Journal of neurosurgery
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Journal of neurosurgery · Dec 2022
Early repeat resection for residual glioblastoma: decision-making among an international cohort of neurosurgeons.
The importance of extent of resection (EOR) in glioblastoma (GBM) has been thoroughly demonstrated. However, few studies have explored the practices and benefits of early repeat resection (ERR) when residual tumor deemed resectable is unintentionally left after an initial resection, and the survival benefit of ERR is still unknown. Herein, the authors aimed to internationally survey current practices regarding ERR and to analyze differences based on geographic location and practice setting. ⋯ Results of this survey reveal current practices regarding ERR, but they also demonstrate the variability in how neurosurgeons approach ERR. Standardized guidelines based on future studies incorporating tumor molecular characteristics are needed to guide neurosurgeons in their decision-making on this complicated issue.
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Journal of neurosurgery · Dec 2022
Impact of collateral flow on cost-effectiveness of endovascular thrombectomy.
Acute ischemic stroke patients with large-vessel occlusion and good collateral blood flow have significantly better outcomes than patients with poor collateral circulation. The purpose of this study was to evaluate the cost-effectiveness of endovascular thrombectomy (EVT) based on collateral status and, in particular, to analyze its effectiveness in ischemic stroke patients with poor collaterals. ⋯ EVT treatment in the early time window for good outcome after ischemic stroke is cost-effective irrespective of the quality of collateral circulation, and patients should not be excluded from thrombectomy solely on the basis of collateral status. Despite relatively lower benefits of EVT in patients with poor collaterals, even smaller differences in better outcomes have significant long-term financial implications that make EVT cost-effective.
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Journal of neurosurgery · Dec 2022
Regrowth factors of WHO grade I skull base meningiomas following incomplete resection.
The role of adjuvant radiation therapy following incomplete resection of WHO grade I skull base meningiomas (SBMs) is controversial, and little is known regarding the behavior of residual tumors. The authors investigated the factors that influence regrowth of residual WHO grade I SBMs following incomplete resection. ⋯ Ki-67 PI and Simpson resection grade showed significant associations with RFS for WHO grade I SBMs following incomplete resection. Ki-67 PI and Simpson resection grade could be utilized to stratify the level of risk for regrowth.
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Journal of neurosurgery · Dec 2022
An independent, external validation and component analysis of the Surviving Penetrating Injury to the Brain score for civilian cranial gunshot injuries.
The Surviving Penetrating Injury to the Brain (SPIN) score utilizes clinical variables to estimate in-hospital and 6-month mortality for patients with civilian cranial gunshot wounds (cGSWs) and demonstrated good discrimination (area under the receiver operating characteristic curve [AUC] 0.880) in an initial validation study. The goal of this study was to provide an external, independent validation of the SPIN score for in-hospital and 6-month mortality. ⋯ Given these findings, continuous 6-point mGCS score may be sufficient as a generalizable predictor of inpatient and 6-month mortality in patients with cGSW, demonstrating excellent discrimination and reduced bias due to missing data.
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Journal of neurosurgery · Dec 2022
Pituitary adenoma in the elderly: surgical outcomes and treatment trends in the United States.
Decision-making in how to manage pituitary adenomas (PAs) in the elderly (age ≥ 65 years) can be challenging given the benign nature of these tumors and concerns about surgical morbidity in these patients. In this study involving a large multicenter national registry, the authors examined treatment trends and surgical outcomes in elderly compared to nonelderly patients. ⋯ The study findings confirm that elderly patients with PA are at higher risk for postoperative mortality than younger patients. Surgical risk in this age group may have been previously underreported in the literature. Resection at HVFs better reflects these historical rates, which has important implications in elderly patients for whom surgery is being considered.