Journal of neurosurgery
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Journal of neurosurgery · Apr 2024
Asleep triple-modality motor mapping for perirolandic gliomas: an update on outcomes.
Maximal safe resection of gliomas near motor pathways is facilitated by intraoperative mapping. Here, the authors review their results with triple-modality asleep motor mapping with motor evoked potentials and bipolar and monopolar stimulation for cortical and subcortical mapping during glioma surgery in an expanded cohort. ⋯ Asleep triple motor mapping results in a low rate of permanent deficits, especially for low-grade gliomas. Peri-resection cavity ischemia continues to be a significant risk factor for permanent deficit despite maintaining appropriate distance for subcortical tracts based on monopolar feedback.
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Journal of neurosurgery · Apr 2024
Trends in medical device company payments in neurosurgery: a nationwide, multidatabase, geospatial analysis.
Industry partnerships help advance the field of neurosurgery. Given the nature of the field and its close relationship with innovation, neurosurgeons frequently partner with the medical device industry to advance technology and improve outcomes. However, this can create important ethical concerns for patients. In this paper, the authors sought to comprehensively study how physician payments from medical device companies have changed and what geographic parameters influence the trends observed over the years. ⋯ This analysis demonstrates that there are national hot spots and cold spots of physician payments, and offers some social, economic, and company-dependent predictors that may influence the magnitude of payments. Further analysis is needed to better understand this clinical-commercial partnership in healthcare, specifically within neurosurgical practice.
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Journal of neurosurgery · Apr 2024
The 5-factor modified frailty index as a prognostic factor of stereotactic radiosurgery for metastatic disease to the brain.
Frailty, a state of increased vulnerability to adverse health outcomes, is associated with poor neurosurgical outcomes. The relationship between frailty and stereotactic radiosurgery (SRS) for brain metastases (BMs), however, has not been adequately described. In this study, the authors attempted to examine the connection between frailty and outcomes for patients receiving SRS for BMs. ⋯ Higher frailty scores at the time of SRS treatment were predictive of shorter OS and PFS intervals.
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Journal of neurosurgery · Apr 2024
Sodium fluorescein uptake by the tumor microenvironment in human gliomas and brain metastases.
Intravenous sodium fluorescein (SF) is increasingly used during surgery of gliomas and brain metastases to improve tumor resection. Currently, SF is believed to permeate the brain regions where the blood-brain barrier (BBB) is damaged and to accumulate in the extracellular space but not in tumor or healthy cells, making it possible to demarcate tumor margins to guide resection. By evaluating the immune contexture of a number of freshly resected gliomas and brain metastases from patients undergoing SF-guided surgery, the authors recurrently observed fluorescence-positive cells. Therefore, the aim of this study was to determine if SF accumulates inside the cells of the tumor microenvironment (TME), and if so, in which type of cells, and whether incorporation can also be observed in the leukocytes of peripheral blood. ⋯ SF is not just a marker of BBB damage, but its intracellular detection suggests that it selectively accumulates intracellularly. Future efforts should target the mechanisms of its differential uptake by the different TME cell types in depth.
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Journal of neurosurgery · Apr 2024
Healthcare disparities in deep brain stimulation access and utilization: a systematic review.
Since FDA approval of deep brain stimulation (DBS) for essential tremor over 2 decades ago, indications and utilization of this modality have rapidly expanded worldwide. However, certain patient populations are known to be underrepresented among those undergoing DBS for various indications. ⋯ As the indications and utilization continue to grow, addressing healthcare disparities related to DBS has become increasingly important. The authors suggest that increasing patient and provider education, expanding the role of telemedicine within DBS care, and improving support services for DBS patients may improve access and utilization.