Journal of neurosurgery
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Journal of neurosurgery · Dec 2024
Endoscopic pituitary gland transposition techniques to the interpeduncular and prepontine regions: an anatomical study.
The floor of the third ventricle and the interpeduncular and prepontine regions represent challenging surgical targets. The expanded endoscopic endonasal approach (EEA) with pituitary gland (PG) transposition has been proposed to provide direct access to these anatomical regions. Through the years, different endoscopic PG transposition techniques have been studied and presented. The goal of this study was to compare the techniques, relevant anatomy, and surgical exposure of extradural, intradural, and interdural PG transposition techniques. ⋯ The extradural PG transposition is indicated for lesions of the upper clivus region that extend bilaterally and do not have a cranial extension beyond the MBs. The inter- and intradural PG transpositions are beneficial for unilateral lesions that extend cranially to the MBs. Both techniques require coagulation of the ipsilateral inferior hypophyseal artery. The intradural technique requires more manipulation of the PG, while the interdural technique requires opening and access to the cavernous sinus. If needed, the intra- and interdural techniques can also be performed bilaterally.
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Journal of neurosurgery · Dec 2024
Effects of optimal versus suboptimal median household income on the surgically treated traumatic brain injury population at a level I trauma center in the Boston metropolitan area: a propensity score-matched analysis.
The median household income is a useful metric for healthcare disparity assessment. New England holds the highly diverse, densely populated Boston metropolitan area, which is known for having one of the highest living wages in the US. To the authors' knowledge, there is no published data on the effects of optimal versus suboptimal median household income on the surgical treatment of patients with traumatic brain injury (TBI). The authors sought to evaluate the disparities of an optimal versus suboptimal median household income-stratified population of patients with TBI who underwent surgical treatment at a single level I trauma center with a high safety-net burden in a major US metropolitan area. ⋯ Although the suboptimal income group is significantly more ethnically diverse, median household income does not seem to affect TBI outcomes and discharge disposition. Patients in the optimal income group more frequently presented as transfers from other facilities, potentially indicating fair high-level care at a specialized trauma center with a high safety-net burden adapted to a diverse patient population.
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Journal of neurosurgery · Dec 2024
Cost-minimizing thresholds and recurrence rates in surgical evacuation with adjunctive middle meningeal artery embolization versus evacuation alone.
Cost-minimization approaches for the treatment of patients with chronic subdural hematoma (cSDH) are important given the increasing incidence of this pathology, particularly among elderly patients receiving antiplatelet and anticoagulation medications. The use of middle meningeal artery embolization (MMAE) as an adjunct to surgical evacuation has shown promise in reducing surgical recurrence; however, additional costs are involved with this procedure. Using their institutional experience, the authors identified thresholds for cost and the cSDH surgical recurrence rate that could influence treatment decisions in patients requiring surgical evacuation for cSDH. ⋯ Although ES/MMAE is more efficacious for the prevention of surgical recurrence in patients requiring surgical evacuation of cSDH than ES alone, ES alone remains the cost-minimizing option. However, in select situations, as with a low RS rate and low cost for ES/MMAE or a high RS rate and high cost for ES alone, then ES/MMAE also becomes the cost-minimizing option. These thresholds can be used in combination with institutional costs and RS rates to help guide clinical and economic decision-making.
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Journal of neurosurgery · Dec 2024
A proposed new classification system of hypothalamic hamartomas in the era of stereotactic ablation surgery.
Since the recent development of stereotactic ablation surgery, which can provide good seizure outcomes without limitations in size or location, conventional classification systems have become unsuitable for surgical guidance. The present study aimed to evaluate the validity of a newly proposed classification system focusing on the attachment pattern. ⋯ The new classification predicts clinical features, as well as surgical complexity and complications. Although seizure outcomes were not different among subtypes because the authors' surgical strategy is consistently based on complete disconnection at the border, the new classification could improve seizure outcomes and would be helpful in the appropriate guidance for surgery of hypothalamic hamartomas to provide consistently good outcomes regardless of surgical procedures.
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Journal of neurosurgery · Dec 2024
Microsurgical obliteration of craniocervical junction dural arteriovenous fistulas via a suboccipital median approach: a retrospective study.
The authors report on a broad range of microsurgical procedures in which the suboccipital median technique was used to treat craniocervical junction arteriovenous fistulas. Their aim was to evaluate the efficacy of the suboccipital posteromedian approach and to assess the associated clinical outcomes. ⋯ The suboccipital posteromedian approach is suitable for resections of nearly all craniocervical junction dural arteriovenous fistulas. The prognosis of the patients with SAH was better than that of the patients without it.