Journal of neurosurgery
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Journal of neurosurgery · Sep 2024
Prediction of contralateral progression in patients with bilateral nonhemorrhagic moyamoya disease following unilateral revascularization surgery.
This study was designed to identify predictive factors associated with substantial contralateral progression in adult patients with bilateral nonhemorrhagic moyamoya disease (MMD) who undergo revascularization surgery (RS) on one hemisphere. ⋯ The study revealed a 7.7% per person-year rate of contralateral progression in patients with bilateral non-hMMD following unilateral RS. Younger age and a BMI ≥ 25 were identified as significant risk factors. For these patients, careful weight management and the use of antilipid agents may be crucial strategies for reducing the risk of contralateral progression after unilateral RS.
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Journal of neurosurgery · Sep 2024
Improvement of diffusion tensor imaging-based tractography by free-water correction in nonedematous gliomas: assessment with brain mapping.
The free-water correction algorithm (Freewater Estimator Using Interpolated Initialization [FERNET]) can be applied to standard diffusion tensor imaging (DTI) tractography to improve visualization of subcortical bundles in the peritumoral area of highly edematous brain tumors. Interest in its use for presurgical planning in purely infiltrative gliomas without peritumoral edema has never been evaluated. Using subcortical maps obtained with direct electrostimulation (DES) in awake surgery as a reference standard, the authors sought to 1) assess the accuracy of preoperative DTI-based tractography with FERNET in a series of nonedematous glioma patients, and 2) determine its potential usefulness in presurgical planning. ⋯ Free-water correction significantly increased the anatomical plausibility of the stimulated fascicles and the volume of tracts of interest in the peritumoral area of purely infiltrative nonedematous gliomas. Because of the functional importance of the peritumoral zone, applying FERNET to DTI could have potential implications on surgical planning and the safety of glioma resection.