Journal of neurosurgery
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Journal of neurosurgery · Feb 2025
Meta Analysis Comparative StudyAwake versus asleep deep brain stimulation for Parkinson's disease: a comprehensive systematic review and meta-analysis.
Deep brain stimulation (DBS) has become an effective and safe treatment in patients with Parkinson's disease (PD) not responding to conventional treatments. With the growing body of literature regarding the use of DBS in different movement disorders, there remain controversies regarding performing awake or asleep DBS. This systematic review provides the most comprehensive review of the literature comparing the two techniques from various aspects in detail. ⋯ These findings suggest comparable clinical outcomes between the two DBS approaches. The two methods had their salient differences in terms of lead passes and specific adverse events. The decision to perform awake or asleep DBS should be based on the patient's preference, the surgeon's experience, the availability of advanced intraoperative imaging, and the patient's tolerance for specific adverse events.
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Journal of neurosurgery · Feb 2025
Enhancing surgical precision: a novel electromyography finding for confident identification of the root exit zone during microvascular decompression surgery.
The lateral spread response (LSR) is an important electrophysiological sign that predicts successful decompression in patients undergoing microvascular decompression (MVD) for hemifacial spasm (HFS). However, LSRs do not consistently correlate with clinical outcomes, and there are cases in which LSRs are absent. In this study, the authors identified a unique pattern on facial nerve electromyography (EMG) when the root exit zone (REZ) is touched. This distinctive EMG pattern, which the authors coined the "Sang-ku sign" (SKS), could aid in identifying the offending vessel on the REZ, even in the absence of LSRs. ⋯ The SKS could serve as an excellent guide for the facial nerve REZ during surgery. Given that HFS results from abnormal vascular contact on the REZ, this finding plays a crucial role in ensuring surgical success. Alongside LSRs, the SKS could provide valuable insights for neurosurgeons.
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Journal of neurosurgery · Feb 2025
Case ReportsLateral compartment of the cavernous sinus from the endoscopic endonasal approach: anatomical considerations and surgical relevance to adenoma surgery.
The cavernous sinus (CS) has 4 compartments: superior, inferior, posterior, and lateral. Among these, the lateral compartment is the most common location for residual tumor, given the risk of neurovascular injury. The authors' study aimed to delineate the anatomical landmarks in this area and illustrate the technical nuances of the lateral transcavernous approach. ⋯ This study provides valuable insights into the anatomical intricacies of the lateral compartment of the CS and underscores the potential benefits of the endoscopic endonasal lateral transcavernous approach. Further clinical applications are essential for validating these findings and optimizing surgical outcomes.
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Journal of neurosurgery · Feb 2025
Optimizing indirect targeting of the centromedian nucleus for deep brain stimulation by incorporating third ventricular anatomy.
Deep brain stimulation (DBS) of the centromedian nucleus (CM) is used to treat diverse brain diseases including epilepsy, Tourette syndrome, and disorders of consciousness. However, the CM is challenging to visualize on routine MRI. Many surgeons use an indirect targeting method based on established stereotactic coordinates. The authors aimed to quantify how often a DBS electrode's contacts were positioned within the CM using this approach, and to identify alternative indirect coordinates that are more accurate. ⋯ The unavailability of advanced MRI for direct targeting limits access to CM-DBS in resource-constrained neurosurgical programs. Standard indirect coordinates do not provide optimal targeting of the CM, with most contacts laterally placed in the sensory thalamus. The proposed indirect approach may therefore increase the accuracy and availability of CM-DBS, while reducing side effects.
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Journal of neurosurgery · Feb 2025
A management algorithm for idiopathic intracranial hypertension in skull base meningoencephaloceles.
In this study, the authors assessed an algorithm for the diagnosis and management of idiopathic intracranial hypertension (IIH) in patients who had undergone surgical repair of skull base meningoencephaloceles presenting with spontaneous cerebrospinal fluid (sCSF) leakage. ⋯ Utilizing an algorithm of direct meningoencephalocele repair and selective shunting, acute and remote CSF leak recurrence rates were each 3.8%, and the VPS rate was 15.0%. These data provide further insight into CSF dynamics in this population and argue against the theoretical concern that CSF pressure will increase postrepair. Significant intraindividual variability suggests multiple LPs may be necessary before committing to invasive IIH treatment. Further work is necessary to determine the optimal IIH management strategy.