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Cushing’s dogged struggle against death: the astonishing case of a patient under cardiac arrest surviving craniopharyngioma surgery
Ruth Prieto and José Mar?a Pascual
doi : 10.3171/2019.11.JNS192487
The decisive role Dr. Harvey Cushing (1869–1939) played in medicine goes far beyond the development of neurosurgery. His scientific devotion and commitment to patient care made him an ethical model of strict professionalism. This paper seeks to analyze the decisions Cushing made with the challenging case of HW, an adolescent boy with a craniopharyngioma (CP) involving the third ventricle. Cushing’s earlier failure to successfully remove two similar lesions alerted him to the proximity of HW’s tumor and the hypothalamus. Consequently, he decided to use the chiasm-splitting technique for the first time, with the aim of dissecting the CP-hypothalamus boundaries under direct view. Unexpectedly, HW suffered cardiac arrest during the surgery, but Cushing did not give up. He continued with the operation while his assistants performed resuscitation maneuvers. Such determined and courageous action allowed Cushing to succeed in an apparently hopeless case. Cushing’s unwavering willingness to save patients’ lives, even under extreme circumstances, was a fundamental trait defining his identity as a neurosurgeon. Analyzing the way Cushing dealt with HW’s case provides valuable lessons for neurosurgeons today, particularly the importance of assuming proactive attitudes and, in certain cases, making painstaking efforts to overcome daunting situations to save a life.
One hundred years of neurosurgery: contributions of American women
Jacquelyn Corley, Eliana Kim, Chris Ann Philips, Martina Stippler, Ann M. Parr, Jennifer Sweet, and Gail Rosseau
doi : 10.3171/2019.12.JNS192878
The end of the first 100 years of any endeavor is an appropriate time to look back and peer forward. As neurosurgery celebrates its 1st century as a specialty, the increasing role of women neurosurgeons is a major theme. This article documents the early women pioneers in neurosurgery. The contributions of these trailblazers to the origins, academics, and professional organizations of neurosurgery are highlighted. The formation of Women in Neurosurgery in 1989 is described, as is the important role this organization has played in introducing and promoting talented women in the profession. Contributions of women neurosurgeons to academic medicine and society as a whole are briefly highlighted. Contemporary efforts and initiatives indicate future directions in which women may lead neurosurgery in its 2nd century.
Exemplary mentorship in action: Harvey Cushing’s trainees from 1912 to 1919
Michael P. Catalino and Edward R. Laws Jr.
doi : 10.3171/2019.12.JNS192371
Harvey Cushing overcame tremendous obstacles to his personal and professional development from 1912 to 1919. These trials could have jeopardized the early and necessary formation of the Society of Neurological Surgeons in 1920. War separated young neurosurgeons pursuing the advancement of this “special field,” but Cushing’s principled mentoring of these aspiring surgeons in the midst of this demanding time was unwavering. This historical vignette is a collection of stories composed to highlight certain trainees during this period in his career. It also puts the mentoring relationship into a context that is often encountered today. There is much to learn from those who endure trials of any kind, but there is much more to learn from those, like Cushing, who inspire perseverance in others during their trials.
Multitarget deep brain stimulation for clinically complex movement disorders
Tariq Parker, Ashley L. B. Raghu, James J. FitzGerald, Alexander L. Green, and Tipu Z. Aziz
doi : 10.3171/2019.11.JNS192224
Deep brain stimulation (DBS) of single-target nuclei has produced remarkable functional outcomes in a number of movement disorders such as Parkinson’s disease, essential tremor, and dystonia. While these benefits are well established, DBS efficacy and strategy for unusual, unclassified movement disorder syndromes is less clear. A strategy of dual pallidal and thalamic electrode placement is a rational approach in such cases where there is profound, medically refractory functional impairment. The authors report a series of such cases: midbrain cavernoma hemorrhage with olivary hypertrophy, spinocerebellar ataxia-like disorder of probable genetic origin, Holmes tremor secondary to brainstem stroke, and hemiballismus due to traumatic thalamic hemorrhage, all treated by dual pallidal and thalamic DBS. All patients demonstrated robust benefit from DBS, maintained in long-term follow-up. This series demonstrates the flexibility and efficacy, but also the limitations, of dual thalamo-pallidal stimulation for managing axial and limb symptoms of tremors, dystonia, chorea, and hemiballismus in patients with complex movement disorders.
Short- and long-term cognitive effects of deep brain stimulation in the caudal zona incerta versus best medical treatment in patients with Parkinson’s disease
Johanna Philipson, Patric Blomstedt, Anna Fredricks, Marwan Hariz, Rasmus Stenmark Persson, and Marjan Jahanshahi
doi : 10.3171/2019.12.JNS192654
A growing number of studies are showing positive effects of deep brain stimulation (DBS) in the caudal zona incerta (cZi) in various tremor disorders, as well as motor symptoms of Parkinson’s disease (PD). The focus of the present study was to evaluate short- and long-term cognitive effects of bilateral cZi DBS in patients with PD.
Deep brain stimulation for aggressiveness: long-term follow-up and tractography study of the stimulated brain areas
Cristina V. Torres, Guillermo Blasco, Marta Navas Garc?a, Elena Ezquiaga, Jes?s Pastor, Lorena Vega-Zelaya, Paloma Pulido Rivas, Silvia Pérez Rodrigo, and Rafael Manzanares
doi : 10.3171/2019.11.JNS192608
Initial studies applying deep brain stimulation (DBS) of the posteromedial hypothalamus (PMH) to patients with pathological aggressiveness have yielded encouraging results. However, the anatomical structures involved in its therapeutic effect have not been precisely identified. The authors’ objective was to describe the long-term outcome in their 7-patient series, and the tractography analysis of the volumes of tissue activated in 2 of the responders.
MR-guided focused ultrasound cerebellothalamic tractotomy for chronic therapy-resistant essential tremor: anatomical target reappraisal and clinical results
Marc N. Gallay, David Moser, and Daniel Jeanmonod
doi : 10.3171/2019.12.JNS192219
In addition to the well-recognized ventral intermediate nucleus (Vim) thalamotomy for the treatment of chronic therapy-resistant essential tremor (ET), an alternative approach targeting the posterior part of the subthalamus was proposed in the 1960s and early 1970s and then was reactualized as cerebellothalamic tractotomy (CTT) with the advent of MR-guided focused ultrasound (MRgFUS) surgery. The goal of this study was to improve target coverage and thus efficacy (i.e., tremor control and its consistency). The authors undertook a histological reappraisal of the CTT target and proposed a targeting strategy of the MRgFUS CTT based on 1) the MR visualization of the center of the red nucleus and 2) the application of preplanned target subunits realized with short sonications under thermal dose control. This study was aimed at demonstrating the efficacy and risk profile of this approach against chronic therapy-resistant ET.
Predictors of second-sided deep brain stimulation for Parkinson’s disease
Joshua L. Golubovsky, Hong Li, Arbaz Momin, Jianning Shao, Maxwell Y. Lee, Leonardo A. Frizon, Olivia Hogue, Benjamin Walter, André G. Machado, and Sean J. Nagel
doi : 10.3171/2019.12.JNS19638
Parkinson’s disease (PD) is a progressive neurological movement disorder that is commonly treated with deep brain stimulation (DBS) surgery in advanced stages. The purpose of this study was to investigate factors that affect time to placement of a second-sided DBS lead for PD when a unilateral lead is initially placed for asymmetrical presentation. The decision whether to initially perform unilateral or bilateral DBS is largely based on physician and/or patient preference.
Occipital nerve stimulation and deep brain stimulation for refractory cluster headache: a prospective analysis of efficacy over time
Juan ?ngel Aibar-Dur?n, Mar?a Jes?s ?lvarez Holzapfel, Rodrigo Rodr?guez Rodr?guez, Robert Belvis Nieto, Carles Roig Arnall, and Joan Molet Teixido
doi : 10.3171/2019.11.JNS192042
Occipital nerve stimulation (ONS) and deep brain stimulation (DBS) are widely used surgical treatments for chronic refractory cluster headache (CH). However, there is little literature regarding long-term follow-up of these treatments.
Subcutaneous sumatriptan: association with decreases in postoperative pain and opioid use after elective cranial surgery
Kunal S. Patel, Azim N. Laiwalla, Jasmine A. T. DiCesare, Matthew C. Garrett, and Anthony C. Wang
doi : 10.3171/2019.10.JNS192503
Sumatriptan, a serotonin receptor agonist, has been used in the management of primary headache disorders and has been shown to affect trigeminal dural afferents. There is limited literature on the safety and efficacy of sumatriptan for postcraniotomy pain management. This study aimed to identify whether subcutaneous sumatriptan is a safe and efficacious pain management strategy after elective craniotomy.
Predictors of recurrence and high growth rate of residual meningiomas after subtotal resection
Joshua Materi, David Mampre, Jeff Ehresman, Jordina Rincon-Torroella, and Kaisorn L. Chaichana
doi : 10.3171/2019.10.JNS192466
The extent of resection has been shown to improve outcomes in patients with meningiomas. However, resection can be complicated by constraining local anatomy, leading to subtotal resections. An understanding of the natural history of residual tumors is necessary to better guide postsurgical management and minimize recurrence. This study seeks to identify predictors of recurrence and high growth rate following subtotal resection of intracranial meningiomas.
Contralesional homotopic functional plasticity in patients with temporal glioma
Dongming Liu, Jiu Chen, Xinhua Hu, Guanjie Hu, Yong Liu, Kun Yang, Chaoyong Xiao, Yuanjie Zou, and Hongyi Liu
doi : 10.3171/2019.11.JNS191982
This study aimed to explore the contralesional homotopic functional plasticity in the brain of patients with unilateral temporal glioma.
Combination of ALA-induced fluorescence-guided resection and intraoperative open photodynamic therapy for recurrent glioblastoma: case series on a promising dual strategy for local tumor control
Stephanie Schipmann, Michael Müther, Louise St?gbauer, Sebastian Zimmer, Benjamin Brokinkel, Markus Holling, Oliver Grauer, Eric Suero Molina, Nils Warneke, and Walter Stummer
doi : 10.3171/2019.11.JNS192443
High-grade glioma (HGG) prognosis remains dismal, with inevitable, mostly local recurrence. Regimens for improving local tumor control are therefore needed. Photodynamic therapy (PDT) using porfimer sodium has been investigated but was abandoned due to side effects and lack of survival benefits. Intracellular porphyrins induced by 5-aminolevulinic acid (5-ALA) are approved for fluorescence-guided resections (FGRs), but are also photosensitizers. Activated by light, they generate reactive oxygen species with resultant cytotoxicity. The authors present a combined approach of 5-ALA FGR and PDT.
Epidemiology, natural history, and optimal management of neurohypophyseal germ cell tumors
Hirokazu Takami, Christopher S. Graffeo, Avital Perry, Caterina Giannini, and David J. Daniels
doi : 10.3171/2019.10.JNS191136
Intracranial germ cell tumors (iGCTs) often arise at the neurohypophysis, their second most common origination, following the pineal region. Neurohypophyseal iGCTs present with stereotypical symptoms, including pituitary dysfunction and visual field deficit, due to their suprasellar location. The goal of this study was to present a large, longitudinal single-institution experience with neurohypophyseal iGCTs to better understand their natural history and identify opportunities for further improvement in treatment outcomes.
Comparison on epidemiology, tumor location, histology, and prognosis of intracranial germ cell tumors between Mayo Clinic and Japanese consortium cohorts
Hirokazu Takami, Avital Perry, Christopher S. Graffeo, Caterina Giannini, Yoshitaka Narita, Yoichi Nakazato, Nobuhito Saito, Ryo Nishikawa, Masao Matsutani, Koichi Ichimura, and David J. Daniels
doi : 10.3171/2019.11.JNS191576
Central nervous system (CNS) germ cell tumors (GCTs) are rare malignant neoplasms that arise predominantly in adolescents and young adults. CNS GCTs demonstrate characteristic trends in national associations, with implications for both tumor incidence and genetics. Although the incidence of CNS GCTs is markedly higher in East Asia than Western countries, direct comparative analyses between these CNS GCT populations are limited.
A preoperative risk classifier that predicts tumor progression in patients with cranial base chondrosarcomas
Andrew S. Venteicher, Michael M. McDowell, Ezequiel Goldschmidt, Eric W. Wang, Carl H. Snyderman, and Paul A. Gardner
doi : 10.3171/2019.10.JNS191672
The authors conducted a study to identify clinical features of cranial base chondrosarcomas that will predict tumor progression after resection.
The effect of Gamma Knife radiosurgery on large posterior fossa metastases and the associated mass effect from peritumoral edema
Baha’eddin A. Muhsen, Krishna C. Joshi, Bryan S. Lee, Bicky Thapa, Hamid Borghei-Razavi, Xuefei Jia, Gene H. Barnett, Samuel T. Chao, Alireza M. Mohammadi, John H. Suh, Michael A. Vogelbaum, and Lilyana Angelov
doi : 10.3171/2019.11.JNS191485
Gamma Knife radiosurgery (GKRS) as monotherapy is an option for the treatment of large (? 2 cm) posterior fossa brain metastases (LPFMs). However, there is concern regarding possible posttreatment increase in peritumoral edema (PTE) and associated compression of the fourth ventricle. This study evaluated the effects and safety of GKRS on tumor and PTE control in LPFM.
Safety and feasibility of multiple blood-brain barrier disruptions for the treatment of glioblastoma in patients undergoing standard adjuvant chemotherapy
So Hee Park, Myung Ji Kim, Hyun Ho Jung, Won Seok Chang, Hyun Seok Choi, Itay Rachmilevitch, Eyal Zadicario, and Jin Woo Chang
doi : 10.3171/2019.10.JNS192206
Glioblastoma (GBM) remains fatal due to the blood-brain barrier (BBB), which interferes with the delivery of chemotherapeutic agents. The purpose of this study was to evaluate the safety and feasibility of repeated disruption of the BBB (BBBD) with MR-guided focused ultrasound (MRgFUS) in patients with GBM during standard adjuvant temozolomide (TMZ) chemotherapy.
Intraoperative MRI versus 5-ALA in high-grade glioma resection: a network meta-analysis
Danielle Golub, Jonathan Hyde, Siddhant Dogra, Joseph Nicholson, Katherine A. Kirkwood, Paulomi Gohel, Stephen Loftus, and Theodore H. Schwartz
doi : 10.3171/2019.12.JNS191203
High-grade gliomas (HGGs) continue to carry poor prognoses, and patient outcomes depend heavily on the extent of resection (EOR). The utility of conventional image-guided surgery is limited by intraoperative brain shift. More recent techniques to maximize EOR, including intraoperative imaging and the use of fluorescent dyes, combat these limitations. However, the relative efficacy of these two techniques has never been systematically compared. Thus, the authors performed an exhaustive systematic review in conjunction with quantitative network meta-analyses to evaluate the comparative effectiveness of 5-aminolevulinic acid (5-ALA) and intraoperative MRI (IMRI) in optimizing EOR in HGG. They secondarily analyzed associated progression-free and overall survival and performed subgroup analyses by level of evidence.
MEG3/MIR-376B-3P/HMGA2 axis is involved in pituitary tumor invasiveness
Dimin Zhu, Zheng Xiao, Zongming Wang, Bin Hu, Chengbin Duan, Ziyan Zhu, Nailin Gao, Yonghong Zhu, and Haijun Wang
doi : 10.3171/2019.10.JNS191959
To date, long noncoding RNAs (lncRNAs) have proven to function as key regulators in tumorigenesis. Among these lncRNAs, MEG3 displays low levels in various neoplasms and tumor cell lines. However, the regulatory mechanism of MEG3 and MIR-376B-3P, one of the microRNAs from downstream gene clusters of the DLK1-MEG3 locus, remains insufficiently defined.
Reversibility of impaired brain structures after transsphenoidal surgery in Cushing’s disease: a longitudinal study based on an artificial intelligence–assisted tool
Bo Hou, Lu Gao, Lin Shi, Yishan Luo, Xiaopeng Guo, Geoffrey S. Young, Lei Qin, Huijuan Zhu, Lin Lu, Zihao Wang, Ming Feng, Xinjie Bao, Renzhi Wang, Bing Xing, and Feng Feng
doi : 10.3171/2019.10.JNS191400
Cushing’s disease (CD) involves brain impairments caused by excessive cortisol. Whether these impairments are reversible in remitted CD after surgery has long been controversial due to a lack of high-quality longitudinal studies. In this study the authors aimed to assess the reversibility of whole-brain changes in remitted CD after transsphenoidal surgery (TSS), and its correlations with clinical and hormonal parameters, in the largest longitudinal study cohort to date for CD patient brain analysis.
External jugular venous sampling for Cushing’s disease in a patient with hypoplastic inferior petrosal sinuses
Keyan A. Peterson, Christofer D. Burnette, Kyle M. Fargen, Patrick A. Brown, James L. West, Stephen B. Tatter, and Stacey Q. Wolfe
doi : 10.3171/2019.11.JNS192374
The authors report the case of a 30-year-old female patient with suspected Cushing’s disease with an anatomical variation of hypoplastic inferior petrosal sinuses and nearly exclusive anterior drainage from the cavernous sinus, who underwent external jugular venous blood sampling with successful disease confirmation and microadenoma localization. The patient presented with signs and symptoms consistent with Cushing’s syndrome, but with discordant preliminary diagnostic testing. She underwent attempted bilateral inferior petrosal sinus sampling; however, she had hypoplastic inferior petrosal sinuses bilaterally and predominantly anterior drainage from the cavernous sinus into the external jugular circulation. Given this finding, the decision was made to proceed with external jugular venous access and sampling in addition to internal jugular venous sampling. A positive adrenocorticotropic hormone (ACTH) response to corticotropin-releasing factor was obtained in the right external jugular vein alone, suggesting a right-sided pituitary microadenoma as the cause of her Cushing’s disease. The patient subsequently underwent a transsphenoidal hypophysectomy that confirmed the presence of a right-sided ACTH-secreting microadenoma, which was successfully resected. She was hypocortisolemic on discharge and has had no signs of recurrence or relapse at 6 months postoperation.
Comparison of intraoperative cortisol levels after preoperative hydrocortisone administration versus placebo in patients without adrenal insufficiency undergoing endoscopic transsphenoidal removal of nonfunctioning pituitary adenomas: a double-blind randomized trial
Hyung-Chul Lee, Hyun-Kyu Yoon, Jung Hee Kim, Yong Hwy Kim, and Hee-Pyoung Park
doi : 10.3171/2019.11.JNS192381
In this double-blind randomized trial, the necessity of preoperative steroid administration in patients without adrenal insufficiency (AI) undergoing endoscopic transsphenoidal surgery (ETSS) for pituitary adenoma was evaluated.
Long-term outcomes after endoscopic endonasal surgery for nonfunctioning pituitary macroadenomas
Mina M. Gerges, Kavelin Rumalla, Saniya S. Godil, Iyan Younus, Walid Elshamy, Georgiana A. Dobri, Ashutosh Kacker, Abtin Tabaee, Viay K. Anand, and Theodore H. Schwartz
doi : 10.3171/2019.11.JNS192457
Nonfunctioning pituitary adenomas are benign, slow-growing tumors. After gross-total resection (GTR) or subtotal resection (STR), tumors can recur or progress and may ultimately require additional intervention. 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.
Outcomes of Cushing’s disease following Gamma Knife radiosurgery: effect of a center’s growing experience and era of treatment
Adomas Bunevicius, Darrah Sheehan, Mary Lee Vance, David Schlesinger, and Jason P. Sheehan
doi : 10.3171/2019.12.JNS192743
Stereotactic radiosurgery (SRS) is used for the management of residual or recurrent Cushing’s disease (CD). Increasing experience and technological advancements of Gamma Knife radiosurgery (GKRS) systems can impact the outcomes of CD patients. The authors evaluated the association of their center’s growing experience and the era in which GKRS was performed with treatment success and adverse events in patients with CD.
CBF changes and cerebral energy metabolism during hypervolemia, hemodilution, and hypertension therapy in patients with poor-grade subarachnoid hemorrhage
Henrik Engquist, Anders Lewén, Lars Hillered, Elisabeth Ronne-Engstr?m, Pelle Nilsson, Per Enblad, and Elham Rostami
doi : 10.3171/2019.11.JNS192759
Despite the multifactorial pathogenesis of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH), augmentation of cerebral blood flow (CBF) is still considered essential in the clinical management of DCI. The aim of this prospective observational study was to investigate cerebral metabolic changes in relation to CBF during therapeutic hypervolemia, hemodilution, and hypertension (HHH) therapy in poor-grade SAH patients with DCI.
Association between aneurysm hemodynamics and wall enhancement on 3D vessel wall MRI
Muhammad Owais Khan, Veronica Toro Arana, Christian Rubbert, Jan F. Cornelius, Igor Fischer, Richard Bostelmann, Hendrik-Jan Mijderwijk, Bernd Turowski, Hans-Jakob Steiger, Rebecca May, and Athanasios K. Petridis
doi : 10.3171/2019.10.JNS191251
Aneurysm wall enhancement (AWE) on 3D vessel wall MRI (VWMRI) has been suggested as an imaging biomarker for intracranial aneurysms (IAs) at higher risk of rupture. While computational fluid dynamics (CFD) studies have been used to investigate the association between hemodynamic forces and rupture status of IAs, the role of hemodynamic forces in unruptured IAs with AWE is poorly understood. The authors investigated the role and implications of abnormal hemodynamics related to aneurysm pathophysiology in patients with AWE in unruptured IAs.
Cerebral vessel anatomy as a predictor of first-pass effect in mechanical thrombectomy for emergent large-vessel occlusion
Shaarada Srivatsa, Yifei Duan, John P. Sheppard, Shivani Pahwa, Jonathan Pace, Xiaofei Zhou, and Nicholas C. Bambakidis
doi : 10.3171/2019.11.JNS192673
Mechanical thrombectomy is effective in acute ischemic stroke secondary to emergent large-vessel occlusion, but optimal efficacy is contingent on fast and complete recanalization. First-pass recanalization does not occur in the majority of patients. The authors undertook this study to determine if anatomical parameters of the intracranial vessels impact the likelihood of first-pass complete recanalization.
“Strokenomics”: bending the cost curve in stroke care
Stephan A. Munich, Kunal Vakharia, Matthew J. McPheeters, Michael K. Tso, Adnan H. Siddiqui, Kenneth V. Snyder, Jason M. Davies, and Elad I. Levy
doi : 10.3171/2019.11.JNS191960
The mortality rates for stroke are decreasing, yet it remains a leading cause of disability and the principal neurological diagnosis in patients discharged to nursing homes. The societal and economic burdens of stroke are substantial, with the total annual health care costs of stroke expected to reach $240.7 billion by 2030. Mechanical thrombectomy has been shown to improve functional outcomes compared to medical therapy alone. Despite an incremental cost of $10,840 compared to medical therapy, the improvement in functional outcomes and decreased disability have contributed to the cost-effectiveness of the procedure. In this study the authors describe a physician-led device bundle purchase program implemented for the delivery of stroke care.
Early experience with a novel net temporary bridging device (Cascade) to assist endovascular coil embolization of intracranial aneurysms
Alejandro Tomasello, David Hernandez, Laura Ludovica Gramegna, Sonia Aixut, Roger Barranco Pons, Olav Jansen, Michal Zawadzki, Antonio Lopez-Rueda, Carmen Parra-Fari?as, Carlos Pi?ana, Lavinia Dinia, Fuat Arikan, and Alex Rovira
doi : 10.3171/2019.11.JNS192477
The goal of this study was to evaluate the effectiveness and safety of a new noncompletely occlusive net-assisted remodeling technique in which the Cascade net device is used for temporary bridging of intracranial aneurysms.
Variation of membrane particle–bound CD133 in cerebrospinal fluid of patients with subarachnoid and intracerebral hemorrhage
Tobias Bobinger, Sebastian S. Roeder, Maximilian I. Spruegel, Kilian Froehlich, Vanessa D. Beuscher, Philip Hoelter, Hannes Lücking, Denis Corbeil, and Hagen B. Huttner
doi : 10.3171/2019.11.JNS191861
Previous studies have demonstrated that human CSF contains membrane particles carrying the stem cell antigenic marker CD133 (prominin-1). Here, the authors analyzed the variation of the amount of these CD133-positive particles in the CSF of patients with subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH).
Endoscopic approaches to orbital lesions: case series and systematic literature review
Matteo Zoli, Giacomo Sollini, Laura Milanese, Emanuele La Corte, Arianna Rustici, Federica Guaraldi, Sofia Asioli, Luigi Cirillo, Ernesto Pasquini, and Diego Mazzatenta
doi : 10.3171/2019.10.JNS192138
Surgical treatment of orbital lesions is challenging because complex approaches with a high risk of postoperative sequelae are required. Recently, minimally invasive endoscopic approaches through endonasal (EEA) and transpalpebral (ETP) routes have been proposed. The objective of this study was to assess outcomes of EEA and ETP in the authors’ series of patients with orbital lesions.
Cranial flap fixation in sheep using a resorbable bone adhesive
Kevin T. Foley, Eric J. Woodard, Jonathan R. Slotkin, Cassandra K. Mayotte, Abigail C. Baldwin, Michael C. Brown, and Brian J. Hess
doi : 10.3171/2019.11.JNS192806
The authors’ goal in this study was to investigate the use of a novel, bioresorbable, osteoconductive, wet-field mineral-organic bone adhesive composed of tetracalcium phosphate and phosphoserine (TTCP-PS) for cranial bone flap fixation and compare it with conventional low-profile titanium plates and self-drilling screws.
The use of intraoperative neurosurgical ultrasound for surgical navigation in low- and middle-income countries: the initial experience in Tanzania
Aingaya J. Kaale, Nicephorus Rutabasibwa, Laurent Lemeri Mchome, Kevin O. Lillehei, Justin M. Honce, Joseph Kahamba, and D. Ryan Ormond
doi : 10.3171/2019.12.JNS192851
Neuronavigation has become a crucial tool in the surgical management of CNS pathology in higher-income countries, but has yet to be implemented in most low- and middle-income countries (LMICs) due to cost constraints. In these resource-limited settings, neurosurgeons typically rely on their understanding of neuroanatomy and preoperative imaging to help guide them through a particular operation, making surgery more challenging for the surgeon and a higher risk for the patient. Alternatives to assist the surgeon improve the safety and efficacy of neurosurgery are important for the expansion of subspecialty neurosurgery in LMICs. A low-cost and efficacious alternative may be the use of intraoperative neurosurgical ultrasound. The authors analyze the preliminary results of the introduction of intraoperative ultrasound in an LMIC setting.
Assessment of the NIH-supported relative citation ratio as a measure of research productivity among 1687 academic neurological surgeons
Vamsi Reddy, Arjun Gupta, Michael D. White, Raghav Gupta, Prateek Agarwal, Arpan V. Prabhu, Bryan Lieber, Yue-Fang Chang, and Nitin Agarwal
doi : 10.3171/2019.11.JNS192679
Publication metrics such as the Hirsch index (h-index) are often used to evaluate and compare research productivity in academia. The h-index is not a field-normalized statistic and can therefore be dependent on overall rates of publication and citation within specific fields. Thus, a metric that adjusts for this while measuring individual contributions would be preferable. The National Institutes of Health (NIH) has developed a new, field-normalized, article-level metric called the “relative citation ratio” (RCR) that can be used to more accurately compare author productivity between fields. The mean RCR is calculated as the total number of citations per year of a publication divided by the average field-specific citations per year, whereas the weighted RCR is the sum of all article-level RCR scores over an author’s career. The present study was performed to determine how various factors, such as academic rank, career duration, a Doctor of Philosophy (PhD) degree, and sex, impact the RCR to analyze research productivity among academic neurosurgeons.
In vitro and in vivo characterization of a cranial window prosthesis for diagnostic and therapeutic cerebral ultrasound
Francesco Prada, Andrea Franzini, Shayan Moosa, Frederic Padilla, David Moore, Luigi Solbiati, Francesco DiMeco, and Wynn Legon
doi : 10.3171/2019.10.JNS191674
The authors evaluated the acoustic properties of an implantable, biocompatible, polyolefin-based cranial prosthesis as a medium to transmit ultrasound energy into the intracranial space with minimal distortion for imaging and therapeutic purposes.
Critical area for memory decline after mesial temporal resection in epilepsy patients
Dahye Kim, June Sic Kim, Woorim Jeong, Min-Sup Shin, and Chun Kee Chung
doi : 10.3171/2019.10.JNS191932
Mesial temporal lobe epilepsy (MTLE) surgery is associated with a risk of memory decline after surgery, but the effect of the extent and locus of temporal resection on postoperative memory function are controversial. The authors’ aim in this study was to confirm if selective resection is effective in preserving memory function and identify critical areas for specific memory decline after temporal resection.
Risk factors for developing subdural hematoma: a registry-based study in 1457 patients with shunted idiopathic normal pressure hydrocephalus
Johan Gasslander, Nina Sundstr?m, Anders Eklund, Lars-Owe D. Koskinen, and Jan Malm
doi : 10.3171/2019.10.JNS191223
Subdural hematomas and hygromas (SDHs) are common complications in idiopathic normal pressure hydrocephalus (iNPH) patients with shunts. In this registry-based study, patients with shunted iNPH were screened nationwide to identify perioperative variables that may increase the risk of SDH.
Erratum. Predictors of recurrence and high growth rate of residual meningiomas after subtotal resection
Kaisorn L. Chaichana
Letter to the Editor. Hyperglycolysis as a common cause for elevated lactate in subarachnoid hemorrhage
Mendel Castle-Kirszbaum, Scott Ayton, and Tony Goldschlager
doi : 10.3171/2020.1.JNS20191
