Journal of neurosurgery
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Journal of neurosurgery · Aug 2024
Multicenter StudyThe natural history of aneurysms incompletely occluded by placement of a flow diverter: a multiinstitutional study.
Treatment of intracranial aneurysms by flow diversion is safe and effective and is increasingly popular. However, the correct treatment paradigm for aneurysms incompletely treated by initial placement of a flow diverter has not been established, nor have the subsequent natural history and occlusion rates of such aneurysms. The authors sought to outline the natural history of such aneurysms, which to date have been considered partially treated. ⋯ Aneurysms that have been incompletely treated by flow diversion have a benign natural history with progression toward occlusion over time, with or without retreatment.
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Journal of neurosurgery · Aug 2024
Multicenter StudyRisk factors for delayed postoperative hemorrhage in patients with brain arteriovenous malformations: an analysis of the nationwide multicenter prospective registry MATCH study.
Reducing the incidence of delayed postoperative hemorrhage (DPH) is one of the challenges in the surgical treatment of patients with brain arteriovenous malformations (bAVMs). This study aimed to identify several risk factors for DPH after bAVM resection and evaluate the impact of these risk factors in patients with bAVMs. ⋯ Patients with giant bAVMs or periventricular lesions are at higher risk for DPH after surgery. Strategies such as blood pressure control, preoperative embolization, intraoperative monitoring, and careful patient selection should be considered to reduce the risk of DPH in high-risk patients.
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Journal of neurosurgery · Aug 2024
Multicenter StudyEpidemiology of moderate traumatic brain injury and factors associated with poor neurological outcome.
The objective of this study was to investigate the epidemiology of moderate traumatic brain injury (TBI) and factors associated with poor neurological outcome. ⋯ Almost half of the patients with moderate TBI had poor neurological outcome at hospital discharge. Several factors including older age, higher CCI, GCS scores of 9 or 10, severe trauma, and mechanical ventilation or craniotomy were found to be associated with poor neurological outcome in patients with moderate TBI. Additionally, these data suggest that tranexamic acid administration and admission to the ICU might be important for improving prognosis. Further investigations are warranted to elucidate the appropriate management for patients with moderate TBI.
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Journal of neurosurgery · Aug 2024
Multicenter StudyThe relevance of biologically effective dose for pain relief and sensory dysfunction after Gamma Knife radiosurgery for trigeminal neuralgia: an 871-patient multicenter study.
Recent studies have suggested that biologically effective dose (BED) is an important correlate of pain relief and sensory dysfunction after Gamma Knife radiosurgery (GKRS) for trigeminal neuralgia (TN). The goal of this study was to determine if BED is superior to prescription dose in predicting outcomes in TN patients undergoing GKRS as a first procedure. ⋯ BED and physical dose were both predictive of pain relief and could be used as treatment planning goals for distal and proximal targets, respectively, while considering maximum brainstem point dose < 29.5 Gy as a potential constraint for bothersome numbness.
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Journal of neurosurgery · Aug 2024
Review Historical ArticleThe role of medical illustration in the evolution of transsphenoidal pituitary surgery.
Medical illustration played a crucial, yet often overlooked, role in the evolution of pituitary surgery. From the late 1800s to the present, many preeminent surgeons, in partnership with their surgical illustrator collaborators, developed and then shifted the paradigm of pituitary surgery, from an open procedure with high mortality and morbidity, to an endonasal approach with high success rates that is widely utilized today. This work aims to highlight the role of surgical illustrators as partners to their physician colleagues, creating artistically accessible road maps that shaped the development of the transsphenoidal approach.