World Neurosurg
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Extent of resection and tumor grade are considered the most important predictors of progression-free survival (PFS) in meningiomas. However, adjuvant therapy for atypical meningiomas remains controversial, with variable PFS rates of up to 40%. The current mitotic index (MI) range for atypical meningiomas is broad, comprising all tumors with >4 and <20 mitotic count per 10 high-power fields, leading to substantial within-grade variation of recurrence risk, especially in borderline histologic cases, creating discordance between the clinical course and the application of the classification criteria. ⋯ The pooled study results in this meta-analysis demonstrate a homogeneous statistically significant correlation between the MI and the rate of local recurrence after surgical resection regardless of the reporting method (continuous: HR = 1.20; categorical: HR = 2.65). However, significant limitations were noted, including the lack of a standardized method for MI calculation and heterogeneity of MI reports. We encourage the community to report their experience with the MI with greater precision and uniformity to further assess the influence of the MI on PFS within atypical meningiomas.
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Review Historical Article
The Microscopic and Endoscopic Skull Base Approaches Hands-On Cadaver Course at 30: a Historical Vignette.
Laboratory-based cadaveric training is essential for the development and refinement of neurosurgical technical skills in the operating room and has become an integral training component around the world. Postresidency fellowship-the first pillar of skull base surgery training-includes both hands-on clinical care and surgery supervised by an experienced skull base surgeon. Time is spent in a skull base laboratory practicing approaches and developing anatomic mastery. ⋯ At the Microscopic and Endoscopic Hands-on Cadaver Workshop, held in St. Louis, Missouri, we celebrated its 30th anniversary in April 2019. We also present the impact this course has had on neurosurgery and skull base surgery and on the professional and scientific developments of its participants in particular.
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Case Reports Multicenter Study
Utility of P2Y12 reactive unit (PRU) assessment on ticagrelor in cerebral aneurysms treated with intracranial stenting and flow diversion: Cohort study and Case Report from 2 Neurovascular Centers.
Dual antiplatelet therapy consisting of aspirin and clopidogrel is the standard of care for neurointerventional stenting and flow diversion. Platelet function testing has been increasingly performed to identify patients with a hypo- or hyper-response to clopidogrel. Ticagrelor has been a popular alternative antiplatelet agent for such patients. We assessed the role of platelet function testing in patients receiving ticagrelor and undergoing stenting or flow diversion. ⋯ A risk of thromboembolic complications exists for patients receiving ticagrelor, which correlated with the PRUs in the present preliminary study. The findings from the present study suggest that the safe PRU range for patients receiving ticagrelor should be shifted to 0-100, which is lower than that of clopidogrel, thought to be 60-210. Further validation of the optimal PRU range for patients receiving ticagrelor is necessary.
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Review Case Reports
Primary intracranial mesenchymal tumor with EWSR1-CREM gene fusion: a case report and literature review.
The prevalence of gene translocation in some mesenchymal tumors can be used as highly specific molecular diagnostic markers in clinic and pathology. EWSR1 is a partner gene in a large, diverse range of mesenchymal tumors. ⋯ This case is a novel entity of intracranial mesenchymal neoplasm with EWSR1-CREM gene fusion which was confirmed by histopathology, molecular pathology, and next-generation sequencing (NGS). The literature review shows only 5 cases of intracranial tumor harboring EWSR1-CREM gene fusion with similar features. With the further application of molecular pathology and NGS in clinical practice, there will be more intracranial mesenchymal tumor cases with EWSR1-CREM gene fusion found in the future, which may lead to further understanding of the diagnosis and clinical features of this neoplasm.
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Review Biography Historical Article
Harvey Cushing's Wanderjahr (1900-1901).
Harvey Cushing's 14-month Wanderjahr had a profound effect on his subsequent personal career, which in turn ushered in the modern age of American neurosurgery. From July 1900 to August 1901, he traveled to European neurosurgical centers in England, France, Switzerland, Italy, and Germany. His excursion happened at a crucial moment in his trajectory; it was built on his existing foundation of Halstedian surgical training and occurred at a time when interest in the special field of neurological surgery was emerging. ⋯ This article highlights tensions in prior works and reveals new insights into the transformative nature of his Wanderjahr. Furthermore, we contextualize his travels and achievements within the broader transformation of American medical education at the turn of the 20th century to elucidate how Europe influenced American medicine. We briefly consider parallel benefits of Harvey Cushing's Wanderjahr and modern domestic or international training opportunities and present potential areas of implementation.