Journal of neurosurgery
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The authors' aim was to assess the velocity and pattern of growth of meningiomas and to correlate the kinetics of tumor growth with their previously reported two-item radiological risk stratification and CNS WHO grade (5th edition, 2021). ⋯ A radiological risk assessment using two parameters-T2-weighted signal iso/hyperintensity and absence of calcifications-allows estimation of growth velocity and characteristics of untreated intracranial meningiomas. Only high-risk tumors exhibit the potential for rapid growth. However, rapid tumor growth does not indicate a higher CNS WHO grade per se.
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Journal of neurosurgery · Aug 2024
Impact of standardized care guidelines featuring next-day discharge on outcome, healthcare consumption, and patient healthcare experience in patients with idiopathic normal pressure hydrocephalus receiving ventriculoperitoneal shunts.
The aim of this study was to evaluate the effect of standardized care guidelines featuring next-day discharge on hospital length of stay (LOS), outcomes, patient experience, and healthcare consumption in patients receiving ventriculoperitoneal shunts (VPSs) for idiopathic normal pressure hydrocephalus (iNPH). ⋯ Standardized discharge guidelines featuring next-day discharge are safe for iNPH patients undergoing VPS surgery, maintain the quality of the patient experience, and are an effective method for mitigating healthcare consumption in an expanding patient group.
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Journal of neurosurgery · Aug 2024
Lateral compartment of the cavernous sinus from the endoscopic endonasal approach: anatomical considerations and surgical relevance to adenoma surgery.
The cavernous sinus (CS) has 4 compartments: superior, inferior, posterior, and lateral. Among these, the lateral compartment is the most common location for residual tumor, given the risk of neurovascular injury. The authors' study aimed to delineate the anatomical landmarks in this area and illustrate the technical nuances of the lateral transcavernous approach. ⋯ This study provides valuable insights into the anatomical intricacies of the lateral compartment of the CS and underscores the potential benefits of the endoscopic endonasal lateral transcavernous approach. Further clinical applications are essential for validating these findings and optimizing surgical outcomes.
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Journal of neurosurgery · Aug 2024
Optimizing indirect targeting of the centromedian nucleus for deep brain stimulation by incorporating third ventricular anatomy.
Deep brain stimulation (DBS) of the centromedian nucleus (CM) is used to treat diverse brain diseases including epilepsy, Tourette syndrome, and disorders of consciousness. However, the CM is challenging to visualize on routine MRI. Many surgeons use an indirect targeting method based on established stereotactic coordinates. The authors aimed to quantify how often a DBS electrode's contacts were positioned within the CM using this approach, and to identify alternative indirect coordinates that are more accurate. ⋯ The unavailability of advanced MRI for direct targeting limits access to CM-DBS in resource-constrained neurosurgical programs. Standard indirect coordinates do not provide optimal targeting of the CM, with most contacts laterally placed in the sensory thalamus. The proposed indirect approach may therefore increase the accuracy and availability of CM-DBS, while reducing side effects.
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In 1783, Alexander Monro secundus maintained that because the brain is enclosed in a case of bone and its substance is nearly incompressible, the quantity of blood within the head must be the same, or very nearly the same, at all times. Years later, this hypothesis was experimentally supported by George Kellie, and became known as the Monro-Kellie doctrine. ⋯ Yet, almost nothing has been published about some of the physiological, pathophysiological, and therapeutic ideas prevailing at that time that may have influenced Monro's hypothesis. Lastly, and perhaps most importantly, it is not clear why Monro, who knew the ventricular system in detail, did not include it as a potential compensatory compartment for changes in the intracranial blood volume.