Journal of neurosurgery
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Journal of neurosurgery · Nov 2024
Multinuclear thalamic targeting with human stereotactic electroencephalography: surgical technique and nuances.
The authors recently demonstrated the utility of a novel multinuclear thalamic stereotactic electroencephalography (sEEG) approach to identify personalized seizure propagation networks through the human thalamus. In this study, they detail their strategy to efficiently sample the thalamus. ⋯ This study provides a strategy and specific implementation details for these approaches to identify the thalamic seizure networks that are increasingly important in the surgical treatment of epilepsy.
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Journal of neurosurgery · Nov 2024
ReviewSafety of early chemoprophylaxis for venous thromboembolism after traumatic brain injury: a systematic review and meta-analysis. A military traumatic brain injury initiative study.
There is continuing uncertainty about the safety of early chemoprophylaxis for venous thromboembolism (VTE) in patients with traumatic brain injury (TBI). The objective of this paper was to 1) calculate the risk of progression of posttraumatic intracranial hemorrhage (ICH) after VTE chemoprophylaxis, and 2) compare the probability of ICH progression in early versus late VTE prophylaxis. ⋯ The review of the literature shows that VTE chemoprophylaxis 72 hours after TBI is considered safe by the majority of authors. This meta-analysis did not reveal any evidence of increased risk of ICH when starting VTE chemoprophylaxis earlier, i.e., within 72 hours of TBI; however, it is important to emphasize that only a small number of lower-quality studies addressed the 48-hour or 24-hour time point. A randomized noninferiority trial should be the next step in answering the question of early (within 72 hours) VTE chemoprophylaxis after TBI.
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Journal of neurosurgery · Nov 2024
The impact of initial vascular morphology on outcomes in patients with intracranial vertebral artery dissection presenting with isolated headache.
The prognosis of isolated headache intracranial vertebral artery dissection (iVAD) without subarachnoid hemorrhage (SAH) or stroke is unknown. The authors of this study aimed to evaluate isolated headache iVAD prognosis. ⋯ Most patients with isolated headache iVAD had a favorable prognosis. However, patients with aneurysm dilatation without stenosis required the most careful follow-up, as this group had the highest aneurysm enlargement risk from early disease onset through the chronic phase. In such cases, patients may require surgical intervention to prevent critical conditions.
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Journal of neurosurgery · Nov 2024
Primary and salvage radiosurgery for neurofibromatosis type 2-associated meningiomas.
The optimal management of neurofibromatosis type 2 (NF2)-associated meningiomas must be personalized case by case. Stereotactic radiosurgery (SRS) is one option for patients with one or multiple intracranial meningiomas associated with the NF2 mutation. In this study, the authors evaluated their single-institution experience of SRS treatment for NF2-associated meningiomas. ⋯ In this case series, the LTC rates of both primary and salvage SRS exceeded 90%. However, nearly half of the patients required additional SRS for new untreated meningiomas. No significant differences in long-term LTC were found when comparing upfront versus salvage SRS for patients with NF2 meningiomas. These results establish SRS as a valuable and safe option for managing NF2-associated meningiomas.