Journal of neurosurgery
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Journal of neurosurgery · Oct 2024
Spin in traumatic brain injury literature: prevalence and associated factors. A systematic review.
Spin is characterized as a misinterpretation of results that, whether deliberate or unintentional, culminates in misleading conclusions and steers readers toward an excessively optimistic perspective of the data. The primary objective of this systematic review was to estimate the prevalence and nature of spin within the traumatic brain injury (TBI) literature. Additionally, the identification of associated factors is intended to provide guidance for future research practices. ⋯ The prevalence of spin in the TBI literature is high, even at leading medical journals. Studies with higher risks of bias are more frequently associated with spin. Critical interpretation of results and authors' conclusions is advisable regardless of the study design and published journal.
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Journal of neurosurgery · Oct 2024
Evaluation of the Glasgow Coma Scale-Pupils score for predicting inpatient mortality among patients with traumatic subdural hematoma at United States trauma centers.
The Glasgow Coma Scale-Pupils (GCS-P) score has been suggested to better predict patient outcomes compared with GCS alone, while avoiding the need for more complex clinical models. This study aimed to compare the prognostic ability of GCS-P versus GCS in a national cohort of traumatic subdural hematoma (SDH) patients. ⋯ The GCS-P score provides better short-term prognostication compared with the GCS score alone among traumatic SDH patients with penetrating TBI. The GCS-P score overestimates inpatient mortality risk among penetrating TBI patients with higher rates of observed mortality. For penetrating TBI patients, which comprised 2.4% of our SDH cohort, a low GCS-P score should not justify clinical nihilism or forgoing aggressive treatment.
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Journal of neurosurgery · Oct 2024
Prediction of postoperative cerebral infarction after combined bypass surgery in adult moyamoya disease: combining quantitative parameters on RAPID perfusion CT with clinically related factors.
The aim of this study was to identify predictive factors of postoperative cerebral infarction (PostCI) following combined bypass (CB) surgery in adult patients with moyamoya disease (MMD) using quantitative parameters from the rapid processing of perfusion and diffusion (RAPID) perfusion CT (PCT) software. ⋯ For adult patients with MMD and a large volume of Tmax > 6 sec over 59.5 ml, more caution is required when deciding to undergo bypass surgery and in postoperative management.
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Journal of neurosurgery · Oct 2024
Optimal hippocampal targeting in responsive neurostimulation for mesial temporal lobe epilepsy.
The aim of this study was to identify features of responsive neurostimulation (RNS) lead configuration and contact placement associated with greater seizure reduction in mesial temporal lobe epilepsy (MTLE). ⋯ Dual unilateral hippocampal implantation increased RNS contact density in patients with unilateral MTLE, which contributed to improved outcomes, not by stimulating more of the hippocampus, but instead by being more likely to stimulate a latent subtarget in the anterior hippocampus. It remains to be explored whether a single electrode targeted selectively to this region would also result in improved outcomes.
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Journal of neurosurgery · Oct 2024
Risk assessment of early therapeutic anticoagulation following cranial surgery: an institutional case series.
Postoperative thrombotic complications represent a unique challenge in cranial neurosurgery as primary treatment involves therapeutic anticoagulation. The decision to initiate therapy and its timing is nuanced, as surgeons must balance the risk of catastrophic intracranial hemorrhage (ICH). With limited existing evidence to guide management, current practice patterns are subjective and inconsistent. The authors assessed their experience with early therapeutic anticoagulation (≤ 7 days postoperatively) initiation for thrombotic complications in neurosurgical patients undergoing cranial surgery to better understand the risks of catastrophic ICH. ⋯ The incidence of catastrophic ICH was significantly increased when anticoagulation was initiated within 48 hours of cranial surgery. Patients undergoing intra-axial exploration during their index surgery were at higher risk of a catastrophic ICH.