Volume 134: Issue 2 (Feb 2021)
in Journal of NeurosurgeryImage from Muhsen et al. (pp 466–474).
In Brief
This article seeks to analyze the decisions Harvey Cushing made with the challenging case of HW, an adolescent boy with a craniopharyngioma involving the third ventricle. HW's case provides valuable lessons for neurosurgeons today, particularly the importance of dedicating all possible time and energy to save a life. Cushing's concepts and perspectives about the importance of scientific knowledge and ethical commitment to the patients are as relevant as ever to guide current generations of neurosurgeons.
In Brief
The authors highlight the important women in neurosurgery’s history. This is an important reminder to celebrate our leaders and learn from their achievements.
In Brief
The authors looked at records pertinent to Harvey Cushing’s training of young surgeons between 1912 and 1919. It is important to see how he was able to mentor others through times of personal trial.
In Brief
This study evaluates the short- and long-term cognitive effects of deep brain stimulation (DBS) in the caudal zona incerta in patients with Parkinson’s disease (PD). The findings are important because DBS has become the standard treatment of advanced PD and the target has not been previously evaluated with regard to cognitive effects in this group of patients. It is beneficial if clinicians have multiple targets to choose from when considering DBS, because a more tailored treatment might be possible.
In Brief
This study describes the first tractographies performed in patients with refractory aggressiveness treated with deep brain stimulation of the posteromedial hypothalamus. Only 4 groups have reported series of patients who underwent deep brain stimulation for pathological aggressiveness, and none have described the tractography, although it is fundamental to describe what is being stimulated. Moreover, to the authors’ knowledge this is the first reported paper describing tractography and MRI in patients with implanted electrodes, which demonstrated that this is feasible.
In Brief
This study was aimed at demonstrating the efficacy and risk profile of an improved targeting strategy to perform the MR-guided focused ultrasound cerebellothalamic tractotomy for the treatment of chronic therapy-resistant essential tremor. The results of this series of 10 consecutive patients suggest that MR-guided focused ultrasound cerebellothalamic tractotomy is a very effective and safe treatment option for therapy-resistant essential tremor.
In Brief
This study defined parameters to help decide whether unilateral or bilateral deep brain stimulation (DBS) should be initially performed for asymmetrical Parkinson’s disease, and found that age, surgical target, and medication/surgical responsiveness were all significant predictors of time to second lead placement. This study is significant because it presents data to supplement the often-subjective decision process between a surgeon and a patient regarding whether to perform unilateral versus bilateral DBS.
In Brief
The surgical treatment for refractory cluster headache is randomly selected and its efficacy is still being proved. In the present study the authors attempted to show how the treatments they use (occipital nerve stimulation and deep brain stimulation) are affecting their patients over time and also tried to determine if there are any predictors of good clinical response to these treatments. The authors believe this is important because it allows one to better select the right technique for the right population.
In Brief
In order to decrease opioid use in the midst of an opioid crisis in healthcare, the authors studied the use of sumatriptan, a medication commonly used to treat migraines, for pain control after brain surgery. The authors found that the use of sumatriptan decreased pain in the early period after surgery and decreased opioid use after surgery.
In Brief
The authors analyzed meningioma brain tumor growth rates among a group of adult patients and determined that tumor size, location, and the amount of tumor left after initial surgery are important factors in predicting if and how quickly the tumor grows back, which helps to personalize treatment decisions such as the imaging follow-up schedule and additional therapies after tumor removal.
In Brief
The authors focused on the recruitment of homotopic areas in brain lesion–induced functional neuroplasticity in patients with temporal glioma. Their findings provide evidence for a homotopic functional reorganization in glioma patients, which may contribute to memory recovery and predict the extent of specific functional impairment. The findings may have great clinical significance to help neurosurgeons make individualized treatment assessments for patients when considering the iterative resection or extended resection of gliomas in eloquent areas.
In Brief
The authors present an analysis of 20 patients with recurrent malignant gliomas that were treated with combined 5-aminolevulinic acid (5-ALA) fluorescence-guided resection and photodynamic therapy (PDT) as an innovative and safe method for local tumor control. In the past, PDT using porfimer sodium has been investigated but abandoned due to side effects and lack of survival benefits. The authors believe that their new approach offers possible treatment options for patients with glioblastoma.
In Brief
This is a novel prospective cohort study focused on the clinical findings of neurohypophyseal germ cell tumors. The authors’ principal findings include dramatically increased latency period before radiographic diagnosis in cases with diabetes insipidus; biochemical abnormalities on presentation predictive of long-term posttreatment hormone supplementation; and the importance of incorporating whole-ventricle radiation in treatment. The authors believe that this study will be an important contribution to improving clinical care and future translational research in this disease impacting adolescent and young adult population.
In Brief
This study describes a unique comparison of clinical findings of germ cell tumors (GCTs) between the two large databases from the Mayo Clinic and Japanese Intracranial GCT Consortium. The study found a striking difference in tumor location, in which a basal ganglia lesion was significantly less frequent in Mayo Clinic cases than in the Japanese database, which was corroborated by the literature review of cases since 1990. The authors also compared sex and histology distributions, tumor markers, and progression-free survival/overall survival between these two databases.
In Brief
The authors discovered that patient age and artery involvement by the tumor strongly predict tumor recurrence in patients with cranial base chondrosarcoma. Importantly, these two variables are known preoperatively and can guide pre-, intra-, and postoperative surgical management decisions. To this end, the authors propose a simple risk classifier that can inform intraoperative decision-making and guide postoperative management.
In Brief
The authors studied the safety, efficacy, and clinicoradiological outcomes of Gamma Knife radiosurgery (GKRS) on large posterior fossa metastases. There is a paucity of literature that addresses the effect of GKRS in large posterior fossa brain metastases (LPFMs) on peritumoral edema (PTE) and corresponding fourth ventricle volume. In this retrospective review, the authors showed that GKRS resulted in a statistically significant reduction in tumor, PTE, and fourth ventricular volumes. This treatment can be considered for select cases of LPFM, especially in poor surgical candidates.
In Brief
This study is the first in which repetitive MR-guided focused ultrasound (MRgFUS) was used at the same target with a standard chemotherapy protocol for malignant brain tumor. This study showed that repeatedly performed temporary blood-brain barrier (BBB) disruption at the desired locations by MRgFUS is feasible and safe. It offers the potential for additional studies to be performed on other therapeutic agents that could not be used because of the BBB.
In Brief
The authors performed the first exhaustive systematic review and quantitative meta-analysis of the comparative effectiveness of intraoperative MRI (IMRI) and 5-aminolevulinic acid (5-ALA) for achieving gross-total resection in high-grade glioma. Study findings indicate that between IMRI and 5-ALA, neither surgical adjunct is superior, but each is better than conventional image guidance alone. These results have significant implications for economically prudently incorporating these novel neuronavigational aids into routine neurosurgical care.
In Brief
The authors analyzed clinical specimens and found that the regulatory network of the MEG3/MIR-376B-3P/HMGA2 pathway was involved in the invasiveness of clinical nonfunctional pituitary adenomas (PAs). The authors confirmed their hypothesis through in vivo and in vitro experiments. These results can provide evidence for the treatment of invasive PAs.
In Brief
In the largest longitudinal brain analysis cohort of CD patients to date, the authors assessed the reversibility of whole-brain changes in Cushing’s disease (CD) cured by transsphenoidal surgery and the correlations of brain recovery with clinical and hormonal parameters. These findings are important because they provide the first direct demonstration of the rapid reversal of total gray matter loss in remitted CD and suggest that levels of ACTH and serum cortisol are reliable serum biomarkers for clinical use to assess brain recovery after surgical treatment of CD.
In Brief
The necessity of preoperative steroid replacement in patients with an intact hypothalamic-pituitary-adrenal (HPA) axis undergoing endoscopic transsphenoidal surgery (ETSS) for nonfunctioning pituitary adenoma (NFPA) was evaluated. Intraoperative serum cortisol levels were significantly higher in patients receiving 100 mg of preoperative hydrocortisone compared with those receiving saline. No patient showed intraoperative hypotension due to adrenal insufficiency. These results suggest that preoperative steroid replacement may be unnecessary in patients with an intact HPA axis undergoing ETSS for NFPA.
In Brief
A greater understanding of long-term recurrence and progression rates following complete or partial resection and the need for further intervention will help clinicians provide meaningful counsel for their patients and assist data-driven decision-making.
In Brief
The authors analyzed the possible impact of the timeline of stereotactic radiosurgery (a proxy for experience and technological advances) on treatment outcomes of Cushing’s disease. The results show that clinician experience and technological advancements are associated with better treatment results.
In Brief
The authors investigated changes in cerebral blood flow (CBF) and the energy metabolic state of the brain during treatment to improve blood flow and avoid ischemic complications in patients after severe aneurysmal subarachnoid hemorrhage. This study contributes to the understanding of the effects of different strategies to augment CBF, which may hopefully be of aid in future clinical decision-making and management of this group of patients.
In Brief
The authors explored the use of vessel wall MRI (VWMRI), which has shown potential for use in detecting unstable aneurysms, and hemodynamic characteristics and pathophysiological links to instability, which have not been investigated, to improve risk assessment of incidentally detected unruptured intracranial aneurysms by combining high-resolution computational fluid dynamics with 3D VWMRI to detect and characterize potentially unstable aneurysms. This research is of critical importance because the authors propose hemodynamic predictors that may be more robust than the current standard, which is based on the size and shape of the aneurysm.
In Brief
The authors studied whether or not differences in individual patient anatomy impact the likelihood of procedural success for mechanical thrombectomy in acute ischemic stroke with large-vessel occlusion. Their work is important because an association between anatomical factors and procedural success has not been previously described. The authors’ findings may help in the development of improved thrombectomy devices and techniques.
In Brief
Stroke is a leading cause of adult morbidity and mortality. The incremental cost of mechanical thrombectomy is $10,840 compared to medical therapy alone. However, its improvement in functional outcome and avoidance of disability makes it a cost-effective procedure. For mechanical thrombectomy, purchasing devices through a bundled model resulted in a significant hospital cost savings compared to the traditional model of à la carte device purchasing. Adoption of bundled purchasing may improve the risk-sharing balance so that device companies share an increased portion of the cost of acute stroke care.
In Brief
This study was performed to evaluate the effectiveness and safety of a new noncompletely occlusive net-assisted remodeling technique using the Cascade net device for temporary bridging of intracranial aneurysms.
In Brief
Many patients are still suffering from intracerebral hemorrhages despite extensive research. The authors aimed to establish the role of a cell surface marker in CSF to gain further insights after intracerebral hemorrhages. This study showed an impressive increase of these markers compared to healthy adults and also revealed an impact on outcome.
In Brief
The aim of this study was to provide an honest and critical assessment of the current state of the art of endoscopic surgery for orbital tumors, involving the personal case series of the authors and a systematic literature review. The recent technological advancement of new intraoperative tools to help the surgeon is extensively considered as well. The endoscopic endonasal and endoscopic transpalprebal approaches have demonstrated to be safe and effective for tumors located in medial and lateral quadrants, respectively, permitting one to approach orbital lesions endoscopically from 360°.
In Brief
The authors demonstrated the safe and effective use of a novel bioresorbable bone adhesive to fixate cranial bone flaps in a large-animal sheep model as an alternative to conventional metal fixation technology (e.g., plates and screws).
In Brief
This is a description of the training of neurosurgeons in Tanzania in the use of intraoperative ultrasound and their initial use of this technology at their hospital. It has made surgery safer for patients in a country that has no access to other forms of surgical navigation in neurosurgery.
In Brief
A retrospective data analysis was performed using the iCite database to determine how various factors such as academic rank, longer career duration, acquisition of a Doctor of Philosophy (PhD) degree, and sex impacted the relative citation ratio (RCR) in order to analyze research productivity among academic neurosurgeons. The authors found that the mean advanced academic rank, a longer career duration, and PhD acquisition were all associated with increased mean and weighted RCRs. Their study data showed that current academic neurosurgeons are exceptionally productive compared to both physicians in other specialties and the general scientific community.
In Brief
The authors performed in vitro and in vivo studies of ultrasound transmission through a cranial prosthesis. The prosthesis may serve for several diagnostic and therapeutic ultrasound-based applications, including bedside imaging of the brain and ultrasound-guided focused ultrasound cerebral procedures.
In Brief
The authors found that resection of the hippocampus was associated with associative memory, and that resection of the anterior part of the hippocampus was associated with immediate recall. Resection of the posterior part of the hippocampus was associated with delayed recall. This is the first study to investigate the effect of temporal resection on postoperative memory decline by employing voxel-based analysis, which accounts for individual differences in the extent and locus of resection.
In Brief
Subdural hematomas and hygromas (SDHs) are common complications in patients with shunted idiopathic normal pressure hydrocephalus (iNPH), and in this registry-based study, such patients were screened nationwide to identify perioperative variables that might increase the risk of SDH.
