Journal of neurosurgery
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Journal of neurosurgery · Jul 2021
Direct carotid puncture for mechanical thrombectomy in acute ischemic stroke patients with prohibitive vascular access.
While the benefit of mechanical thrombectomy (MT) for patients with anterior circulation acute ischemic stroke with large-vessel occlusion (AIS-LVO) has been clearly established, difficult vascular access may make the intervention impossible or unduly prolonged. In this study, the authors evaluated safety as well as radiographic and functional outcomes in stroke patients treated with MT via direct carotid puncture (DCP) for prohibitive vascular access. ⋯ DCP for emergency MT in patients with anterior circulation AIS-LVO and prohibitive vascular access is safe and effective and is associated with higher recanalization rates, smaller infarct volumes, and improved functional outcome compared with patients with abMT after failed transfemoral access. DCP should be considered in this patient population.
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Journal of neurosurgery · Jul 2021
Endoscopic bimanual sharp dissection technique for gross-total resection of colloid cysts: technical note.
Neuroendoscopic resection of colloid cysts has gained tremendous popularity over the last 2 decades because of good clinical outcomes and a low complication profile. However, in comparison to microsurgical resections, endoscopic resection has a lower rate of gross-total resection, which leaves the patient at risk for cyst recurrence. At present, there is still ongoing debate as to the best surgical approach for colloid cysts. ⋯ It is the authors' belief that gross-total resection should be the aim of endoscopic cyst resection. In this technical note, they describe their surgical technique for achieving safe gross-total resection of colloid cysts by using a ventriculoscopic system. The surgical technique includes a far anterolateral entry point, navigational guidance, bimanual sharp dissection, use of the endoscopic sheath as a retractor, the small-chamber irrigation technique, and the dry-field technique for hemostasis.
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Journal of neurosurgery · Jul 2021
A data-driven model to identify high-risk aneurysms and guide management decisions: the Rupture Resemblance Score.
Previous studies have found that ruptured intracranial aneurysms (RIAs) have distinct morphological and hemodynamic characteristics, including higher size ratio and oscillatory shear index and lower wall shear stress. Unruptured intracranial aneurysms (UIAs) that possess similar characteristics to RIAs may be at a higher risk of rupture than those UIAs that do not. The authors previously developed the Rupture Resemblance Score (RRS), a data-driven computer model that can objectively gauge the similarity of UIAs to RIAs in terms of morphology and hemodynamics. The authors aimed to explore the clinical utility of RRS in guiding the management of UIAs, especially for challenging cases such as small UIAs. ⋯ Although not a rupture predictor, RRS is a data-driven model that gauges the similarity of UIAs to RIAs in terms of morphology and hemodynamics. In cases in which the UIATS-based recommendation is not definitive, RRS provides additional stratification to assist the identification of high-risk UIAs. The current study highlights the clinical utility of RRS in a real-world setting as an adjunctive tool for the management of UIAs.
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Journal of neurosurgery · Jul 2021
Case ReportsPituitary hyperplasia causing complete bitemporal hemianopia with resolution following surgical decompression: case report.
In this report, the authors demonstrated that idiopathic pituitary hyperplasia (PH) can cause complete bitemporal hemianopia and amenorrhea, even in the setting of mild anatomical compression of the optic chiasm and normal pituitary function. Furthermore, complete resolution of symptoms can be achieved with surgical decompression. PH can occur in the setting of pregnancy or end-organ insufficiency, as well as with medications such as oral contraceptives and antipsychotics, or it can be idiopathic. ⋯ Pathology results demonstrated PH. A postoperative visual field examination revealed complete resolution of the bitemporal hemianopia, and menstruation resumed 3 days later. The patient remains asymptomatic with no hormonal deficits.
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Journal of neurosurgery · Jul 2021
Oblique trajectory angles in robotic stereo-electroencephalography.
Traditional stereo-electroencephalography (sEEG) entails the use of orthogonal trajectories guided by seizure semiology and arteriography. Advances in robotic stereotaxy and computerized neuronavigation have made oblique trajectories more feasible and easier to implement without formal arteriography. Such trajectories provide access to components of seizure networks not readily sampled using orthogonal trajectories. However, the dogma regarding the relative safety and predictability of orthogonal and azimuth-based trajectories persists, given the absence of data regarding the safety and efficacy of oblique sEEG trajectories. In this study, the authors evaluated the relative accuracy and efficacy of both orthogonal and oblique trajectories during robotic implantation of sEEG electrodes to sample seizure networks. ⋯ The magnitude of stereotactic errors in this study falls squarely within the range reported in the sEEG literature, which primarily features orthogonal trajectories. The patient outcomes reported in this study suggest that seizure foci are well localized using oblique trajectories. Thus, the selective use of oblique trajectories in the authors' cohort was associated with excellent safety and efficacy, with no patient incidents, and the findings support the use of oblique trajectories as an effective and safe means of investigating seizure networks.