Journal of neurosurgery
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Journal of neurosurgery · Oct 2024
Association between accumulation of 2-hydroxyglutarate detected by MR spectroscopy and preoperative seizure in IDH-mutant glioma.
Epileptic seizures are common in patients with gliomas, and their control represents an important aspect of treatment. The oncometabolite 2-hydroxyglutarate (2HG), produced by mutant isocitrate dehydrogenase (IDH), is thought to be associated with seizures due to its structural similarity to the excitatory neurotransmitter glutamate. Using 3T MR spectroscopy (MRS), the authors investigated whether 2HG accumulation might indicate preoperative glioma-associated seizures. ⋯ An elevated 2HG concentration on MRS could be associated with preoperative seizure, suggesting that 2HG accumulation increases the risk of preoperative seizures in IDH-mutant gliomas.
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Journal of neurosurgery · Oct 2024
Regional differences in reimbursement rates from Medicare, Medicaid, and FAIR Health across common procedures for neurological surgeons.
FAIR Health-a nonprofit, state-funded database-was created as an independent repository of healthcare claims paid data to address allegations of price fixing. Many insurers have forced physicians to negotiate payments based on Medicare rates, rather than utilizing FAIR Health. The authors' objective was to provide an overview of regional differences in reimbursement rates per several sample neurosurgical Current Procedural Terminology (CPT) codes and to compare Medicare, Medicaid, and usual, customary, and reasonable rates via FAIR Health rate estimates. ⋯ Inherent differences exist between cities and states, including median income, employment rates, and health coverage. Despite geographic cost practice indices for Medicare and state-specific production of Medicaid, Medicaid/Medicare reimbursement rates did not vary across regions but were consistently and significantly lower than FAIR Health estimates throughout the US. Locale-specific variation in FAIR Health may further indicate a better accounting of regional differences in cost of practice.
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Journal of neurosurgery · Oct 2024
Endoscopic transorbital approach for resection of mediobasal temporal lesions using an optic radiation-sparing strategy.
The endoscopic transorbital approach (ETOA) has emerged as a promising minimally invasive technique for resection of lesions in the mediobasal temporal region (MTR) due to its potential to preserve the integrity of the optic radiation (OR). This study evaluated the safety and efficacy of ETOA using an OR-sparing surgical strategy for mediobasal temporal lesions. ⋯ The combined use of ETOA and OR tractography appears to be a feasible approach for resecting lesions involving the MTR, especially in the anterior segment. In the authors' experience, this surgical strategy enables maximal safe resection while minimizing the risk of postoperative visual dysfunction. Further studies with larger sample sizes are warranted to validate these findings and assess long-term outcomes.
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Journal of neurosurgery · Oct 2024
Chordoma incidence, treatment, and survival in the 21st century: a population-based Ontario cohort study.
This study estimates the incidence, treatment patterns, and overall survival for patients with chordoma treated in Ontario. ⋯ Chordoma is a rare disease with no significant change in the average annual incidence rate between 2003 to 2019. During this time, treatment with less invasive modalities increased, particularly for skull base chordoma. Overall survival exceeds 10 years for many patients, with no change in the hazard of death across the study period.