Safety and completeness of using indocyanine green videoangiography combined with digital subtraction angiography for aneurysm surgery in a hybrid operating theater
This study aimed to evaluate the safety and completeness of using intraoperative indocyanine green videoangiography (ICGV) combined with intraoperative angiography (IOA) for aneurysm clipping in a hybrid operating room (hOR). All patients who underwent microsurgical clipping in the hOR were identified from prospectively maintained neurosurgical databases. Medical charts and operative videos with ICGV and IOA were reviewed to determine the adequacy of clipping, and clinical and angiographic outcomes were retrospectively analyzed. Fifty-four cerebral aneurysms (ruptured, 31; unruptured, 23) in 50 patients (mean age, 59.4 &th...
Source: Neurosurgical Review - July 17, 2019 Category: Neurosurgery Source Type: research

Navigated neuroendoscopy combined with intraoperative magnetic resonance cysternography for treatment of arachnoid cysts
AbstractEndoscopic cystocysternostomy or cystoventriculostomy is the treatment of choice in patients with symptomatic intracranial arachnoid cysts. There are no objective diagnostic tests for reliable intraoperative evaluation of the effectiveness of performed stomies. The aim of this prospective open-label study is to demonstrate for the first time the usefulness of intraoperative cysternography performed with the low-field 0.15-T magnetic resonance imager Polestar N20 during endoscopic cysternostomies. The study was performed in patients operated for middle fossa arachnoid cysts (n = 10), suprasellar cysts ...
Source: Neurosurgical Review - July 16, 2019 Category: Neurosurgery Source Type: research

Management of hydrocephalus after resection of posterior fossa lesions in pediatric and adult patients —predictors for development of hydrocephalus
AbstractThe surgical management of hydrocephalus in patients with posterior fossa lesions (PFL) is critical for optimal patient outcome(s). Accordingly, it is prudent to identify patients in need of aggressive surgical intervention (i.e., ventriculoperitoneal [VP] shunting). To analyze prevalence of, and risk factors associated with, the development of post-operative hydrocephalus in both pediatrics and adults. A retrospective institutional analysis and review of patient records in those who had undergone PFL surgery was performed. In so doing, the authors identified patients that went on to develop post-operative hydrocep...
Source: Neurosurgical Review - July 9, 2019 Category: Neurosurgery Source Type: research

Incision of the anterior petroclinoidal fold during clipping for securing the proximal space of an internal carotid artery –posterior communicating artery aneurysm: a technical note
AbstractSurgical clipping of an internal carotid artery (ICA) –posterior communicating artery (ICPC) aneurysm is often difficult in cases involving limited space to insert a clip at the proximal aneurysm neck hidden by the tent. In such cases, we perform incision of the anterior petroclinoidal fold to secure the proximal space for clip insertion. Between Apr il 2013 and March 2018, we treated 89 ICPC aneurysm cases by clipping. Incision of the anterior petroclinoidal fold was performed in 15 of the 89 cases (16.8%). Fast imaging employing steady-state acquisition (FIESTA) magnetic resonance imaging (MRI) can indicate...
Source: Neurosurgical Review - July 4, 2019 Category: Neurosurgery Source Type: research

Accuracy of cortical bone trajectory screw placement using patient-specific template guide system
This study was a retrospective clinical evaluation of prospectively collected patients. Forty-three consecutively enrolled patients who underwent posterior lumbar spinal fusion using the guide system were included. First, three-dimensional planning of CBT screw placement was performed using computer simulation software. The trajectory was directed in a more anterior position of the vertebral body, compared with the original CBT, and the standard size was set as 5 –6 mm in diameter and 40–45 mm in length. Then, screw guides were created for each vertebra preoperatively and used. The safety and accuracy...
Source: Neurosurgical Review - July 3, 2019 Category: Neurosurgery Source Type: research

Hyperhomocysteinemia is an independent risk factor for intracranial aneurysms: a case-control study in a Chinese Han population
AbstractIntracranial aneurysms (IAs) are common lesions in the brain. There is a strong relation between hyperhomocysteinemia (HHcy) and cerebrovascular disease; we perform a retrospective study within the Chinese Han population to explore the association between HHcy and IAs. Two hundred six patients with IAs and 206 control subjects were evaluated for their serum total homocysteine levels. With multiple logistic regression analysis, the association between HHcy and the risk of IAs was estimated. Interaction and stratified analyses were conducted according to age, sex, BMI, smoking status, drinking status, and chronic dis...
Source: Neurosurgical Review - June 29, 2019 Category: Neurosurgery Source Type: research

Pituitary adenomas and neuropsychological status: a systematic literature review
AbstractNeurocognitive and psychological dysfunctions associated with pituitary adenomas (PAs) are clinically relevant, though probably under-reported. The aim of the current review is to provide an update on neuropsychological status, psychopathology, and perceived quality of life (QoL) in patients with PAs. A systematic research was performed in PubMed and Scopus in order to identify reports on neurocognitive, psychiatric, and psychological disorders in PAs. Prevalence of alterations, QoL evaluation, and used tests were also recorded. PRISMA guidelines were followed. Of 62,448 identified articles, 102 studies were includ...
Source: Neurosurgical Review - June 27, 2019 Category: Neurosurgery Source Type: research

Anterior lumbar interbody fusions combined with posterior column osteotomy in patients who had sagittal imbalance associated with degenerative lumbar flat-back deformity: a retrospective case series
AbstractAnterior lumbar interbody fusion (ALIF) combined with posterior column osteotomy (PCO) may be effective to achieve ideal lumbar curve correction in lumbar flat-back deformity (LFD). We aimed to investigate the radiographic and clinical outcomes of patients with primary degenerative LFD treated with multi-level ALIFs combined with PCOs. Seventy patients with primary degenerative LFD who underwent corrective surgery were divided into three groups according to the 1-month postoperative pelvic incidence/lumbar lordosis (PI-LL) angles ( ≤ − 10°, from − 9° to 9°, and ≥&t...
Source: Neurosurgical Review - June 24, 2019 Category: Neurosurgery Source Type: research

Correction to: Clinical and radiological outcomes of unilateral biportal endoscopic lumbar interbody fusion (ULIF) compared with conventional posterior lumbar interbody fusion (PLIF): 1-year follow-up
The original publication of this article has incorrect presentation of one of the author names. Instead of Sangu-Kyu Son, it should have been Sang-Kyu Son. (Source: Neurosurgical Review)
Source: Neurosurgical Review - June 24, 2019 Category: Neurosurgery Source Type: research

Perioperative multidisciplinary management of endoscopic transsphenoidal surgery for sellar lesions: practical suggestions from the Padova model
AbstractPerioperative management of patients with sellar lesion submitted to endoscopic transsphenoidal neurosurgery (TSS) lacks standardization and therefore it is committed to each center clinical practice. Although neurosurgical procedure remains the same for all sellar lesions, perioperative approach can require different measures depending on the underlying disease. With the aim of standardizing our perioperative procedures and sharing our experience with other centers involved in the management of pituitary disease, we developed a clinical care path for patients with sellar lesions candidate to endoscopic TSS. For th...
Source: Neurosurgical Review - June 22, 2019 Category: Neurosurgery Source Type: research

Spinal subependymoma surgery: do no harm. Little may be more!
Conclusion: The reviewed cases report a rate of 65% total resection of which 5 7% had worsened function after surgery. There were no reports of malignant transformation; therefore, long-term survival is expected, and surgical caution should be exercised where there is minimal symptom progression. (Source: Neurosurgical Review)
Source: Neurosurgical Review - June 18, 2019 Category: Neurosurgery Source Type: research

Current understanding of lymphatic vessels in the central nervous system
AbstractLymphangiogenesis is associated with some pathological conditions such as inflammation, tissue repair, and tumor growth. Recently, a paradigm shift occurred following the discovery of meningeal lymphatic structures in the human central nervous system (CNS); these structures may be a key drainage route for cerebrospinal fluid (CSF) into the peripheral blood and may also contribute to inflammatory reaction and immune surveillance of the CNS. Lymphatic vessels located along the dural sinuses absorb CSF from the adjacent subarachnoid space and brain interstitial fluid via the glymphatic system, which is composed of aqu...
Source: Neurosurgical Review - June 18, 2019 Category: Neurosurgery Source Type: research

Treatment of neurofibromatosis 1-associated malignant peripheral nerve sheath tumors: a systematic review
AbstractMalignant peripheral nerve sheath tumors (MPNST) are a rare and aggressive group of tumors that are challenging to treat. Neurofibromatosis type 1 (NF-1)-associated MPNSTs have been associated with poorer clinical outcomes. The treatment options for NF-1-associated MPNSTs broadly include surgery (SG), chemotherapy (CT), and adjuvant radiotherapy (RT). Overall, the role and efficacy of CT and RT are unclear. Examination of existing literature for studies reporting on NF-1-associated MPNSTs and respective treatment-related outcomes was conducted. We conducted a systematic review according to PRISMA guidelines in PubM...
Source: Neurosurgical Review - June 17, 2019 Category: Neurosurgery Source Type: research

High variance of intraoperative blood pressure predicts early cerebral infarction after revascularization surgery in patients with Moyamoya disease
AbstractFew studies focused on the intraoperative blood pressure in Moyamoya disease (MMD) patients. We aimed to clarify whether or not it relates to early cerebral infarction after revascularization. We reviewed a retrospective cohort of Moyamoya disease from 2011 to 2018 in Beijing Tiantan Hospital, and patients with radiologically confirmed early postoperative infarction were included in the analysis. Controls were matched based on age, sex, and revascularization modality at a ratio of 1:5. Perioperative clinical factors and intraoperative blood pressure data were collected and analyzed. A total of 52 patients out of 14...
Source: Neurosurgical Review - June 15, 2019 Category: Neurosurgery Source Type: research

Craniocervical trauma above the age of 90: are current prognostic scores sufficient?
AbstractClinical data following head or spine trauma in patients over 90  years is rare. The aim of this study was to analyze this patient cohort, assessing clinical characteristics, outcomes, and survival rates and to identify variables that may predict early mortality. A retrospective analysis of all patients over the age of 90 that were treated between January 2006 a nd December 2016 at our department was performed. Patient characteristics, type of injury, and comorbidities were analyzed with regard to the 30-day mortality rate as the primary outcome. One hundred seventy-nine patients were identified. Mean age was ...
Source: Neurosurgical Review - June 13, 2019 Category: Neurosurgery Source Type: research

Anterior interhemispheric approach for clipping of subcallosal distal anterior cerebral artery aneurysms: case series and technical notes
AbstractDistal anterior cerebral artery (DACA) aneurysms are rare, accounting for 1 –9% of all intracranial aneurysms. Previous systematic reviews have highlighted that given the markedly increased incidence of major complications after endovascular treatment, microsurgical clipping is the more attractive treatment option with generally excellent clinical outcomes. Subcallosal DA CA aneurysms constitute a rare subset of these aneurysms, requiring special anatomic considerations—particularly with regard to the approach. The aim of this study is to review the technical nuances of microsurgical treatment of subcal...
Source: Neurosurgical Review - June 11, 2019 Category: Neurosurgery Source Type: research

WHO grade I meningiomas: classification-tree for prognostic factors of survival
AbstractWorld Health Organization (WHO) grade I meningiomas are intracranial extracerebral tumors, in which microsurgery as a stand-alone therapy provides high rates of disease control and low recurrence rates. Our aim was to identify prognostic factors of overall survival and time-to-retreat (OS; TTR) in a cohort of patients with surgically managed WHO grade I meningioma. Patients with WHO grade I meningiomas from a retrospectively (1990 to 2002) and prospectively managed (2003 to 2010) databank of Oslo University Hospital, Norway, were included. The mean follow-up was 9.2  ± 5.7 years, with a to...
Source: Neurosurgical Review - June 10, 2019 Category: Neurosurgery Source Type: research

CCM1/KRIT1 mutation in monozygotic twins of a polyzygotic triplet birth: genetic, clinical and radiological characteristics
AbstractCerebral cavernous malformations are focal vascular lesions of the brain, occurring sporadically or as an autosomal dominant familial form. The genetic background influences not only the clinical course but also patients ’ consultation and the indication to treat. We here present the rare case of monozygotic male twins of a polyzygotic triplet birth, carrying aCCM1 mutation, inherited from the mother. Both twins showed an identical site and size of a large frontobasal lesion. The genetic segregation and the clinical course in affected family members are presented and discussed. (Source: Neurosurgical Review)
Source: Neurosurgical Review - June 6, 2019 Category: Neurosurgery Source Type: research

Angiosarcoma-related cerebral metastases: a systematic review of the literature
AbstractAngiosarcoma-related cerebral metastases have only been recorded in a few case reports and case series and have not been systematically reviewed to date. Our objective was therefore to perform a systematic literature review on cases of angiosarcomas metastasizing to the brain to inform current practice. All three major libraries —PubMed/MEDLINE, Embase, and Cochrane—were systematically searched, until January 2019. Articles in English reporting angiosarcoma-related cerebral metastases via hematogenous route were included. Our search yielded 45 articles (38 case reports, 5 retrospective studies, 1 case s...
Source: Neurosurgical Review - June 4, 2019 Category: Neurosurgery Source Type: research

The effectiveness of lumbar cerebrospinal fluid drainage in aneurysmal subarachnoid hemorrhage with different bleeding amounts
AbstractContinuous lumbar drainage (LD) of cerebrospinal fluid can reduce the risk of aneurysmal subarachnoid hemorrhage (aSAH) –related complications. We evaluated the effectiveness of LD in aSAH patients with aneurysmal clipping and the relative benefits of different bleeding amounts. We retrospectively reviewed all consecutive aSAH patients who underwent aneurysm clipping in our hospital between January 1, 2014 and Dece mber 31, 2014. Outcomes and incidence of post-operative complications were compared between the LD group and the non-LD group in all patients and further analyzed in patients with the low modified ...
Source: Neurosurgical Review - June 3, 2019 Category: Neurosurgery Source Type: research

Is nontraumatic intracerebral hemorrhage different between young and elderly patients?
This study investigated the clinical characteristics and outcome of nontraumatic intracerebral hemorrhage in young patients in comparison to those of the elderly. A retrospective review of consecutive patients admitted at the department of neurosurgery of two tertiary care medical centers presenting with first-ever nontraumatic intracerebral hemorrhage was performed. We identified and compared the demographics, etiologies, risk factors, and laboratory, radiological, and clinical findings between elderly and young patients. Additionally, logistic regression analyses of independent prognostic factors associated with 1-month ...
Source: Neurosurgical Review - June 3, 2019 Category: Neurosurgery Source Type: research

Brain invasion in meningiomas: does surgical sampling impact specimen characteristics and histology?
AbstractBrain invasion (BI) is a new criterion for atypia in meningiomas and therefore potentially impacts adjuvant treatment. However, it remains unclear whether surgical practice and specimen characteristics influence histopathological analyses and the accuracy of detecting BI. Tumor location, specimen characteristics, and rates of BI were compared in meningioma samples obtained from 2938 surgeries in different neurosurgical departments but diagnosed in a single neuropathological institute. Non-skull base tumor location was associated with CNS tissue on the microscopic slides (OR 1.45;p 
Source: Neurosurgical Review - June 3, 2019 Category: Neurosurgery Source Type: research

Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials
AbstractHyperosmolar therapy is regarded as the mainstay for treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI). This still has been disputed as application of hypertonic saline (HS) or mannitol for treating patients with severe TBI. Thus, this meta-analysis was performed to further compare the advantages and disadvantages of mannitol with HS for treating elevated ICP after TBI. We conducted a systematic search on PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Wan Fang Data, VIP Data, SinoMed, and China National Knowledge Infrastructure (CNKI) databases. Studies wer...
Source: Neurosurgical Review - May 6, 2019 Category: Neurosurgery Source Type: research

MRI combined with PET-CT of different tracers to improve the accuracy of glioma diagnosis: a systematic review and meta-analysis
AbstractBased on studies focusing on positron emission tomography (PET)-computed tomography (CT) combined with magnetic resonance imaging (MRI) in the diagnosis of glioma, we conducted a systematic review and meta-analysis evaluating the pros and cons and the accuracy of different examinations. PubMed and Cochrane Library were searched. The search was conducted until April 2017. Two reviewers independently conducted the literature search according to the criteria set initially. Based on the exclusion criteria, 15 articles are included in this study. Of all studies that used MRI examination, there are five involving 18F-flu...
Source: Neurosurgical Review - May 6, 2019 Category: Neurosurgery Source Type: research

Two-level cervical corpectomy —long-term follow-up reveals the high rate of material failure in patients, who received an anterior approach only
AbstractIn contrast to a one-level cervical corpectomy, a multilevel corpectomy without posterior fusion is accompanied by a high material failure rate. So far, the adequate surgical technique for patients, who receive a two-level corpectomy, remains to be elucidated. The aim of this study was to determine the long-term clinical outcome of patients with cervical myelopathy, who underwent a two-level corpectomy. Outcome parameters of 21 patients, who received a two-level cervical corpectomy, were retrospectively analyzed concerning reoperations and outcome scores (VAS, Neck Disability Index (NDI), Nurick scale, modified Jap...
Source: Neurosurgical Review - May 6, 2019 Category: Neurosurgery Source Type: research

Evaluation of the risk of rupture of intracranial aneurysms in patients with aneurysmal subarachnoid hemorrhage according to the PHASES score
AbstractThe PHASES score was developed to determine the risk of rupture of un-ruptured intracranial aneurysms (UIAs). The purposes of the current study were to apply this score on patients with actually ruptured intracranial aneurysms and to analyze the hypothetically prediction of the risk in this particularly patient group. We extracted the data of 100 recently treated patients (23 male, 77 female, mean age 56.4  years, range 17–93 years) with ruptured saccular intracranial aneurysms from our prospectively maintained neurovascular database according to the parameters used in the PHASES score (population, ...
Source: Neurosurgical Review - May 6, 2019 Category: Neurosurgery Source Type: research

One-stage frame-guided resection and reconstruction with PEEK custom-made prostheses for predominantly intraosseous meningiomas: technical notes and a case series
AbstractTreatment of intraosseous meningiomas is a two-staged procedure including tumor resection and cranial reconstruction. Several are the potential pitfall of this kind of surgery such as the conspicuous dimensions usually reached by the tumor and the peculiar involvement of irregular and deep bony structures. For these reasons, a surgical accurate virtual planning and a careful removal followed by tailored reconstruction are mandatory to achieve satisfactory results. We analyzed six patients operated on for intraosseous meningiomas between September 2014 and June 2018. Resection strategy was planned beforehand and sha...
Source: Neurosurgical Review - May 4, 2019 Category: Neurosurgery Source Type: research

Does three-grade classification of T2-weighted increased signal intensity reflect the severity of myelopathy and surgical outcomes in patients with cervical compressive myelopathy? A systematic review and meta-analysis
The objective of this study is to investigate the efficacy and value in prediction of the three-grade classification of ISI on the severity of myelopathy and surgical outcomes. Randomized or non-randomized controlled studies using three-grade classification of ISI (grade 0, none; grade 1, light or obscure; and grade 2, intense or bright) in patients with CCM were sought in the following databases: PubMed, Embase, and Cochrane Library. The pooled Japanese Orthopedic Association (JOA)/modified JOA (mJOA) score, neuro-functional recovery rate, C2-C7 lordotic angle, and range of motion (ROM) were calculated. A total of 8 studi...
Source: Neurosurgical Review - May 3, 2019 Category: Neurosurgery Source Type: research

Recurrence of Rathke ’s cleft cysts based on gross total resection of cyst wall: a meta-analysis
AbstractRathke ’s cleft cysts (RCCs) are benign growths of the embryological Rathke’s pouch. Surgical decompression provides effective symptomatic relief in most cases; however, the effect of gross total resection (GTR) of the cyst wall on recurrence, as well as pituitary function, is unclear. The aim of this meta-analysis was to pool the current literature and ascertain the recurrence control afforded by GTR of the cyst wall compared with subtotal resection (STR). Searches of seven electronic databases from inception to January 2019 were conducted following PRISMA guidelines, resulting in 476 articles t o be s...
Source: Neurosurgical Review - April 30, 2019 Category: Neurosurgery Source Type: research

Recovery of shoulder abduction in traumatic brachial plexus palsy: a systematic review and meta-analysis of nerve transfer versus nerve graft
AbstractBrachial plexus palsy is a surgically manageable condition. Re-animating the shoulder is a high priority for restoring upper extremity function. Methods for reinnervating injured nerves include the transfer of a healthy nerve or fascicle distal to the site of injury, or grafting a healthy sensory nerve to restore motor function. Studies aiming to compare these two techniques for restoring shoulder abduction have yielded conflicting results. We conducted a systematic review and meta-analysis following the PRISMA guidelines. We reviewed the PubMed database for studies comparing nerve transfer and nerve grafting for s...
Source: Neurosurgical Review - April 17, 2019 Category: Neurosurgery Source Type: research

Stereotactic radiosurgery and radiotherapy for acoustic neuromas
We described the results of different doses used for SRS and FSRT, the current status, and a comparison between the two radiotherapy approaches. Stereotactic radiotherapy techniques aim to control tumor growth with minimal toxicity. SRS using either a cobalt unit or a linear accelerator has given high rates of tumor control and of cranial nerve function preservation with marginal doses range of 12 –14 Gy. Fractionated stereotactic radiotherapy (FSRT) is optimal for tumors larger than 3 cm. Doses as low as 50.4 Gy provide excellent control rates and low morbidity. Overall, both SRS and FSRT are equally ...
Source: Neurosurgical Review - April 13, 2019 Category: Neurosurgery Source Type: research

What is the best therapeutic approach to a pediatric patient with a deep-seated brain AVM?
AbstractAlthough brain arteriovenous malformations (bAVMs) account for a very small proportion of cerebral pathologies in the pediatric population, they are the cause of roughly 50% of spontaneous intracranial hemorrhages. Pediatric bAVMs tend to rupture more frequently and seem to have higher recurrence rates than bAVMs in adults. Thus, the management of pediatric bAVMs is particularly challenging. In general, the treatment options are conservative treatment, microsurgery, endovascular therapy (EVT), gamma knife radiosurgery (GKRS), proton-beam stereotactic radiosurgery (PSRS), or a combination of the above. In order to i...
Source: Neurosurgical Review - April 13, 2019 Category: Neurosurgery Source Type: research

Periodontitis and gingival bleeding associate with intracranial aneurysms and risk of aneurysmal subarachnoid hemorrhage
AbstractOral bacteria DNA has been found in intracranial aneurysms (IA) and a high prevalence of periodontitis was reported in IA patients. We investigated whether periodontitis associates with IA formation and aneurysmal subarachnoid hemorrhage (aSAH). First, we compared in a case-control setting the prevalence of periodontal disease in IA patients (42 unruptured IA, 34 ruptured IA) and in age- and gender-matched controls (n = 70) from the same geographical area (Health 2000 Survey, BRIF8901). Next, we investigated whether periodontitis at baseline associated with aSAH in a 13-year follow-up study of 5170 He...
Source: Neurosurgical Review - April 10, 2019 Category: Neurosurgery Source Type: research

Intraoperative MRI in transsphenoidal resection of invasive pituitary macroadenomas
AbstractThe use of intraoperative MRI (iMRI) increases extent of resection in transsphenoidal pituitary surgery. Microsurgical and endoscopic techniques have been established as equal and standard surgical methods. The object of the current study was to evaluate the additional value of iMRI for resection of invasive pituitary adenomas. We conducted a retrospective monocenter study of all consecutive patients treated with invasive pituitary adenomas graded as Knosp III-IV at our department after the introduction of iMRI in 2008. Out of 315 transsphenoidal surgeries for pituitary adenomas, 111 met the criteria for analysis. ...
Source: Neurosurgical Review - April 4, 2019 Category: Neurosurgery Source Type: research

In-hospital mortality and poor outcome after surgical clipping and endovascular coiling for aneurysmal subarachnoid hemorrhage using nationwide databases: a systematic review and meta-analysis
AbstractThere has never been evidence for aneurysmal subarachnoid hemorrhage (aSAH) by endovascular coiling compared to surgical clipping with all grade. The present study and meta-analysis aimed to clarify the in-hospital mortality and poor outcome in the nationwide databases of patients with all grade aSAH between them. The outcome of modified Rankin scale (mRS) at discharge was investigated according to the comprehensive nationwide database in Japan. The propensity score-matched analysis was conducted among patients with aSAH in this database registered between 2010 and 2015. Meta-analysis of studies was conducted based...
Source: Neurosurgical Review - April 2, 2019 Category: Neurosurgery Source Type: research

Gamma Knife radiosurgery for trigeminal neuralgia: when?
(Source: Neurosurgical Review)
Source: Neurosurgical Review - April 1, 2019 Category: Neurosurgery Source Type: research

Endovascular reconstruction of extracranial traumatic internal carotid artery dissections: a systematic review
AbstractExtracranial internal carotid artery dissection (ICAD) is a potential source of morbidity and mortality in trauma patients and requires high degree of suspicion for diagnosis after the initial presentation. Occasionally, if standard therapy is contraindicated, endovascular reconstruction is a treatment option. The aim of this systematic review was to report clinical and radiographic outcomes following endovascular repair of ICAD of traumatic and iatrogenic etiology. A comprehensive systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines...
Source: Neurosurgical Review - March 22, 2019 Category: Neurosurgery Source Type: research

Adult spinal deformity surgery: a systematic review of venous thromboprophylaxis and incidence of venous thromboembolic events
AbstractVenous thromboprophylaxis consisting of chemical and/or mechanical prophylaxis is administered to patients undergoing adult spinal deformity (ASD) surgery to prevent venous thromboembolic events. However, the true incidence of venous thromboembolism (VTE) after these surgeries is unknown resulting in weak recommendations and lack of consensus regarding type and timing of prophylaxis in these patients. A systematic literature review was conducted to examine VTE incidence in addition to optimal type and timing of VTE prophylaxis. A detailed search was carried out on Embase, PubMed, and Cochrane Library databases thro...
Source: Neurosurgical Review - March 18, 2019 Category: Neurosurgery Source Type: research

Determination of optimal time window for cortical mapping in awake craniotomy: assessment of intraoperative reaction speed
AbstractCurrently, there is no known time frame when the patients are the most responsive during awake craniotomy. The aim of this work is therefore to determine when the patient has the shortest reaction time and so to extrapolate the optimal time window for cortical mapping. In this analytic observational study, our group has recorded the reaction times of 35 patients undergoing an awake craniotomy and compared them with the preoperative baseline. The operations were performed according to a “sleep–awake–awake” protocol. Data collection was performed in parallel with standard methods for evaluatio...
Source: Neurosurgical Review - March 15, 2019 Category: Neurosurgery Source Type: research

Clinical and histopathological predictors of outcome in malignant meningioma
AbstractWe investigated possible clinical and histopathological prognostic factors in a malignant meningioma cohort with comprehensive long-term population-based follow-up data. Twenty-four consecutive patients treated surgically for malignant meningioma at the Department of Neurosurgery and the Department of Pathology, Rigshospitalet, Copenhagen, Denmark, from December 2000 to March 2014 were retrospectively evaluated regarding progression-free survival (PFS) and overall survival (OS). Clinical parameters were recorded. All specimens underwent immunohistochemical analysis for Ki-67 and phosphohistone-H3 (PHH3). Prognostic...
Source: Neurosurgical Review - March 13, 2019 Category: Neurosurgery Source Type: research

Prognostic variables and outcome in relation to different bleeding patterns in arteriovenous malformations
AbstractSubarachnoid hemorrhage as bleeding pattern occurs rarely in ruptured arteriovenous malformations (AVM). The aim of the present study is to evaluate different bleeding patterns in hemorrhages due to an AVM and their impact on outcome in terms of risk and treatment stratification. We evaluated 158 patients with ruptured AVMs who were admitted to our neurosurgical department from 2002 to 2017. We compared different bleeding patterns, such as intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), or both (ICH  + SAH) and evaluated predictive variables for outcome in the last follow-up. ICH was fo...
Source: Neurosurgical Review - March 5, 2019 Category: Neurosurgery Source Type: research

Usefulness of the knot-tightener device following dural suturing in endonasal transsphenoidal surgery: technical report
AbstractTranssphenoidal surgery (TSS) has become a well-established standard surgical technique, but the cerebrospinal fluid leakage remains controversial. Direct suturing of the dura, which is a routine procedure within transcranial surgery, can be applied for closure of the sella turcica within TSS. However, as the dura is not accessible by the index finger, knot tying in the narrow and deep surgical corridor following dural suturing is extremely difficult, cumbersome, and time-consuming in TSS. Here, we present a new, simple, and effective technique for knot tying using our newly developed instrument the “knot tig...
Source: Neurosurgical Review - March 1, 2019 Category: Neurosurgery Source Type: research

Impact of randomized controlled trials on neurosurgical practice in decompressive craniectomy for ischemic stroke
AbstractRandomized controlled trials (RCTs) are gold standard for comparing treatment modalities. Recently, RCTs transformed ischemic stroke care by first proving benefit of decompressive craniectomy (DC) and later of interventional mechanical thrombectomy. Aim of this study was to explore the impact of RCTs on neurosurgical practice. RCTs investigating DC and thrombectomy were identified. Annual numbers of DCs for ischemic stroke between 2000 and 2017 were determined and correlated with publication dates of RCTs. The initial RCTs demonstrating efficacy of DC were published in 2007, followed by an increase in DC numbers be...
Source: Neurosurgical Review - February 26, 2019 Category: Neurosurgery Source Type: research

Risk factors for shunt dependency in patients suffering from spontaneous, non-aneurysmal subarachnoid hemorrhage
AbstractPatients presenting with spontaneous, non-aneurysmal subarachnoid hemorrhage (SAH) achieve better outcomes compared to patients with aneurysmal SAH. Nevertheless, some patients develop shunt-dependent hydrocephalus during treatment course. We therefore analyzed our neurovascular database to identify factors determining shunt dependency after non-aneurysmal SAH. From 2006 to 2016, 131 patients suffering from spontaneous, non-aneurysmal SAH were admitted to our department. Patients were stratified according to the distribution of cisternal blood into patients with perimesencephalic SAH (pSAH) versus non-perimesenceph...
Source: Neurosurgical Review - February 26, 2019 Category: Neurosurgery Source Type: research

The fragility of randomized controlled trials in intracranial hemorrhage
This study aimed to evaluate the fragility of RCTs in intracranial hemorrhage. Literature search (PubMed/Embase) identified all RCTs of intracranial hemorrhage since 2006. The overall distribution of FI was evaluated. Subgroup and spearman correlation analyses were made to explore potential factors that may affect FI value. All the included RCTs were divided into two groups (positive and negative trials) according to the statistical significance of selected outcomes. Finally, 47 positive and 51 negative trials were included. Both the median FI ([2; IQR, 1 –4] vs. [6; IQR, 4–9],p 
Source: Neurosurgical Review - February 26, 2019 Category: Neurosurgery Source Type: research

Surgery versus stereotactic radiosurgery for the treatment of multiple meningiomas in neurofibromatosis type 2: illustrative case and systematic review
We describe a particularly challenging case in a 39-year-old male with over 120 lesions who underwent more than 30 surgical procedures, and review the literature. We also searched three popular databases and compared outcomes of SRS versus surgery for the treatment of multiple meningiomas in patients with NF2. A total of 50 patients (27 radiosurgical and 23 surgical) were identified. For patients treated with SRS, local tumor control was achieved in 22 patients (81.5%) and distal control was achieved in 14 patients (51.8%). No malignant inductions were observed at an average follow-up duration of 90  months. Complicat...
Source: Neurosurgical Review - February 26, 2019 Category: Neurosurgery Source Type: research

Does the subspecialty of an intensive care unit (ICU) has an impact on outcome in patients suffering from aneurysmal subarachnoid hemorrhage?
AbstractWe retrospectively compared the outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients treated in a neurosurgical ICU (nICU) between 1990 and 2005 with that of patients treated in a general ICU (gICU) between 2005 and 2013 with almost identical treatment strategies. Among other parameters, we registered the initial Hunt and Hess grade, Fisher score, the incidence of vasospasm, and outcome. A multivariate analysis (logistic regression model) was performed to adjust for different variables. In total, 755 patients were included in this study with 456 patients assigned to the nICU and 299 patients to the gICU. M...
Source: Neurosurgical Review - February 26, 2019 Category: Neurosurgery Source Type: research

Telomerase activity, TERT expression, hTERT promoter alterations, and alternative lengthening of the telomeres (ALT) in meningiomas – a systematic review
AbstractTelomerase activity and (human) Telomerase Reverse Transcriptase (hTERT) expression are considered hallmarks in oncogenesis of neoplasms and are upregulated by alterations of the hTERT promoter. In meningiomas, numerous studies investigated hTERT expression, telomerase activity, promoter mutations, and methylations. Moreover, reports about hTERT-targeted chemotherapy in meningiomas have recently been published. We provide a systematic review of the literature about the role of hTERT in meningiomas. TERT expression and telomerase activity is found in benign and high-grade meningiomas and increase with WHO grade. Rem...
Source: Neurosurgical Review - February 20, 2019 Category: Neurosurgery Source Type: research

Risk factors and control of seizures in 778 Chinese patients undergoing initial resection of supratentorial meningiomas
AbstractThis retrospective study explored the risk factors for the occurrence of seizures in the pre- and postoperative period in patients undergoing supratentorial meningiomas surgery to investigate those who are likely to benefit from prophylactic antiepileptic drugs (AEDs). We reviewed the medical records of 778 supratentorial meningiomas patients who were operated at our institution between 2011 and 2012. A total of 100 (12.9%) patients experienced preoperative seizures; 41 patients (5.3%) experienced postoperative in-hospital seizures, and 91 (13.5%,n = 673) patients experienced postoperative seizures af...
Source: Neurosurgical Review - February 15, 2019 Category: Neurosurgery Source Type: research

Predictive factors for acute thrombogenesis occurring immediately after bypass procedure for moyamoya disease
This study included 48 patients (66 EC-IC bypass procedures) with moyamoya disease and 52 controls (54 procedures) without moyamoya disease. The development of acute thrombogenesis was compared between the moyamoya disease and control groups. In the moyamoya disease group, clinical and radiological characteristics were assessed with respect to acute thrombogenesis. In the patients with acute thrombogenesis, causes of technical problems were retrospectively examined. The incidence of acute thrombogenesis was significantly higher in the moyamoya disease group than those in the control group. In the moyamoya disease group, ac...
Source: Neurosurgical Review - February 14, 2019 Category: Neurosurgery Source Type: research