Journal of neurosurgery
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Journal of neurosurgery · Aug 2023
Observational StudyPerioperative risk factors associated with unplanned neurological intensive care unit readmission following elective supratentorial brain tumor resection.
The aim of this study was to describe the clinical and procedural risk factors associated with the unplanned neurosurgical intensive care unit (NICU) readmission of patients after elective supratentorial brain tumor resection and serves as an exploratory analysis toward the development of a risk stratification tool that may be prospectively applied to this patient population. ⋯ A predictive model that included age, lesion type, KPS < 70 at admission, duration of surgery, retention of endotracheal intubation on NICU entry, and NICU LOS after surgery had an acceptable ability to identify elective supratentorial brain tumor resection patients at high risk for an unplanned NICU readmission. These risk factors and this prediction model may facilitate better resource allocation in the NICU and improve patient outcomes.
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Journal of neurosurgery · Aug 2023
Percutaneous CT-guided trigeminal tractotomy-nucleotomy under general anesthesia for intractable craniofacial pain.
When used to treat craniofacial pain, CT-guided trigeminal tractotomy-nucleotomy (TR-NC) is usually performed with local anesthesia. Unfortunately, local anesthesia is insufficient for patients with such severe pain that they cannot tolerate the required head positioning while awake. This study aimed to contextualize previous findings associated with TR-NC performed under general anesthesia. The authors examined clinical and operative factors that could impact postoperative pain outcomes. ⋯ These results suggest that CT-guided TR-NC performed under general anesthesia is safe and effective. Postoperative outcomes were found to be associated with a number of clinical and operative factors. Such associations should be further explored and evaluated in the context of future, better-powered analyses.
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Journal of neurosurgery · Aug 2023
Comparative StudyGrowth potential of small residual tumors after vestibular schwannoma surgery: comparison between remnants and the natural history of small tumors.
Due to the heterogeneous definitions of tumor regrowth and various tumor volume distributions, the nature of small remnants after vestibular schwannoma (VS) surgery and the appropriate timing of adjuvant stereotactic radiosurgery for these remnants remain unclear. In this study, the growth potential of small remnants (< 1 cm3) after VS surgery was compared with that of treatment-naïve (TN) small VSs. ⋯ This study demonstrated that the growth potential of small VS remnants was lower than that of TN tumors. Observing for small remnants may be appropriate after STR of a large VS. Given the risk of tumor regrowth, careful observation using MRI should be mandatory during follow-up.
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Journal of neurosurgery · Aug 2023
Biography Historical ArticleA utopian idea: Cushing, Bailey, Penfield, and the National Institute of Neurological Diseases and Blindness.
Toward the end of the First World War, Harvey Cushing conceived of a National Institute of Neurology (NIN) that would integrate neurology, neurosurgery, psychiatry, and allied disciplines within a single institution. It would first be established for the care of American casualties in an existing military hospital in France, and then relocate to the United States. Cushing was unsuccessful in acquiring funding for this project despite appeals to the army and to the Carnegie and Rockefeller foundations. ⋯ The MNI's faculty held full-time university appointments and they limited their practice to the institute, where their offices and clinics were housed, and to adjoining research laboratories in neuroanatomy, neurochemistry, neurophysiology, and neuropsychology, as Cushing had envisioned. In this paper the argument is made that although Cushing's plan for the NIN was premature, the success of the MNI proved its feasibility. In addition, the MNI's success in integrating clinical care and research within a single institution was a model for the National Institute of Neurological Diseases and Blindness and drove its first clinical research program.
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Journal of neurosurgery · Aug 2023
Identification of risk factors associated with leptomeningeal disease after resection of brain metastases.
Resection of brain metastases (BMs) may be associated with increased risk of leptomeningeal disease (LMD). This study examined rates and predictors of LMD, including imaging subtypes, in patients who underwent resection of a BM followed by postoperative radiation. ⋯ Tumor location, absence of extracranial disease at the time of surgery, ventricle contact, and increased tumor volume were associated with LMD. Further work is needed to determine whether escalating therapies in patients at risk of LMD prevents disease dissemination.