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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Neuroablative Procedures for Patients With Cancer Pain
Ahmed M Raslan, MD, Sharona Ben-Haim, MD, Steven M Falowski, MD, André G Machado, MD, PhD, Jonathan Miller, MD ...
doi : 10.1093/neuros/nyaa527
Volume 88, Issue 3, March 2021, Pages 437–442
Managing cancer pain once it is refractory to conventional treatment continues to challenge caregivers committed to serving those who are suffering from a malignancy. Although neuromodulation has a role in the treatment of cancer pain for some patients, these therapies may not be suitable for all patients. Therefore, neuroablative procedures, which were once a mainstay in treating intractable cancer pain, are again on the rise. This guideline serves as a systematic review of the literature of the outcomes following neuroablative procedures.
Commentary: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Neuroablative Procedures for Patients With Cancer Pain
Brian J Williams, MD, Joseph S Neimat, MD
doi : 10.1093/neuros/nyaa529
Volume 88, Issue 3, March 2021, Page E218
The authors1 have performed a thorough analysis of the literature and made evide-nce-based recommendations regarding neuroablative procedures for treatment of cancer pain. This is an important and timely service to the care of patients with advanced cancer. Cancer pain continues to be a significant clinical problem. It is estimated that about half of cancer patients experience inadequate pain control and one-quarter will die in pain.
Commentary: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Neuroablative Procedures for Patients With Cancer Pain
Marc Sindou, MD, DSc
doi : 10.1093/neuros/nyaa528
Volume 88, Issue 3, March 2021, Pages E219–E220
This systematic review1 of publications dedicated to neuroablative procedures for the treatment of pain in patients with cancer in which the evidence base is examined has a perfect timing. It became apparent during the last decades that pain secondary to cancer was not sufficiently controlled in a large proportion of patients (approximately one-third according to the authors’ report), even when modern pharmacological methods or image-guided anesthetic blocks are used. As pointed out in this article, pain affects functional status as well as quality of life and shortens survival in those patients with cancer suffering from it.
Diagnostic Pathology of Tumors of Peripheral Nerve
Sarra M Belakhoua, MD, Fausto J Rodriguez, MD
doi : 10.1093/neuros/nyab021
Volume 88, Issue 3, March 2021, Pages 443–456
Neoplasms of the peripheral nervous system represent a heterogenous group with a wide spectrum of morphological features and biological potential. They range from benign and curable by complete excision (schwannoma and soft tissue perineurioma) to benign but potentially aggressive at the local level (plexiform neurofibroma) to the highly malignant (malignant peripheral nerve sheath tumors [MPNST]).
Clinical Pearls and Methods for Intraoperative Motor Mapping
Marco Rossi, MD, Tommaso Sciortino, MD, Marco Conti Nibali, MD, Lorenzo Gay, MD, Luca Vigan?, PhD ...
doi : 10.1093/neuros/nyaa359
Volume 88, Issue 3, March 2021, Pages 457–467
Resection of brain tumors involving motor areas and pathways requires the identification and preservation of various cortical and subcortical structures involved in motor control at the time of the procedure, in order to maintain the patient's full motor capacities.
Claims of Safety in Neurosurgical Literature: We Shouldn’t Call Something Safe Without Strong Justification
Adam Alamgir Khan, MD, Stephen John Haines, MD
doi : 10.1093/neuros/nyaa497
Volume 88, Issue 3, March 2021, Pages 468–476
Many articles published in the neurosurgical literature make claims of safety regarding interventions. The strength of evidence supporting these claims has not been systematically evaluated.
“Zooming in” on Glioblastoma: Understanding Tumor Heterogeneity and its Clinical Implications in the Era of Single-Cell Ribonucleic Acid Sequencing
Adham M Khalafallah, MD, Sakibul Huq, BS, Adrian E Jimenez, BS, Riccardo Serra, MD, Chetan Bettegowda, MD, PhD ...
doi : 10.1093/neuros/nyaa305
Volume 88, Issue 3, March 2021, Pages 477–486
Glioblastoma (GBM) is the most common primary brain malignancy in adults and one of the most aggressive of all human cancers. It is highly recurrent and treatment-resistant, in large part due to its infiltrative nature and inter- and intratumoral heterogeneity. This heterogeneity entails varying genomic landscapes and cell types within and between tumors and the tumor microenvironment (TME).
Bilateral Deep Brain Stimulation is the Procedure to Beat for Advanced Parkinson Disease: A Meta-Analytic, Cost-Effective Threshold Analysis for Focused Ultrasound
Uma V Mahajan, BS, Vinod K Ravikumar, MD, Kevin K Kumar, MD, PhD, Seul Ku, SM, Disep I Ojukwu, MD, MBA, MPH ...
doi : 10.1093/neuros/nyaa485
Volume 88, Issue 3, March 2021, Pages 487–496
Parkinson disease (PD) impairs daily functioning for an increasing number of patients and has a growing national economic burden. Deep brain stimulation (DBS) may be the most broadly accepted procedural intervention for PD, but cost-effectiveness has not been established. Moreover, magnetic resonance image-guided focused ultrasound (FUS) is an emerging incisionless, ablative treatment that could potentially be safer and even more cost-effective.
Circulating Biomarkers for Glioma: A Review
Jordan Jones, MBBS, Hong Nguyen, PhD, Katharine Drummond, MD, Andrew Morokoff, PhD, MBBS
doi : 10.1093/neuros/nyaa540
Volume 88, Issue 3, March 2021, Pages E221–E230
Accurate circulating biomarkers have potential clinical applications in population screening, tumor subclassification, monitoring tumor status, and the delivery of individualized treatments resulting from tumor genotyping.
Ten-Year Outcomes of 1- and 2-Level Cervical Disc Arthroplasty From the Mobi-C Investigational Device Exemption Clinical Trial
Kee Kim, MD, Greg Hoffman, MD, Hyun Bae, MD, Andy Redmond, MD, Michael Hisey, MD ...
doi : 10.1093/neuros/nyaa459
Volume 88, Issue 3, March 2021, Pages 497–505
Short- and mid-term studies have shown the effectiveness of cervical disc arthroplasty (CDA) to treat cervical disc degeneration.
Commentary: Ten-Year Outcomes of 1- and 2-Level Cervical Disc Arthroplasty From the Mobi-C Investigational Device Exemption Clinical Trial
Rodney John Charles Laing, MD, FRCS (SN)
doi : 10.1093/neuros/nyaa480
Volume 88, Issue 3, March 2021, Page E231
This study1 tells the reader that cervical disc arthroplasty (CDA) is as good after 10 yr as it is after 7 yr. In terms of outcome, it is no surprise that the important clinical outcomes, namely arm pain, myelopathy, and neck disability, are no different from any other operation, which has successfully decompressed the neural structures.
First in Man Pilot Feasibility Study in Extracranial Carotid Robotic-Assisted Endovascular Intervention
Virendra R Desai, MD, Jonathan J Lee, MD, Trevis Sample, SST, Neal S Kleiman, MD, Alan Lumsden, MD ...
doi : 10.1093/neuros/nyaa461
Volume 88, Issue 3, March 2021, Pages 506–514
Robotic-assistance in endovascular intervention represents a nascent yet promising innovation.
Commentary: First in Man Pilot Feasibility Study in Extracranial Carotid Robotic-Assisted Endovascular Intervention
Mohamed Abouelleil, MD, Justin Singer, MD
doi : 10.1093/neuros/nyaa519
Volume 88, Issue 3, March 2021, Pages E232–E233
Robotic-assisted neurovascular intervention (R-NVI) is a promising innovation that has the potential for improved procedural outcomes and physician health. However, the current state of robot use in R-NVI does raise a number of concerns that should be considered before a full transition to R-NVI.
Spinal Neurovascular Malformations in Klippel-Trenaunay Syndrome: A Single Center Study
Anthony Larson, BS, Tristan Covington, MD, Katelyn Anderson, MD, Megha Tollefson, MD, Giuseppe Lanzino, MD ...
doi : 10.1093/neuros/nyaa457
Volume 88, Issue 3, March 2021, Pages 515–522
A number of studies have demonstrated spinal anomalies associated with Klippel-Trenaunay syndrome (KTS). To date, there are no large consecutive series examining the prevalence and subtype distribution of spinal neurovascular malformations in patients with KTS.
Commentary: Low-Dose Intravenous Heparin Infusion After Aneurysmal Subarachnoid Hemorrhage Is Associated With Decreased Risk of Delayed Neurological Deficit and Cerebral Infarction
R Loch Macdonald, MD, PhD
doi : 10.1093/neuros/nyaa476
Volume 88, Issue 3, March 2021, Pages E234–E235
This1 is a review of 556 patients with aneurysmal subarachnoid hemorrhage (SAH) treated with intravenous (233 patients) or subcutaneous heparin (323 patients). Intravenous heparin reduced delayed neurological deterioration and cerebral infarction and did not increase bleeding complications. I thought treating patients with SAH with heparin was a very bold experiment when I first read about it.2 This report allays those fears. These data are important to have in the literature since they support an ongoing randomized, open label clinical trial of intravenous heparin in aneurysmal SAH (NCT02501434). Strengths of this report include the pseudorandomization by the surgeon. This introduces the surgeon as another variable that differs between the 2 study groups, although both are very experienced aneurysm surgeons....
Low-Dose Intravenous Heparin Infusion After Aneurysmal Subarachnoid Hemorrhage is Associated With Decreased Risk of Delayed Neurological Deficit and Cerebral Infarction
Matthew J Kole, MD, Aaron P Wessell, MD, Beatrice Ugiliweneza, PhD, MSPH, Gregory J Cannarsa, MD, Enzo Fortuny, MD ...
doi : 10.1093/neuros/nyaa473
Volume 88, Issue 3, March 2021, Pages 523–530
Patients who survive aneurysmal subarachnoid hemorrhage (aSAH) are at risk for delayed neurological deficits (DND) and cerebral infarction. In this exploratory cohort comparison analysis, we compared in-hospital outcomes of aSAH patients administered a low-dose intravenous heparin (LDIVH) infusion (12 U/kg/h) vs those administered standard subcutaneous heparin (SQH) prophylaxis for deep vein thrombosis (DVT; 5000 U, 3 × daily).
Early Prediction of Malignant Cerebellar Edema in Posterior Circulation Stroke Using Quantitative Lesion Water Uptake
Gabriel Broocks, MD, Sarah Elsayed, MD, Helge Kniep, Dipl.Ing, Andre Kemmling, MD, MHBA, Fabian Flottmann, MD ...
doi : 10.1093/neuros/nyaa438
Volume 88, Issue 3, March 2021, Pages 531–537
Malignant cerebellar edema (MCE) is a life-threatening complication of ischemic posterior circulation stroke that requires timely diagnosis and management. Yet, there is no established imaging biomarker that may serve as predictor of MCE. Early edematous water uptake can be determined using quantitative lesion water uptake, but this biomarker has only been applied in anterior circulation strokes.
Reliability of Using the Proposed International Consensus Video Signs of Potential Concussion for National Rugby League Head Impact Events
Andrew J Gardner, PhD
doi : 10.1093/neuros/nyaa437
Volume 88, Issue 3, March 2021, Pages 538–543
Consensus on the definition of extant video signs of concussion have recently been proposed by representatives of international sporting codes for global consistency across professional leagues.
Alterations in Functional Connectomics Associated With Neurocognitive Changes Following Glioma Resection
Kyle R Noll, PhD, Henry S Chen, PhD, Jeffrey S Wefel, PhD, Vinodh A Kumar, MD, Ping Hou, PhD ...
doi : 10.1093/neuros/nyaa453
Volume 88, Issue 3, March 2021, Pages 544–551
Decline in neurocognitive functioning (NCF) often occurs following brain tumor resection. Functional connectomics have shown how neurologic insults disrupt cerebral networks underlying NCF, though studies involving patients with brain tumors are lacking.
Impact of Frailty on Outcomes Following Spine Surgery: A Prospective Cohort Analysis of 668 Patients
Nitin Agarwal, MD, Ezequiel Goldschmidt, MD, PhD, Tavis Taylor, BA, Souvik Roy, BS, Stefanie C Altieri Dunn, PhD ...
doi : 10.1093/neuros/nyaa468
Volume 88, Issue 3, March 2021, Pages 552–557
With an aging population, elderly patients with multiple comorbidities are more frequently undergoing spine surgery and may be at increased risk for complications. Objective measurement of frailty may predict the incidence of postoperative adverse events.
Commentary: Impact of Frailty on Outcomes Following Spine Surgery: A Prospective Cohort Analysis of 668 Patients
Michael M H Yang, MD, MSc, MBiotech, W Bradley Jacobs, MD
doi : 10.1093/neuros/nyaa510
Volume 88, Issue 3, March 2021, Pages E236–E237
Through experience, healthcare providers intuitively understand that, as a cohort, elderly patients have a widely divergent general health status and the ability to cope with and recover from medical or surgical conditions. Frailty, defined as a state of increased vulnerability resulting from a decline in reserve and function across multiple physiological systems,1 provides a conceptual framework for this common observation. Frailty is, of course, not an all or none phenomenon, and as such, the quantification of frailty is important to allow for both the identification of high-risk patients and to contextualize the risk of any proposed surgical or medical intervention in relation to a patient's overall health status.
Occurrence, Risk Factors, and Time Trends for Late Reoperations due to Degenerative Cervical Spine Disease: A Finnish National Register Study of 19?377 Patients Operated on Between 1999 and 2015
Anna Kotkansalo, MD, Ville Leinonen, MD, PhD, Prof, Merja Korajoki, MSc, Katariina Korhonen, MD, PhD, Jaakko Rinne, MD, PhD, Prof ...
doi : 10.1093/neuros/nyaa464
Volume 88, Issue 3, March 2021, Pages 558–573
Surgery for degenerative cervical spine disease has escalated since the 1990s. Fusion has become the mainstay of surgery despite concerns regarding adjacent segment degeneration. The patient-specific trends in reoperations have not been studied previously.
Aneurysmal Subarachnoid Hemorrhage: Trends, Outcomes, and Predictions From a 15-Year Perspective of a Single Neurocritical Care Unit
Owen B Samuels, MD, Ofer Sadan, MD, PhD, Chen Feng, PhD, Kathleen Martin, DNP, Khalid Medani, MD, MPH ...
doi : 10.1093/neuros/nyaa465
Volume 88, Issue 3, March 2021, Pages 574–583
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with disproportionally high mortality and long-term neurological sequelae. Management of patients with aSAH has changed markedly over the years, leading to improvements in outcome.
Prediction of Worse Functional Status After Surgery for Degenerative Cervical Myelopathy: A Machine Learning Approach
Omar Khan, BSc, MASc, Jetan H Badhiwala, MD, Muhammad A Akbar, MD, Michael G Fehlings, MD, PhD, FRCSC
doi : 10.1093/neuros/nyaa477
Volume 88, Issue 3, March 2021, Pages 584–591
Surgical decompression for degenerative cervical myelopathy (DCM) is one of the mainstays of treatment, with generally positive outcomes. However, some patients who undergo surgery for DCM continue to show functional decline.
Differences in Genomic Alterations Between Brain Metastases and Primary Tumors
Antonio Dono, MD, Takeshi Takayasu, MD, PhD, Yuanqing Yan, PhD, Bethany E Bundrant, BA, Octavio Arevalo, MD ...
doi : 10.1093/neuros/nyaa471
Volume 88, Issue 3, March 2021, Pages 592–602
Brain metastases (BMs) occur in ?1/3 of cancer patients and are associated with poor prognosis. Genomic alterations contribute to BM development; however, mutations that predispose and promote BM development are poorly understood.
Failure Types and Related Factors of Spinopelvic Fixation After Long Construct Fusion for Adult Spinal Deformity
Se-Jun Park, MD, PhD, Jin-Sung Park, MD, Yunjin Nam, MD, Tae-Hoon Yum, MD, Youn-Taek Choi, MD ...
doi : 10.1093/neuros/nyaa469
Volume 88, Issue 3, March 2021, Pages 603–611
Rigid internal fixation of the spine is an essential part of adult spinal deformity (ASD) surgery. Despite the use of pelvic fixation and anterior column support, spinopelvic fixation failure (SPFF) still remains an issue. Few studies have evaluated the types of such failure or its related factors.
Commentary: Failure Types and Related Factors of Spinopelvic Fixation After Long Construct Fusion for Adult Spinal Deformity
Lee A Tan, MD
doi : 10.1093/neuros/nyaa489
Volume 88, Issue 3, March 2021, Pages E238–E239
The authors1 conducted a retrospective review of 98 patients who underwent spinal deformity surgery with iliac fixation and examined the rate of spinopelvic fixation failure (SPFF) with a minimum of 2-yr follow-up. They found 46/98 (46.9%) patients with SPFF during the follow-up period (mean = 32.7 mo). There were 15 patients (15.3%) with SPFF above S1 and 31 patients (31.6%) with SPFF below S1. Pseudarthrosis at L5-S1 was a statistically significant risk factor for SPFF above S1, and longer fusion levels along with less postoperative thoracic kyphosis were risk factors for SPFF below S1. Remarkably, there was only 1 patient (1.0%) who required revision surgery due to worsening pain secondary to bilateral rod fractures between L5 and S1.
Commentary: Failure Types and Related Factors of Spinopelvic Fixation After Long Construct Fusion for Adult Spinal Deformity
Mohit Patel, MD, Manish K Kasliwal, MD, MCh
doi : 10.1093/neuros/nyaa516
Volume 88, Issue 3, March 2021, Pages E240–E241
Adult spinal deformity (ASD) surgery has seen an exponential growth over the last 2 decades secondary to advancement in technology, surgical techniques, and improved understanding of spinal alignment. While significant strides in research have helped us in providing improved care for patients with ASD, the pursuit to decrease the complication rate continues.
Higher Baseline Cortical Score Predicts Good Outcome in Patients With Low Alberta Stroke Program Early Computed Tomography Score Treated with Endovascular Treatment
Peng-fei Xing, MD, Yong-wei Zhang, MD, Lei Zhang, MD, Zi-fu Li, MD, Hong-jian Shen, MD ...
doi : 10.1093/neuros/nyaa472
Volume 88, Issue 3, March 2021, Pages 612–618
Patients with large vessel occlusion and noncontrast computed tomography (CT) Alberta Stroke Program Early CT Score (ASPECTS) <6 may benefit from endovascular treatment (EVT). There is uncertainty about who will benefit from it.
Disability Rating Scale in the First Few Weeks After a Severe Traumatic Brain Injury as a Predictor of 6-Month Functional Outcome
Jose-Miguel Yamal, PhD, Imoigele P Aisiku, MD, H Julia Hannay, PhD, Frances A Brito, MS, Claudia S Robertson, MD
doi : 10.1093/neuros/nyaa474
Volume 88, Issue 3, March 2021, Pages 619–626
An early acute marker of long-term neurological outcome would be useful to help guide clinical decision making and therapeutic effectiveness after severe traumatic brain injury (TBI). We investigated the utility of the Disability Rating Scale (DRS) as early as 1 wk after TBI as a predictor of favorable 6-mo Glasgow Outcome Scale extended (GOS-E).
Commentary: Disability Rating Scale in the First Few Weeks After a Severe Traumatic Brain Injury as a Predictor of 6-Month Functional Outcome
Andrew I R Maas, MD, Ewout W Steyerberg, PhD
doi : 10.1093/neuros/nyaa488
Volume 88, Issue 3, March 2021, Pages E242–E243
In this issue of Neurosurgery, Yamal et al1 explore the prognostic value of baseline characteristics plus the Disability Rating Scale (DRS) measured over weeks 1 to 4 after traumatic brain injury (TBI) for 6-mo outcome: a dichotomized classification as favorable vs unfavorable outcome according to the Glasgow Outcome Scale-Extended (GOS-E). The study is based on the dataset of the EPO-TBI (Erythropoietin in Traumatic Brain Injury) clinical trial on severe TBI that enrolled 200 patients.2 The authors report high discriminative ability: an area under the curve (AUC) of 0.82 for baseline + DRS at week 1, increasing to 0.88 for baseline + DRS at week 4. They suggest that the 1- to 4-wk DRS is useful for clinical prognostication. Moreover, the...
Preoperative Navigated Transcranial Magnetic Stimulation Improves Gross Total Resection Rates in Patients with Motor-Eloquent High-Grade Gliomas: A Matched Cohort Study
Philipp Hendrix, MD, Yvonne Dzierma, PhD, Benedikt W Burkhardt, MD, Andreas Simgen, MD, Gudrun Wagenpfeil, MSc ...
doi : 10.1093/neuros/nyaa486
Volume 88, Issue 3, March 2021, Pages 627–636
Navigated transcranial magnetic stimulation (nTMS) is an established, noninvasive tool to preoperatively map the motor cortex. Despite encouraging reports from few academic centers with vast nTMS experience, its value for motor-eloquent brain surgery still requires further exploration.
Posterior Vertebral Column Subtraction Osteotomy for Recurrent Tethered Cord Syndrome: A Multicenter, Retrospective Analysis
Nicholas Theodore, MD, Ethan Cottrill, MS, Samuel Kalb, MD, Corinna Zygourakis, MD, Bowen Jiang, MD ...
doi : 10.1093/neuros/nyaa491
Volume 88, Issue 3, March 2021, Pages 637–647
Few have explored the safety and efficacy of posterior vertebral column subtraction osteotomy (PVCSO) to treat tethered cord syndrome (TCS).
Commentary: Posterior Vertebral Column Subtraction Osteotomy for Recurrent Tethered Cord Syndrome: A Multicenter, Retrospective Analysis
Christina Huang Wright, MD, Manish K Kasliwal, MD, MCh
doi : 10.1093/neuros/nyaa525
Volume 88, Issue 3, March 2021, Pages E244–E245
Detethering surgery for recurrent tethered cord syndrome (TCS) is a challenging procedure that often leads to suboptimal clinical improvement as compared to the index detethering procedure and is accompanied by a significant risk of complications. Posterior vertebral column subtraction osteotomy (PVCSO) has been garnering increasing attention as an alternative surgical option in patients with TCS, especially those that have recurred after a primary detethering surgery.
Enhanced Recovery After Surgery Pathway for Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Decreases Length of Stay and Opioid Consumption
Mena G Kerolus, MD, Ketan Yerneni, BA, Christopher D Witiw, MD, MS, Alena Shelton, MS, William Jeffrey Canar, PhD ...
doi : 10.1093/neuros/nyaa493
Volume 88, Issue 3, March 2021, Pages 648–657
Opioid requirements in the perioperative period in patients undergoing lumbar spine fusion surgery remain problematic. Although minimally invasive surgery (MIS) techniques have been developed, there still remain substantial challenges to reducing length of hospital stay (LOS) because of postoperative opioid requirements.
Commentary: Enhanced Recovery After Surgery Pathway for Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Decreases Length of Stay and Opioid Consumption
Mohamed A Zaazoue, MD, MSc, Eric A Potts, MD
doi : 10.1093/neuros/nyaa508
Volume 88, Issue 3, March 2021, Pages E246–E247
This article by Kerolus et al1 is the largest published study to date assessing the effect of Enhanced Recovery After Surgery (ERAS) pathway for single-level minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF) compared to outcomes of a pre-ERAS reference group that underwent the same procedure, by the same limited group of surgeons, within the same institution. The authors have demonstrated a statistically significant reduction in length of stay (LOS), total admission morphine milligram equivalent (MME), and urinary retention.
Aging Patient Population With Ruptured Aneurysms: Trend Over 28 Years
James Feghali, MD, Abhishek Gami, BS, Sarah Rapaport, BS, Matthew T Bender, MD, Christopher M Jackson, MD ...
doi : 10.1093/neuros/nyaa494
Volume 88, Issue 3, March 2021, Pages 658–665
Given increasing life expectancy in the United States and worldwide, the proportion of elderly patients affected by aneurysmal subarachnoid hemorrhage (aSAH) would be expected to increase.
Commentary: Aging Patient Population With Ruptured Aneurysms: Trend Over 28 Years
Ryan G Eaton, MD, Ciar?n J Powers, MD, PhD
doi : 10.1093/neuros/nyaa520
Volume 88, Issue 3, March 2021, Pages E248–E249
The article by Feghali et al1 highlights the change in age of individuals presenting aneurysmal subarachnoid hemorrhage (aSAH) over the last 28 yr. Briefly, they reported that the mean age of individuals presenting with aSAH has increased significantly. Moreover, the number of patients over the age of 80 at presentation was found to have increased while the number of younger patients presenting with aSAH during the same time period had decreased. There could be a number of reasons for this finding including changes in demographics, increased community awareness of stroke, and improved prehospital care. However, the impact of our decisions to offer treatment for patients with cerebral aneurysms may also alter the natural history of this disease. With the lower approach morbidity...
Clinical and Imaging Characteristics of Spinal Dural Arteriovenous Fistulas and Spinal Epidural Arteriovenous Fistulas
Waleed Brinjikji, MD, Elisa Colombo, MD, Harry J Cloft, MD, PhD, Giuseppe Lanzino, MD
doi : 10.1093/neuros/nyaa492
Volume 88, Issue 3, March 2021, Pages 666–673
Spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation and are distinct from spinal dural arteriovenous fistulas (SDAVFs). Differentiating between these 2 entities is important as operative strategies often differ based on angioarchitecture.
Vitamin D—A New Perspective in Treatment of Cerebral Vasospasm
Sepide Kashefiolasl, MD, Matthias S Leisegang, PhD, Valeska Helfinger, PhD, Christoph Schürmann, PhD, Beatrice Pflüger-Müller, MSc ...
doi : 10.1093/neuros/nyaa484
Volume 88, Issue 3, March 2021, Pages 674–685
Cerebral vasospasm (CVS) is a frequent complication after subarachnoid hemorrhage (SAH), with no sufficient therapy and a complex pathophysiology.
Industry-Sponsored Research Payments in Neurosurgery—Analysis of the Open Payments Database From 2014 to 2018
Aimen Vanood, BSE, Aryana Sharrak, BS, Patrick Karabon, MS, Daniel K Fahim, MD
doi : 10.1093/neuros/nyaa506
Volume 88, Issue 3, March 2021, Pages E250–E258
The Open Payments Database (OPD) started in 2013 to combat financial conflicts of interest between physicians and medical industry.
Length of Stay Beyond Medical Readiness in a Neurosurgical Patient Population and Associated Healthcare Costs
Joseph R Linzey, MD, MS, Rachel Foshee, BS, Francine Moriguchi, BS, Arjun R Adapa, BS, Sravanthi Koduri, MD ...
doi : 10.1093/neuros/nyaa535
Volume 88, Issue 3, March 2021, Pages E259–E264
Length of stay beyond medical readiness (LOS-BMR) leads to increased expenses and higher morbidity related to hospital-acquired conditions.
Commentary: Length of Stay Beyond Medical Readiness in a Neurosurgical Patient Population and Associated Healthcare Costs
Tyler Scullen, MD, Mansour Mathkour, MD, Aaron S Dumont, MD, MBA
doi : 10.1093/neuros/nyaa542
Volume 88, Issue 3, March 2021, Pages E265–E266
The economic impact of healthcare spending has become a major point of discussion in the contemporary United States.1,2 Centers for Medicare & Medicaid Services 2018 national health expenditure projections estimated payments to rise annually by 5.4% to reach 6.2 billion dollars by 2028.1 This growth was expected to be greater than a concurrently rising United States gross domestic product (GDP), bringing expenditure percentage relative to GDP from 17.7% in 2018 to 19.9% in 2028 with expansions in the Medicare and Medicaid sectors and decreases in private payers as the total number of people insured decreases.1 Studies evaluating spending found conditions with the highest allocation in low back and neck pain, followed by systemic conditions such as hypertension, diabetes,...
A Roadmap for Developing Plasma Diagnostic and Prognostic Biomarkers of Cerebral Cavernous Angioma With Symptomatic Hemorrhage (CASH)
Romuald Girard, PhD, Yan Li, PhD, Agnieszka Stadnik, MS, Robert Shenkar, PhD, Nicholas Hobson, MS ...
doi : 10.1093/neuros/nyaa478
Volume 88, Issue 3, March 2021, Pages 686–697
Cerebral cavernous angioma (CA) is a capillary microangiopathy predisposing more than a million Americans to premature risk of brain hemorrhage. CA with recent symptomatic hemorrhage (SH), most likely to re-bleed with serious clinical sequelae, is the primary focus of therapeutic development.
Tract-Specific Relationships Between Cerebrospinal Fluid Biomarkers and Periventricular White Matter in Posthemorrhagic Hydrocephalus of Prematurity
Diego M Morales, MS, Christopher D Smyser, MD, MSCI, Rowland H Han, MD, Jeanette K Kenley, BSE, Joshua S Shimony, MD, PhD ...
doi : 10.1093/neuros/nyaa466
Volume 88, Issue 3, March 2021, Pages 698–706
Posthemorrhagic hydrocephalus (PHH) is associated with neurological morbidity and complex neurosurgical care. Improved tools are needed to optimize treatments and to investigate the developmental sequelae of PHH.
Commentary: Tract-Specific Relationships Between Cerebrospinal Fluid Biomarkers and Periventricular White Matter in Posthemorrhagic Hydrocephalus of Prematurity
Nebras M Warsi, MD, CM, George M Ibrahim, MD, PhD, FRCS(C)
doi : 10.1093/neuros/nyaa483
Volume 88, Issue 3, March 2021, Pages E267–E268
In this issue of Neurosurgery, we were pleased to see the work of Morales et al,1 who reported a novel and rigorous examination of specific cerebrospinal fluid (CSF) proteins and their relationship with diffusion-tensor magnetic resonance imaging (dMRI) features of fiber tracts in infants with posthemorrhagic hydrocephalus (PHH). Specifically, the authors focus on large periventricular tracts: the genu of the corpus callosum, posterior limb of internal capsule, and optical radiations. They demonstrate that CSF concentrations of developmentally relevant proteins, namely amyloid precursor protein (APP), L1 cell adhesion molecule (L1-CAM), and neural cell adhesion molecule 1 (NCAM1), directly relate with measures of axonal loss in each of these tracts.
Book Review: C. Miller Fisher: Stroke in the 20th Century
Jonathan Pineda, MS, Tarek Y El Ahmadieh, MD, Salah G Aoun, MD, Stephen Figueroa, MD
doi : 10.1093/neuros/nyaa526
Volume 88, Issue 3, March 2021, Pages E269–E270
Commentary: Survival Trends After Surgery for Spinal Metastatic Tumors: 20-Year Cancer Center Experience
Anisse N Chaker, BA, Abhiraj D Bhimani, MD, Ankit I Mehta, MD
doi : 10.1093/neuros/nyaa509
Volume 88, Issue 3, March 2021, Pages E271–E272
Treatment of metastatic spinal tumors focuses on 3 aspects of care: cytoreductive surgery, radiotherapy, and medical treatment.1 As these core elements of treatment prove crucial in combating this pathology, advancements within each domain are continuing to surface. Given the current manuscript encompassing an analysis of spinal metastasis survival trends over a recent 20-yr period,2 it is important to highlight the advancements occurring within each of the 3 arms of metastatic spine disease management that may have contributed to the authors’ results.
Commentary: The Glioma-Network Interface: A Review of the Relationship Between Glioma Molecular Subtype and Intratumoral Function
Bryan D Choi, MD, PhD, Benjamin L Grannan, MD, Daniel P Cahill, MD, PhD, William T Curry, MD
doi : 10.1093/neuros/nyaa517
Volume 88, Issue 3, March 2021, Pages E273–E274
In a recent issue of Neurosurgery, the authors1 test a hypothesis that the molecular profile of gliomas may significantly influence their anatomic and functional integration within language and motor networks.1 Using a retrospective approach, they present data showing that gliomas characterized by mutations in isocitrate dehydrogenase (IDH) are more likely to involve, rather than displace, eloquent cortex and subcortical tracts, implying that these lesions may be less amenable to aggressive resection. This timely analysis incorporates modern World Health Organization brain tumor classification2 with new observational data in patients undergoing craniotomy with intraoperative mapping for glial tumors.
Commentary: Robot-Assisted Stereotaxy Reduces Target Error: A Meta-Analysis and Meta-Regression of 6056 Trajectories
Konstantin V Slavin, MD
doi : 10.1093/neuros/nyaa524
Volume 88, Issue 3, March 2021, Pages E275–E276
The authors of this meta-analysis1 were able to confirm an age-old concept: none of the approaches we are using today is capable of completely eliminating a targeting error. They clearly showed that our accuracy is getting better over time, and this is very encouraging, but at the same time, they discovered that the difference for frame versus frameless approach is rather minor, and that the use of robots (as the title states) may improve accuracy by reducing the mean targeting error (MTE).
In Reply: Dismantling the Apocalypse Narrative: The Myth of the COVID-19 Stroke
Pascal Jabbour, MD, Ahmad Sweid, MD, Stavropoula Tjoumakaris, MD, Waleed Brinjikji, MD, Kimon Bekelis, MD ...
doi : 10.1093/neuros/nyaa522
Volume 88, Issue 3, March 2021, Pages E277–E280
Letter: The Withdrawal of the United States From the World Health Organization and Its Impact on Global Neurosurgery
Myron L Rolle, MD, MSc, Ulrick S Kanmounye, MD, Jacquelyn Corley, MD, Kee B Park, MD, MPH, Craig D McClain, MD, MPH
doi : 10.1093/neuros/nyaa496
Volume 88, Issue 3, March 2021, Pages E281–E282
Letter: Deep Brain Stimulation in Epilepsy: A Role for Modulation of the Mammillothalamic Tract in Seizure Control?
Naci Balak, MD
doi : 10.1093/neuros/nyaa500
Volume 88, Issue 3, March 2021, Pages E283–E284
Letter: Evaluating the Role of Advanced Practice Providers in Neurosurgery
Majid Khan, BS, Jonathan Harper, BS, Joshua Curtis Hunsaker, BS, Kristin L Kraus, MSc, Owicho Adogwa, MD, MPH ...
doi : 10.1093/neuros/nyaa502
Volume 88, Issue 3, March 2021, Pages E285–E287
Letter: Forecasting Seizure Freedom After Epilepsy Surgery Assessing Concordance Between Noninvasive and StereoEEG Findings
Jiong Yue, MD, Hui Yang, MD, PhD
doi : 10.1093/neuros/nyaa499
Volume 88, Issue 3, March 2021, Pages E288–E289
In Reply: Forecasting Seizure Freedom After Epilepsy Surgery Assessing Concordance Between Noninvasive and StereoEEG Findings
Reinaldo Uribe-San-Mart?n, MD, Roberta Di Giacomo, MD, Roberto Mai, MD, Francesca Gozzo, MD, Veronica Pelliccia, MD ...
doi : 10.1093/neuros/nyaa503
Volume 88, Issue 3, March 2021, Pages E290–E291
Letter: Assessing Frailty in Neurosurgical Patients: Less is not Always More. Is There Any Construct Validity Left in the Modified Frailty Index?
Dana Pisic?, MD, Victor Volovici, MD, PhD
doi : 10.1093/neuros/nyaa513
Volume 88, Issue 3, March 2021, Pages E292–E293
Letter: Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations
Rob Dickerman, DO, PhD, Julie Williamson, BS, Ezek Mathew, BS
doi : 10.1093/neuros/nyaa518
Volume 88, Issue 3, March 2021, Pages E294–E295
In Reply: Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations
Gregory W J Hawryluk, MD, PhD, FRCSC, Andres M Rubiano, MD, Jamshid Ghajar, MD, PhD
doi : 10.1093/neuros/nyaa523
Volume 88, Issue 3, March 2021, Pages E296–E297
Letter: Predicting Long-Term Outcomes After Poor-Grade Aneurysmal Subarachnoid Hemorrhage Using Decision Tree Modeling
Jaskaran Singh Gosal, MCh, DNB, Kuntal Kanti Das, MCh, Deepak Khatri, MCh, Kamlesh Singh Bhaisora, MCh, Sanjay Behari, MCh, DNB
doi : 10.1093/neuros/nyaa511
Volume 88, Issue 3, March 2021, Pages E298–E299
In Reply: Predicting Long-Term Outcomes After Poor-Grade Aneurysmal Subarachnoid Hemorrhage Using Decision Tree Modeling
Bing Zhao, MD, PhD, Jinjin Liu, PhD
doi : 10.1093/neuros/nyaa521
Volume 88, Issue 3, March 2021, Pages E300–E301
Letter: Altered Motor Excitability in Patients With Diffuse Gliomas Involving Motor Eloquent Areas: The Impact of Tumor Grading
Alexandra Gomes dos Santos, MD, Cintya Yukie Hayashi, MSc, Cesar Cimonari de Almeida, MD, Wellingson Silva Paiva, MD, PhD, Daniel Ciampi de Andrade, MD, PhD ...
doi : 10.1093/neuros/nyaa512
Volume 88, Issue 3, March 2021, Pages E302–E303
In Reply: Altered Motor Excitability in Patients With Diffuse Gliomas Involving Motor Eloquent Areas: The Impact of Tumor Grading
José Pedro Lavrador, MD, Ifigeneia Gioti, MD, Szymon Hoppe, MD, Josephine Jung, MD, Sabina Patel, PA ...
doi : 10.1093/neuros/nyaa514
Volume 88, Issue 3, March 2021, Pages E304–E305
Letter: From Bench-Press to Bedside; Should Neurosurgeons Care About Their Strength and Conditioning?
Marco Mancuso-Marcello, MBBS, BA (Oxon), Chandrasekaran Kaliaperumal, FEBNS, DipMedEd, FRCSI, FRCSEd(Neuro.Surg)
doi : 10.1093/neuros/nyaa515
Volume 88, Issue 3, March 2021, Pages E306–E307
Erratum to: “Thalamic and Subthalamic Deep Brain Stimulation for Essential Tremor: Where Is the Optimal Target?” Ulrika Sandvik, MD, PhD, Lars-Owe Koskinen, MD, PhD, Anders Lundquist, PhD, Patric Blomstedt, MD, PhD. Neurosurgery, Volume 70, Issue 4, April 2012
doi : 10.1093/neuros/nyaa570
Volume 88, Issue 3, March 2021, Page 707
Corrigendum to: “Strategies to Mitigate Toxicities From Stereotactic Body Radiation Therapy for Spine Metastases” by Schaub et al. Neurosurgery, nyz213, https://doi.org/10.1093/neuros/nyz213
doi : 10.1093/neuros/nyaa571
Volume 88, Issue 3, March 2021, Page 707
