Journal of neurosurgery
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Journal of neurosurgery · Feb 2025
Radiographic and neurological outcomes of Gamma Knife radiosurgery for lower cranial nerve schwannomas: a single-institution experience.
Gamma Knife radiosurgery (GKRS) is widely used for treating small- to medium-sized or postoperative residual, recurrent lower cranial nerve schwannomas (LCNSs). This study aimed to evaluate the radiographic and neurological outcomes of GKRS for LCNS. ⋯ GKRS is an alternative treatment option for LCNS that reduces surgical morbidity and enhances tumor control. However, GKRS can potentially lead to neurological deterioration, necessitating extreme caution throughout the procedure, specifically for JFSs.
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Journal of neurosurgery · Feb 2025
Predictors of length of postoperative stay following endoscopic skull base surgery with intraoperative CSF leak.
Establishing benchmarks for length of stay (LOS) may inform strategies to improve resource efficiency, decrease costs, and advance care quality. In this study, the authors characterize postoperative LOS in endoscopic skull base surgery (ESBS) and elucidate prolonging factors. ⋯ With healthcare utilization receiving increased attention, mitigating factors that extend LOS are important. Extent of surgery and certain postoperative complications may constitute key factors prolonging LOS following intradural ESBS with intraoperative CSF leak.
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Journal of neurosurgery · Feb 2025
Case ReportsEarly diagnosis to avoid invasive treatment in cardiac migration of a ventriculoperitoneal catheter: a qualitative systematic review and Weibull analysis of case reports.
The migration of distal catheter after ventriculoperitoneal shunt placement is a rare but significant complication. Especially in a case of cardiac migration, open-heart surgery or catheter intervention may be required. The authors encountered a case of cardiac migration that fortunately could be treated by withdrawal. A systematic review of cardiac migration was performed to clarify when and how migration was diagnosed and why invasive treatments were required. Based on the collected cases, a Weibull analysis of the latency until diagnosis was performed to examine whether cardiac migration is caused by an initial factor and to compare the result with the other migration sites such as gastrointestinal tract or urinary tract. ⋯ In light of the previous reports, the latency until diagnosis of cardiac migration was associated with the rate of thrombosis and adhesion, which resulted in escalation to invasive treatment. Early diagnosis will prevent invasive treatment because most cases are caused by initial factors, as the Weibull analysis showed.
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Journal of neurosurgery · Feb 2025
Pre-stereotactic radiosurgery neutrophil-to-lymphocyte ratio predicts post-stereotactic radiosurgery survival of patients with brain metastases concurrently treated with immune checkpoint inhibitors.
Treatment with immune checkpoint inhibitors (ICIs) has shown clinical benefit for a wide range of cancer types. The neutrophil-to-lymphocyte ratio (NLR) reportedly correlates with survival time or progression-free survival in patients treated with ICIs. However, NLR has not yet been assessed in patients with brain metastases (BMs) receiving stereotactic radiosurgery (SRS) combined with concurrent ICIs. The authors investigated the predictive impact of NLR on the survival data of patients with BMs who received SRS with concurrent ICIs. ⋯ The authors found elevated pre-SRS NLR (> 5) to be associated with shorter OS and IC-PFS after SRS with concurrent ICIs for BMs. NLR is a simple, cost-effective, and widely accessible biomarker, which can thus be used for managing patients with BMs receiving SRS concurrently with ICIs. Further investigation in other large datasets is, however, required to validate these findings.
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Journal of neurosurgery · Feb 2025
Academic productivity and career trajectory of international medical graduates in US neurosurgery residency programs.
The objective of this study was to review and compare the research experiences and career outcomes of international medical graduates (IMGs) with those of US medical graduates (USMGs). ⋯ The results indicate that IMGs often exhibit higher academic productivity than USMGs. Although there was no discernible difference in residency program rankings or postresidency fellowships completed, early academic appointments were more prevalent among IMGs.