Journal of neurosurgery
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Journal of neurosurgery · Jun 2022
IDH-wild-type glioblastoma cell density and infiltration distribution influence on supramarginal resection and its impact on overall survival: a mathematical model.
Recent studies have proposed resection of the T2 FLAIR hyperintensity beyond the T1 contrast enhancement (supramarginal resection [SMR]) for IDH-wild-type glioblastoma (GBM) to further improve patients' overall survival (OS). GBMs have significant variability in tumor cell density, distribution, and infiltration. Advanced mathematical models based on patient-specific radiographic features have provided new insights into GBM growth kinetics on two important parameters of tumor aggressiveness: proliferation rate (ρ) and diffusion rate (D). The aim of this study was to investigate OS of patients with IDH-wild-type GBM who underwent SMR based on a mathematical model of cell distribution and infiltration profile (tumor invasiveness profile). ⋯ The impact of SMR on OS for patients with IDH-wild-type GBM is influenced by the degree of tumor invasiveness. The authors' results show that increasing SMR is associated with increased OS in patients with moderate and highly diffuse IDH-wild-type GBMs. When grouping SMR into 10% intervals, this benefit was seen for all tumor subgroups, although for nodular tumors, the maximum beneficial SMR percentage was considerably lower than in moderate and highly diffuse tumors.
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Journal of neurosurgery · Jun 2022
Quick cell-free DNA testing for the prediction of postconcussion syndrome: a single-center prospective pilot trial.
Mild traumatic brain injury (mTBI) is a major cause of emergency room (ER) admission. Thirty percent of mTBI patients have postconcussion syndrome (PCS), and 15% have symptoms for over a year. This population is underdiagnosed and does not receive appropriate care. The authors proposed a fast and inexpensive fluorometric measurement of circulating cell-free DNA (cfDNA) as a biomarker for PCS. cfDNA is a proven, useful marker of a variety of acute pathological conditions such as trauma and acute illness. ⋯ The data from this pilot study show the potential to use cfDNA, as measured with a fast test, as a biomarker to screen for PCS in the ER. A large-scale study is required to establish the value of cfDNA as an early predictor of PCS.
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Journal of neurosurgery · Jun 2022
Vortex formation and associated aneurysmogenic transverse rotational shear stress near the apex of wide-angle cerebral bifurcations.
Aneurysm formation preferentially occurs at the site of wide-angle cerebral arterial bifurcations, which were recently shown to have a high longitudinal positive wall shear stress (WSS) gradient that promotes aneurysm formation. The authors sought to explore the other components of the hemodynamic environment that are altered with increasing bifurcation angle in the apical region and the effects of these components on WSS patterns on the vessel wall that may modulate aneurysm genesis and progression. ⋯ Wider vascular bifurcations are associated with a novel and to the authors' knowledge previously undescribed transverse component rotational wall shear stress associated with a positive (aneurysmogenic) spatial gradient. The resulting hemodynamic insult, demonstrated in both parametric models and patient-based anatomy, is noted to decay rapidly away from the protection of the medial pad in healthy narrow-angle bifurcations but remain elevated distally downstream of wide-angle aneurysm-prone bifurcations. This TRWSS serves as a new contribution to the hemodynamic environment favoring aneurysm formation and progression at wide cerebral bifurcations and may have clinical implications favoring interventions that reduce bifurcation angle.
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Journal of neurosurgery · Jun 2022
Septal rhinopharyngeal flap: a novel technique for skull base reconstruction after endoscopic endonasal clivectomies.
Endoscopic endonasal reconstruction techniques have improved CSF leak rates that were initially reported after surgery for cranial base and intradural lesions. However, wide surgical defects still pose a problem, especially if located in the clival region. The authors propose and describe a novel reconstruction technique they call a septal rhinopharyngeal flap (SRF) specifically designed to address this issue. ⋯ No CSF leaks were encountered after at least 1 postoperative year. The SRF is a novel vascularized reconstruction technique specifically indicated for wide endosanasal clivectomies focused on the middle clivus with caudal extension into the lower clivus and craniocervical junction, as well as rostral extensions into the tubercular or planum sphenoidale. This new reconstruction technique could be added to the skull base reconstruction armamentarium as a safe and optimal option.
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Journal of neurosurgery · Jun 2022
Hemangioblastoma diagnosis and surveillance in von Hippel-Lindau disease: a consensus statement.
Hemangioblastomas are a frequent underlying cause of neurological morbidity and death in patients with von Hippel-Lindau disease (VHL). Although these benign tumors can cause significant neurological debility when undetected and untreated, unified evidence-based surveillance recommendations for VHL patients have not been established. To develop consensus recommendations, the VHL Alliance established an expert committee, named the International VHL Surveillance Guidelines Consortium, to define surveillance recommendations. ⋯ The CNS Hemangioblastoma Subcommittee of the International VHL Surveillance Guidelines Consortium here proposes guidelines that aim to increase the early detection of VHL-associated hemangioblastomas to reduce their morbidity and mortality.