Journal of neurosurgery
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Journal of neurosurgery · Jan 2024
ReviewComputational modeling of whole-brain dynamics: a review of neurosurgical applications.
A major goal of modern neurosurgery is the personalization of treatment to optimize or predict individual outcomes. One strategy in this regard has been to create whole-brain models of individual patients. Whole-brain modeling is a subfield of computational neuroscience that focuses on simulations of large-scale neural activity patterns across distributed brain networks. ⋯ The resulting personalized whole-brain models have translational potential in neurosurgery, allowing investigators to simulate the effects of virtual therapies (such as resections or brain stimulations), assess the effect of brain pathology on network dynamics, or discern epileptic networks and predict seizure propagation in silico. The information gained from these simulations can be used as clinical decision support, guiding patient-specific treatment plans. Here the authors provide an overview of the rapidly advancing field of whole-brain modeling and review the literature on neurosurgical applications of this technology.
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Journal of neurosurgery · Jan 2024
A new classification of parasagittal bridging veins based on their configurations and drainage routes pertinent to interhemispheric approaches: a surgical anatomical study.
Opening the roof of the interhemispheric microsurgical corridor to access various neurooncological or neurovascular lesions can be demanding because of the multiple bridging veins that drain into the sinus with their highly variable, location-specific anatomy. The objective of this study was to propose a new classification system for these parasagittal bridging veins, which are herein described as being arranged in 3 configurations with 4 drainage routes. ⋯ The authors propose a systematic classification for the parasagittal venous network. Using anatomical landmarks, they define 3 venous configurations and 4 drainage routes. Analysis of these configurations with respect to surgical routes indicates 2 highly risky interhemispheric surgical fissure routes. The risks are attributable to the presence of large lacunae that receive multiple veins (type 2) or venous complex (type 3) configurations that negatively impact a surgeon's working space and degree of movement and thus are predisposed to inadvertent avulsions, bleeding, and venous thrombosis.
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Journal of neurosurgery · Jan 2024
Decoding the clinical effects of low-grade glioma-induced cortical excitability.
Patients with low-grade glioma (LGG) in eloquent regions often present with seizures, and findings on detailed neuropsychological testing are often abnormal. This study evaluated the association between cortical excitability, seizures, and cognitive function in patients with LGG. ⋯ RMT was positively correlated with early postoperative seizure risk and negatively correlated with psychomotor processing speed, executive function, and hand dexterity. These findings support the theory of local and regional resting oscillatory network dysfunction from a glioma-brain network.
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Journal of neurosurgery · Jan 2024
Does waiting for surgery matter? How time from diagnostic MRI to resection affects outcomes in newly diagnosed glioblastoma.
Maximal safe resection is the standard of care for patients presenting with lesions concerning for glioblastoma (GBM) on magnetic resonance imaging (MRI). Currently, there is no consensus on surgical urgency for patients with an excellent performance status, which complicates patient counseling and may increase patient anxiety. This study aims to assess the impact of time to surgery (TTS) on clinical and survival outcomes in patients with GBM. ⋯ An increased TTS for patients with imaging concerning for GBM did not impact clinical outcomes, and while there was a significant association with ΔCETV, SPGR remained unaffected. However, SPGR was associated with a worse preoperative KPS, which highlights the importance of tumor growth speed over TTS. Therefore, while it is ill advised to wait an unnecessarily long time after initial imaging studies, these patients do not require urgent/emergency surgery and can seek tertiary care opinions and/or arrange for additional preoperative support/resources. Future studies are needed to explore subgroups for whom TTS may impact clinical outcomes.
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Journal of neurosurgery · Jan 2024
Pipeline embolization device dynamics: prediction of incomplete occlusion by elongation from nominal length.
According to benchtop studies, the oversizing of a Pipeline embolization device (PED) relative to the parent artery leads to a significant increase in porosity and potentially compromises aneurysm occlusion as well as transitional zone (TZ) formation around the neck of aneurysms. However, no clinical assessment has been reported. Here this potential was studied by measuring the dynamic changes of PEDs in the clinical time course. ⋯ PED elongation from the nominal length is a new predictor of incomplete aneurysm occlusion. The PED showed vascular remodeling by changing its diameter and length in the clinical course. TZ formation was remodeled and did not affect the occlusion rate.