Journal of neurosurgery
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Journal of neurosurgery · May 2024
Long-term clinical outcomes of hypofractionated stereotactic radiotherapy using the CyberKnife robotic radiosurgery system for jugular foramen schwannomas.
Jugular foramen schwannomas (JFSs) are rarely seen, benign tumors with slow growth. Today, management options for JFSs include observation, surgery, and radiation. However, the optimal treatment strategy remains controversial. Stereotactic radiosurgery serves as a minimally invasive alternative or adjuvant therapeutic regimen of microsurgery. Gamma Knife radiosurgery is suitable for patients with JFS who have small- and medium-sized tumors and normal cranial nerve (CN) function. Hypofractionated stereotactic radiotherapy (HSRT) offers a potential radiobiological advantage and may result in better preservation of normal structures compared to single-fraction stereotactic radiosurgery. The aim of the article was to review the clinical and radiographic outcomes of patients with JFS who were treated using HSRT. ⋯ HSRT proved to be a safe and effective primary or adjuvant treatment strategy for JFSs, although 14 patients (18.9%) experienced some degree of delayed symptomatic deterioration posttreatment. This therapeutic option was demonstrated to provide both excellent tumor control and improvement in CN function.
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Journal of neurosurgery · May 2024
Effect of surgical modification of deep brain stimulation lead trajectories on radiofrequency heating during MRI at 3T: from phantom experiments to clinical implementation.
Radiofrequency (RF) tissue heating around deep brain stimulation (DBS) leads is a well-known safety risk during MRI, resulting in strict imaging guidelines and limited allowable protocols. The implanted lead's trajectory and orientation with respect to the MRI electric fields contribute to variations in the magnitude of RF heating across patients. Currently, there are no surgical requirements for implanting the extracranial portion of the DBS lead, resulting in substantial variations in clinical lead trajectories and consequently RF heating. Recent studies have shown that incorporating concentric loops in the extracranial lead trajectory can reduce RF heating. However, optimal positioning of the loops and the quantitative benefit of trajectory modification in terms of added safety margins during MRI remain unknown. In this study, the authors systematically evaluated the characteristics of DBS lead trajectories that minimize RF heating during 3T MRI to develop the best surgical practices for safe access to postoperative MRI, and they present the first surgical implementation of these modified trajectories. ⋯ Surgically modifying the extracranial portion of the DBS lead trajectory can substantially reduce RF heating during 3T MRI. The authors' results indicate that simple adjustments to the lead's configuration, such as small, concentric loops near the burr hole, can be readily adopted during DBS lead implantation to improve patient safety during MRI.
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Journal of neurosurgery · May 2024
Association of carotid endarterectomy at low-volume centers with higher likelihood of major complications and nonroutine discharge.
Carotid artery stenosis (CAS) is associated with an annual stroke risk of 2%-5%, and revascularization with carotid endarterectomy (CEA) can reduce this risk. While studies have demonstrated that hospital CEA volume is associated with mortality and myocardial infarction, CEA volume cutoffs in studies are relatively arbitrary, and no specific analyses on broad complications and discharge disposition have been performed. In this study, the authors systematically set out to identify a cutoff at which CEA procedural volume was significantly associated with major complications and nonroutine discharge. ⋯ CEA patients, asymptomatic or symptomatic, are at a higher risk of major complications and nonroutine discharge at low-volume centers. Analysis of CEA as a continuous variable demonstrated a cutoff at 7 cases per year, and further study may identify factors associated with improved outcome at the lowest-volume centers.
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Journal of neurosurgery · May 2024
A taxonomy for deep cerebral cavernous malformations: subtypes of basal ganglia lesions.
Anatomical taxonomy is a practical tool that has successfully guided clinical decision-making for patients with brain arteriovenous malformations and brainstem cavernous malformations (CMs). Deep CMs are similarly complex lesions that are difficult to access and highly variable in size, shape, and position. The authors propose a novel taxonomy for deep CMs in the basal ganglia based on clinical presentation (syndromes) and anatomical location. ⋯ The study confirms the authors' hypothesis that this taxonomy for basal ganglia CMs meaningfully guides the selection of surgical approach and resection strategy. Furthermore, the proposed taxonomy can increase the diagnostic acumen at the patient bedside, help identify optimal surgical approaches, enhance the consistency of clinical communications and publications, and improve patient outcomes.
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Journal of neurosurgery · May 2024
Efficacy of intraoperative visual evoked potential amplitude reduction in predicting visual outcome after extended endoscopic endonasal resection of craniopharyngiomas.
Postoperative visual outcome is a major concern of neurosurgeons for patients with craniopharyngiomas. The current study aimed to investigate the value of visual evoked potential (VEP) amplitude reduction (N75-P100 and P100-N145) for predicting postoperative visual dysfunction (POVD) and refining current warning criteria for VEP monitoring. ⋯ Both N75-P100 and P100-N145 amplitude reduction ratios showed great potential to be indicators for POVD in patients with craniopharyngiomas. Regarding warning criteria for VEP monitoring, the authors recommend that both N75-P100 and P100-N145 amplitude reduction should be considered, with early warning criteria of a 50% reduction for N75-P100 amplitude and/or a 40% reduction for P100-N145 amplitude.