Journal of neurosurgery
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Journal of neurosurgery · Aug 2023
Comparative StudyGrowth potential of small residual tumors after vestibular schwannoma surgery: comparison between remnants and the natural history of small tumors.
Due to the heterogeneous definitions of tumor regrowth and various tumor volume distributions, the nature of small remnants after vestibular schwannoma (VS) surgery and the appropriate timing of adjuvant stereotactic radiosurgery for these remnants remain unclear. In this study, the growth potential of small remnants (< 1 cm3) after VS surgery was compared with that of treatment-naïve (TN) small VSs. ⋯ This study demonstrated that the growth potential of small VS remnants was lower than that of TN tumors. Observing for small remnants may be appropriate after STR of a large VS. Given the risk of tumor regrowth, careful observation using MRI should be mandatory during follow-up.
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Journal of neurosurgery · Aug 2023
2-Hydroxyglutarate magnetic resonance spectroscopy in adult brainstem glioma.
Adult brainstem gliomas (BSGs) are rare tumors of the CNS that are poorly understood. Upregulation of the oncometabolite 2-hydroxyglutarate (2HG) in the tumor indicates the mutation of isocitrate dehydrogenase (IDH), which can be detected by magnetic resonance spectroscopy (MRS). Although histological examination is required for the definitive diagnosis of BSG, 2HG-optimized MRS (2HG-MRS) may be useful, considering the difficult nature of brainstem lesion biopsy. The aim of this study was to evaluate the utility of 2HG-MRS for diagnosing IDH-mutant adult BSG. ⋯ 2HG-MRS demonstrated high sensitivity and specificity for the prediction of IDH-mutant BSG. In addition, 2HG-MRS may be useful for predicting the prognosis of adult BSG patients.
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Journal of neurosurgery · Aug 2023
Biography Historical ArticleA utopian idea: Cushing, Bailey, Penfield, and the National Institute of Neurological Diseases and Blindness.
Toward the end of the First World War, Harvey Cushing conceived of a National Institute of Neurology (NIN) that would integrate neurology, neurosurgery, psychiatry, and allied disciplines within a single institution. It would first be established for the care of American casualties in an existing military hospital in France, and then relocate to the United States. Cushing was unsuccessful in acquiring funding for this project despite appeals to the army and to the Carnegie and Rockefeller foundations. ⋯ The MNI's faculty held full-time university appointments and they limited their practice to the institute, where their offices and clinics were housed, and to adjoining research laboratories in neuroanatomy, neurochemistry, neurophysiology, and neuropsychology, as Cushing had envisioned. In this paper the argument is made that although Cushing's plan for the NIN was premature, the success of the MNI proved its feasibility. In addition, the MNI's success in integrating clinical care and research within a single institution was a model for the National Institute of Neurological Diseases and Blindness and drove its first clinical research program.
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Journal of neurosurgery · Aug 2023
Factors associated with hearing outcomes after a middle fossa approach in 131 consecutive patients with vestibular schwannomas.
The middle fossa approach is an effective option for the treatment of small (Koos grade I and II) vestibular schwannomas (VSs) when the goal is hearing preservation. The authors evaluated the rates of hearing preservation and examined the factors associated with improved hearing outcomes after the middle fossa approach for VSs. ⋯ The hearing preservation rates after microsurgical resection of small VSs using the middle fossa approach are high, with 78% of patients maintaining AAO-HNS class A or B hearing. Poor hearing status at baseline, longer duration of anesthesia, and large overlap between the fundus of the internal auditory canal and the cochlea were independently associated with unfavorable hearing outcomes. Imaging characteristics can be used to stratify patients' risk of hearing loss.
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Journal of neurosurgery · Aug 2023
Multicenter StudyRole of interhemispheric connectivity in recovery from postoperative supplementary motor area syndrome in glioma patients.
Surgical resection of gliomas involving the supplementary motor area (SMA) frequently results in SMA syndrome, a symptom complex characterized by transient akinesia and mutism. Because the factors influencing patient functional outcomes after surgery remain elusive, the authors investigated network-based predictors in a multicentric cohort of glioma patients. ⋯ This study provides evidence for the pathophysiology and predictive factors of postoperative SMA syndrome by demonstrating the relation of the disconnection of callosal fibers with prolonged symptom duration (central segment) and long-term motor deficits (midposterior segment). These data may be useful for presurgical risk assessment and adequate consultation for patients prior to undergoing resection of glioma located within the SMA region.