Thalamomesencephalic lesions remain a challenge to neurosurgeons for their eloquent anatomy and postoperative neurological deficits. With limited cases in the literature, these lesions are still managed in a case-by-case fashion.</p><p><strong>Clinical presentation: </strong>Here, we present a case of an otherwise healthy man who had a 46-day history of impaired vision and right-sided weakness and numbness caused by ventrally located thalamomesencephalic cavernous malformations (CMs). A modified transanterior perforated substance approach using the medial territory was performed for gross total resection of the CMs. No new-onset neurological deficits were observed postoperatively. Apart from visual improvements, the patient's muscle strength constantly improved and recovered full strength on 14-month follow-up.</p><p><strong>Conclusion: </strong>The authors believe that the transanterior perforated substance approach through the medial territory can be considered as an option for ventrally located thalamomesencephalic CMs.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 2","pages":"e00035"},"PeriodicalIF":0.0,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434477","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":"Assessment of Accuracy of Mixed Reality Device for Neuronavigation: Proposed Methodology and Results.","authors":"Swati Jain, Tamara Tajsic, Tilak Das, Yujia Gao, Ngiam Kee Yuan, Tseng Tsai Yeo, Martin J Graves, Adel Helmy","doi":"10.1227/neuprac.0000000000000036","DOIUrl":"10.1227/neuprac.0000000000000036","url":null,"abstract":"<p><p>Intraoperative neuronavigation is currently an essential component of neurosurgical operations in several contexts. Recent progress in mixed reality (MR) technology has attempted to overcome the disadvantages of standard neuronavigation systems allowing the surgeon to superimpose a 3D rendered image onto the patient's anatomy. We present the first study in the literature to assess the surface matching accuracy of MR rendered image. For the purposes of this study, we used HoloLens 2 with virtual surgery intelligence providing the software capability for image rendering. To assess the accuracy of using mixed reality device for neuronavigation intraoperatively. This study seeks to assess the accuracy of rendered holographic images from a mixed reality device as a means for neuronavigation intraoperatively. We used the Realistic Operative Workstation for Educating Neurosurgical Apprentices to represent a patient's skull with intracranial components which underwent standardized computed tomography (CT) and MRI imaging. Eleven predefined points were used for purposes of assessing the accuracy of the rendered image, compared with the intraoperative gold standard neuronavigation. The mean HoloLens values against the ground truth were significantly higher when compared with Stealth using CT scan as the imaging modality. Using extracranial anatomic landmarks, the HoloLens error values continued to be significantly higher in magnitude when compared with Stealth across CT and MRI. This study provides a relatively easy and feasible method to assess accuracy of MR-based navigation without requiring any additions to the established imaging protocols. We failed to show the equivalence of MR-based navigation over the current neuronavigation systems.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 2","pages":"e00031"},"PeriodicalIF":0.0,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434452","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 Flow Diversion for Hemifacial Spasm Due to an Unruptured Fusiform Vertebral Artery Aneurysm: A Case Report.","authors":"Yuki Aonuma, Hideyuki Yoshioka, Kazuya Kanemaru, Koji Hashimoto, So Saito, Takuma Wakai, Norito Fukuda, Hiroyuki Kinouchi","doi":"10.1227/neuprac.0000000000000027","DOIUrl":"10.1227/neuprac.0000000000000027","url":null,"abstract":"<p><strong>Background and importance: </strong>Hemifacial spasm (HFS) caused by a fusiform aneurysm is rare and difficult to treat. We present the first case of successful endovascular flow diversion treatment for HFS due to a fusiform aneurysm.</p><p><strong>Clinical presentation: </strong>A 46-year-old man suffered from right HFS for 6 months because of a fusiform right vertebral artery aneurysm compressing the root exit zone of cranial nerve VII. He successfully underwent flow diversion, with immediate disappearance of his HFS. Follow-up digital subtraction angiography 3 months after treatment showed complete resolution of the aneurysm.</p><p><strong>Conclusion: </strong>Flow diversion might be a promising treatment option for HFS due to a fusiform vertebral artery aneurysm.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 1","pages":"e00027"},"PeriodicalIF":0.0,"publicationDate":"2023-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434475","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}