Journal of neurosurgery
-
Journal of neurosurgery · Oct 2022
Medication intake and hemorrhage risk in patients with familial cerebral cavernous malformations.
The objective of this study was to analyze the impact of medication intake on hemorrhage risk in patients with familial cerebral cavernous malformation (FCCM). ⋯ ICH at diagnosis was identified as a risk factor for recurrent hemorrhage. Although the relationships were not statistically significant, statin and antithrombotic medication tended to be associated with decreased bleeding events.
-
Journal of neurosurgery · Oct 2022
Clinical features and surgical outcomes of intracranial and spinal cord subependymomas.
Subependymomas are low-grade ependymal tumors whose clinical characteristics, radiographic features, and postsurgical outcomes are incompletely characterized due to their rarity. The authors present an institutional case series and a systematic literature review to achieve a better understanding of subependymomas. ⋯ The authors' case series and literature review demonstrate that patients with subependymoma are well managed with resection and generally have a favorable prognosis.
-
Journal of neurosurgery · Oct 2022
Double dose of 5-aminolevulinic acid and its effect on protoporphyrin IX accumulation in low-grade glioma.
Administration of 5-aminolevulinic acid (5-ALA) does not regularly elicit fluorescence in low-grade glioma (LGG) at currently established doses and timing of administration. One explanation may be differences in blood-brain barrier (BBB) integrity compared to high-grade glioma. The authors hypothesized that for a BBB semipermeable to 5-ALA there might be a relationship between plasma 5-ALA concentration and its movement into the brain. A higher dose would elicit more 5-ALA conversion into protoporphyrin IX (PPIX). The authors present a case series of patients harboring LGG who received higher doses of 5-ALA. ⋯ These observations demonstrate different regions with different levels of PPIX accumulation in LGG. With higher 5-ALA doses cPPIX increases, leading to more regions surpassing the visibility threshold of 1 μg/ml. These observations can be explained by the fact that the BBB in LGG is semipermeable to 5-ALA. Higher 5-ALA doses result in more PPIX conversion, an observation with implications for future dosing in LGG.
-
Journal of neurosurgery · Oct 2022
Development of multiple intracranial aneurysms: beyond the common risk factors.
The prevalence of multiple intracranial aneurysms (MIAs) has increased over the last decades. Because MIAs have been identified as an independent risk factor for formation, growth, and rupture of intracranial aneurysms (IAs), a more profound understanding of the underlying pathophysiology of MIAs is needed. Therefore, the authors' extensive institutional aneurysm database was analyzed to elucidate differences between patients with a single IA (SIA) and those with MIAs. ⋯ In this sizable consecutive series of patients with IAs, the authors confirmed the impact of common IA risk factors on the genesis of MIAs. In addition, specific hemorheological and hemocytological features may also contribute to the development of MIAs.
-
Journal of neurosurgery · Oct 2022
Assessment of learning curves on a simulated neurosurgical task using metrics selected by artificial intelligence.
Understanding the variation of learning curves of experts and trainees for a given surgical procedure is important in implementing formative learning paradigms to accelerate mastery. The study objectives were to use artificial intelligence (AI)-derived metrics to determine the learning curves of participants in 4 groups with different expertise levels who performed a series of identical virtual reality (VR) subpial resection tasks and to identify learning curve differences among the 4 groups. ⋯ Learning curves generated using AI-derived metrics provided novel insights into technical skill acquisition, based on expertise level, during repeated VR-simulated subpial tumor resections, which will allow educators to develop more focused formative educational paradigms for neurosurgical trainees.