Journal of neurosurgery
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Journal of neurosurgery · Aug 2023
Intraoperative valence testing to adjudicate between ventral capsule/ventral striatum and bed nucleus of the stria terminalis target selection in deep brain stimulation for obsessive-compulsive disorder.
Deep brain stimulation (DBS) is an accepted therapy for severe, treatment-refractory obsessive-compulsive disorder (trOCD). The optimal DBS target location within the anterior limb of the internal capsule, particularly along the anterior-posterior axis, remains elusive. Empirical evidence from several studies in the past decade has suggested that the ideal target lies in the vicinity of the anterior commissure (AC), either just anterior to the AC, above the ventral striatum (VS), or just posterior to the AC, above the bed nucleus of the stria terminalis (BNST). Various methods have been utilized to optimize target selection for trOCD DBS. The authors describe their practice of planning trajectories to both the VS and BNST and adjudicating between them with awake intraoperative valence testing to individualize permanent target selection. ⋯ Planning and intraoperatively testing trajectories flanking the AC-superjacent to the VS anteriorly and to the BNST posteriorly-allowed identification of positive valence responses and acute adverse effects. Awake testing helped to select between possible trajectories and identify individually optimized targets in DBS for trOCD.
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Journal of neurosurgery · Aug 2023
Comparative StudyA comparative analysis of the Hospital Frailty Risk Score in predicting postoperative outcomes among intracranial tumor patients.
In recent years, frailty indices such as the 11- and 5-factor modified frailty indices (mFI-11 and mFI-5), American Society of Anesthesiologists (ASA) physical status classification, and Charlson Comorbidity Index (CCI) have been shown to be effective predictors of various postoperative outcomes in neurosurgical patients. The Hospital Frailty Risk Score (HFRS) is a well-validated tool for assessing frailty; however, its utility has not been evaluated in intracranial tumor surgery. In the present study, the authors investigated the accuracy of the HFRS in predicting outcomes following intracranial tumor resection and compared its utility to those of other validated frailty indices. ⋯ The study findings suggest that the HFRS is an effective predictor of postoperative outcomes in intracranial tumor patients and more effectively predicts adverse outcomes than other frailty indices. The HFRS may serve as an important tool for reducing patient morbidity and mortality in intracranial tumor surgery.
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Journal of neurosurgery · Aug 2023
Predicting glioblastoma molecular subtypes and prognosis with a multimodal model integrating convolutional neural network, radiomics, and semantics.
The aim of this study was to build a convolutional neural network (CNN)-based prediction model of glioblastoma (GBM) molecular subtype diagnosis and prognosis with multimodal features. ⋯ The authors propose a novel multimodal model integrating C3D, radiomics, and semantics, which had a great performance in predicting IDH1, ATRX, and MGMT molecular subtypes and the 1-year prognosis of GBM.
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Journal of neurosurgery · Aug 2023
Comparison of the Contour Neurovascular System and Woven EndoBridge device for treatment of wide-necked cerebral aneurysms at a bifurcation or sidewall.
The authors compared the Contour Neurovascular System (Contour) with the Woven EndoBridge (WEB) device for the treatment of wide-necked cerebral aneurysms at a bifurcation or sidewall. ⋯ Results for the Contour were promising, although longer follow-up is necessary to draw more solid conclusions on the utility and risk profile of this new device compared with the already widely used WEB device. Adequate occlusion at last follow-up was the same for both devices, whereas the probability of complete occlusion at last follow-up was significantly higher for the Contour, and the WEB showed a significantly higher retreatment rate. Median deployment times were significantly shorter with the Contour than the WEB.
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Journal of neurosurgery · Aug 2023
Observational StudyTumor sound, auditory cues, and tissue pathology in glioma surgery: a proof-of-concept study.
Visual, tactile, and auditory cues are used during surgery to differentiate tissue type. Auditory cues in glioma surgery have not been studied previously. The objectives of this study were 1) to evaluate the feasibility of recording sound generated by the suction device during glioma surgery in matched tissue samples, and 2) to characterize the acoustic variation that occurs in different tissue samples. ⋯ This study supports the feasibility of collecting intraoperative data on acoustic features during glioma surgery, and it provides an example of how an analysis could be performed to compare different types of tissues.