Neurosurgery
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Recent advancements in neuroimaging and machine learning have significantly improved our ability to diagnose and categorize isocitrate dehydrogenase (IDH)-wildtype glioblastoma, a disease characterized by notable tumoral heterogeneity, which is crucial for effective treatment. Neuroimaging techniques, such as diffusion tensor imaging and magnetic resonance radiomics, provide noninvasive insights into tumor infiltration patterns and metabolic profiles, aiding in accurate diagnosis and prognostication. Machine learning algorithms further enhance glioblastoma characterization by identifying distinct imaging patterns and features, facilitating precise diagnoses and treatment planning. ⋯ Future directions should focus on refining machine learning models, integrating emerging imaging techniques, and elucidating the complex interplay between imaging features and underlying molecular processes. This review highlights the pivotal role of neuroimaging and machine learning in glioblastoma research, offering invaluable noninvasive tools for diagnosis, prognosis prediction, and treatment planning, ultimately improving patient outcomes. These advances in the field promise to usher in a new era in the understanding and classification of IDH-wildtype glioblastoma.
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Improved imaging modalities have led to an increased detection of intracranial aneurysms, many of which are small. There is uncertainty in the appropriate management of tiny aneurysms. The objective of this study was to use a large, multi-institutional NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) to assess the frequency, safety, and efficacy of treatment of tiny, unruptured middle cerebral artery (MCA) aneurysms. ⋯ Treatment of tiny, unruptured MCA aneurysms is efficacious but may have a high rate of complications. Physicians should be cautious when deciding to treat tiny, unruptured MCA aneurysms.
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Over the course of their career, 66% of neurosurgeons will witness someone accidentally dropping a bone flap on the floor during a craniotomy procedure. Although this event is rare, it can have significant consequences for the patient, and little literature is available to guide management of this complication. Our objective was to compare 5 bone flap decontamination protocols for efficacy in reducing bacterial load, with the goal of safely reimplanting the dropped flap. ⋯ In the event of the accidental fall of a bone flap, decontamination by rinsing in an alcohol-chlorhexidine solution followed by 3 successive washes in saline seemed to provide the best balance between effectiveness, safety, and complexity of the method.
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The optimal management strategy for pediatric patients with symptomatic moyamoya disease (MMD) is not well established. This systematic review and meta-analysis compares surgical vs conservative management and direct/combined bypass (DB/CB) vs indirect bypass (IB) for pediatric patients with symptomatic MMD. ⋯ Surgical revascularization yielded more favorable clinical outcomes than conservative management in this meta-analysis. Clinical outcomes were similar between DB/CB vs IB techniques. Surgical flow augmentation, either by DB/CB or IB, seems to benefit pediatric patients with symptomatic MMD.