Journal of neurosurgery
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Journal of neurosurgery · Dec 2024
Comparative StudyComparison of endoscopic multiport approaches to the petrous apex: contralateral transmaxillary versus contralateral medial transorbital corridor.
Accessing the petrous apex (PA) via an endoscopic endonasal approach (EEA) is challenging due to its posterior and lateral anatomical relationship with the paraclival carotid artery. Typically, the EEA requires the mobilization or compression of the vessel and the use of angled-lens endoscopes and instruments. A sublabial contralateral transmaxillary (CTM) corridor has been used to overcome these challenges. Still, it requires extensive osteo-meatal disruption and drilling of the medial pterygoid process, which risks the vidian nerve and increases nasal morbidity. Furthermore, the CTM corridor positions the endoscope in the same horizontal plane as the instruments passing through the nostrils, leading to fencing. The authors propose a novel minimally invasive route to the PA, the precaruncular contralateral medial transorbital (cMTO) corridor, to address these issues. This anatomical study compares the EEA+CTM and EEA+cMTO corridors in accessing the PA. ⋯ The EEA+cMTO multiport technique may be a better alternative than the EEA+CTM multiport approach for targeting the petroclival region. However, clinical validation is required to confirm these laboratory findings.
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Journal of neurosurgery · Dec 2024
An analysis of potentially avoidable neurosurgical transfers to a tertiary-care level I trauma center.
Previous studies of neurosurgical transfers indicate that substantial numbers of patients may not need to be transferred, suggesting an opportunity to provide more patient-centered care by treating patients in their communities, while probably saving thousands of dollars in transport and duplicative workup. This study of neurosurgical transfers, the largest to date, aimed to better characterize how often transfers were potentially avoidable and which patient factors might affect whether transfer is needed. ⋯ This study demonstrates that a large number of neurosurgical transfers can probably be treated in their home hospitals and highlights that the vast majority of patients transferred for neurosurgical conditions do not receive emergency neurosurgery. Further research is needed to better guide transferring and receiving facilities in reducing the burden of excessive transfers.
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Journal of neurosurgery · Dec 2024
Focal motor weakness and recovery following chronic subdural hematoma evacuation.
The incidence of chronic subdural hematomas (cSDHs) is expected to climb precipitously in the coming decades because of the aging populous. Neurological weakness is one of the most common presenting neurological symptoms of cSDH. Yet, the recovery rates of motor strength recovery are seldom documented, as neurological outcomes have predominantly focused on broader functional assessment scores or mortality. In this study, the authors performed one of the first detailed analyses on functional motor weakness and recovery in patients who underwent cSDH evacuation. ⋯ This study represents one of the first in-depth analyses investigating the rates of motor strength weakness and recovery following cSDH evacuation. Nearly two-thirds of all patients had complete resolution of their weakness by the time of discharge, and more than three-quarters had partial improvement. Risk factors for impaired neurological recovery were longer symptom duration prior to treatment and older age.
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Journal of neurosurgery · Dec 2024
Radiographic abnormalities and their clinical significance in patients with Parkinson disease who receive deep brain stimulation implants.
Preoperative MR images obtained in patients with Parkinson disease (PD) undergoing deep brain stimulation (DBS) often reveal incidental radiographic abnormalities (RAs). These findings range from small changes to gross pathologies. The effect of these findings on patients' clinical outcomes is unknown. The authors characterized RAs in patients with PD who underwent DBS and assessed clinical outcomes. ⋯ Most RAs have no significant effect on clinical outcomes in PD patients undergoing DBS. Generalized ADCs may be associated with poorer subjective responses and may warrant further discussion with the patient if diagnosed on preoperative MRI.
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Journal of neurosurgery · Dec 2024
Microsurgical anatomy and approaches to thalamic gliomas. Part 1: A cartography guide for navigating to the thalamus. Integrating 3D model rendering with anatomical dissections.
The selection of appropriate microsurgical approaches to treat thalamic pathologies is currently largely subjective. The objective of this study was to provide a structured cartography map for surgical navigation to treat gliomas involving different surfaces of the thalamus. ⋯ Microsurgical approaches to thalamic gliomas continue to be challenging. Nonetheless, safe and effective cisternal, ventricular, and cortical corridors can be developed with thoughtful planning, anatomical understanding, and knowledge of the advantages, risks, and limitations of each approach. In some cases, it is wise to combine these approaches with staged procedures, as the authors demonstrate in Part 2. In Part 1 of this two-part series, they discuss thalamic microsurgical anatomy and illustrate the trajectory and exposures of all six approaches to guide decision-making. Part 2 discusses their thalamic glioma microsurgical case series, which utilizes these microsurgical approaches.