Journal of neurosurgery
-
Journal of neurosurgery · Feb 2022
Endovascular catheter manometry reliability: a benchtop validation study.
Catheter manometry is used frequently in neuroendovascular surgery for assessing cerebrovascular pathology. The accuracy of pressure data with different catheter setups requires further validation. ⋯ Mean pressure measurements are accurate through microcatheters as small as 0.013-inch ID. Pulse pressure and waveform morphology may require a microcatheter ≥ 0.031-inch ID to achieve 90% accuracy, although the 0.027-inch ID microcatheter reached 85% accuracy. A 0.070-inch guide catheter with a microcatheter ≤ 0.042-inch outer diameter (e.g., Marksman 0.027-inch ID or smaller) allows accurate transduction of pulse pressure. Further validation of these benchtop findings is necessary before application in a clinical setting.
-
Journal of neurosurgery · Feb 2022
Adapting the 5-factor modified frailty index for prediction of postprocedural outcome in patients with unruptured aneurysms.
The 5-factor modified frailty index (mFI-5) is a practical tool that can be used to estimate frailty by measuring five accessible factors: functional status, history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension. The authors aimed to validate the utility of mFI-5 for predicting endovascular and microsurgical treatment outcomes in patients with unruptured aneurysms. ⋯ mFI-5 and AmFI-5 represent potential predictors of procedure-related complications in unruptured aneurysm patients. After further validation, integration of these tools into clinical workflows may optimize patients for intervention.
-
Journal of neurosurgery · Feb 2022
Intraoperative overlay of optic radiation tractography during anteromesial temporal resection: a prospective validation study.
Anteromesial temporal lobe resection (ATLR) results in long-term seizure freedom in patients with drug-resistant focal mesial temporal lobe epilepsy (MTLE). There is significant anatomical variation in the anterior projection of the optic radiation (OR), known as Meyer's loop, between individuals and between hemispheres in the same individual. Damage to the OR results in contralateral superior temporal quadrantanopia that may preclude driving in 33%-66% of patients who achieve seizure freedom. Tractography of the OR has been shown to prevent visual field deficit (VFD) when surgery is performed in an interventional MRI (iMRI) suite. Because access to iMRI is limited at most centers, the authors investigated whether use of a neuronavigation system with a microscope overlay in a conventional theater is sufficient to prevent significant VFD during ATLR. ⋯ Use of OR tractography with overlay outside of an iMRI suite, with application of an appropriate error margin, can be used during approach to the temporal horn of the lateral ventricle and carries a 5% risk of VFD that is significant enough to preclude driving postoperatively. OR tractography can also be used to inform retractor placement. These results warrant a larger prospective comparative study of the use of OR tractography-guided mesial temporal resection.
-
Journal of neurosurgery · Feb 2022
Launching the Quality Outcomes Database Tumor Registry: rationale, development, and pilot data.
Neurosurgeons generate an enormous amount of data daily. Within these data lie rigorous, valid, and reproducible evidence. Such evidence can facilitate healthcare reform and improve quality of care. To measure the quality of care provided objectively, evaluating the safety and efficacy of clinical activities should occur in real time. Registries must be constructed and collected data analyzed with the precision akin to that of randomized clinical trials to accomplish this goal. ⋯ The authors have demonstrated here, as a pilot study, the feasibility of documenting demographic, clinical, operative, and patient-reported outcome characteristics longitudinally for 6 common intracranial tumor types.
-
Journal of neurosurgery · Feb 2022
Predictors of surgical outcome in focal cortical dysplasia and its subtypes.
The authors analyzed predictors of surgical outcome in patients with focal cortical dysplasia (FCD) and its ILAE (International League Against Epilepsy) subtypes after noninvasive multimodal evaluation and calculated time to first seizure. ⋯ Long-term seizure freedom after surgery can be achieved in more than two-thirds of patients with FCD after noninvasive multimodal evaluation. Multiple seizure types, type I FCD, and APOS were predictors of persistent seizures. Seizures recurred in about 80% of patients within 6 months postsurgery.