Journal of neurosurgery
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Journal of neurosurgery · Feb 2021
ReviewIntraoperative MRI versus 5-ALA in high-grade glioma resection: a network meta-analysis.
High-grade gliomas (HGGs) continue to carry poor prognoses, and patient outcomes depend heavily on the extent of resection (EOR). The utility of conventional image-guided surgery is limited by intraoperative brain shift. More recent techniques to maximize EOR, including intraoperative imaging and the use of fluorescent dyes, combat these limitations. However, the relative efficacy of these two techniques has never been systematically compared. Thus, the authors performed an exhaustive systematic review in conjunction with quantitative network meta-analyses to evaluate the comparative effectiveness of 5-aminolevulinic acid (5-ALA) and intraoperative MRI (IMRI) in optimizing EOR in HGG. They secondarily analyzed associated progression-free and overall survival and performed subgroup analyses by level of evidence. ⋯ IMRI and 5-ALA are individually superior to conventional neuronavigation for achieving GTR of HGG. Between IMRI and 5-ALA, neither method is clearly more effective. Future studies evaluating the comparative cost and surgical time associated with IMRI and 5-ALA will better inform any cost-benefit analysis.
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Journal of neurosurgery · Feb 2021
Assessment of the NIH-supported relative citation ratio as a measure of research productivity among 1687 academic neurological surgeons.
Publication metrics such as the Hirsch index (h-index) are often used to evaluate and compare research productivity in academia. The h-index is not a field-normalized statistic and can therefore be dependent on overall rates of publication and citation within specific fields. Thus, a metric that adjusts for this while measuring individual contributions would be preferable. The National Institutes of Health (NIH) has developed a new, field-normalized, article-level metric called the "relative citation ratio" (RCR) that can be used to more accurately compare author productivity between fields. The mean RCR is calculated as the total number of citations per year of a publication divided by the average field-specific citations per year, whereas the weighted RCR is the sum of all article-level RCR scores over an author's career. The present study was performed to determine how various factors, such as academic rank, career duration, a Doctor of Philosophy (PhD) degree, and sex, impact the RCR to analyze research productivity among academic neurosurgeons. ⋯ The RCR and its derivatives are new metrics that help fill in the gaps of other indices for research output. Here, the authors found that advanced academic rank, longer career duration, and PhD acquisition were all associated with increased mean and weighted RCRs. Male sex was associated with having an increased weighted, but not mean, RCR score, most likely because of historically unequal opportunities for women within the field. Furthermore, the data showed that current academic neurosurgeons are exceptionally productive compared to both physicians in other specialties and the general scientific community.
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Journal of neurosurgery · Feb 2021
Predictors of recurrence and high growth rate of residual meningiomas after subtotal resection.
The extent of resection has been shown to improve outcomes in patients with meningiomas. However, resection can be complicated by constraining local anatomy, leading to subtotal resections. An understanding of the natural history of residual tumors is necessary to better guide postsurgical management and minimize recurrence. This study seeks to identify predictors of recurrence and high growth rate following subtotal resection of intracranial meningiomas. ⋯ By identifying predictors of recurrence and growth rate, this study helps identify potential patients with a high chance of recurrence following subtotal resection, which are those with large preoperative tumor volume, falcine location, tentorial location, and African American race. Higher RVs were associated with tumors with higher postoperative growth rates. Recurrences typically occurred 14 months after surgery.
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The mortality rates for stroke are decreasing, yet it remains a leading cause of disability and the principal neurological diagnosis in patients discharged to nursing homes. The societal and economic burdens of stroke are substantial, with the total annual health care costs of stroke expected to reach $240.7 billion by 2030. Mechanical thrombectomy has been shown to improve functional outcomes compared to medical therapy alone. Despite an incremental cost of $10,840 compared to medical therapy, the improvement in functional outcomes and decreased disability have contributed to the cost-effectiveness of the procedure. In this study the authors describe a physician-led device bundle purchase program implemented for the delivery of stroke care. ⋯ Purchasing devices through a bundled model resulted in substantial cost savings while maintaining the therapeutic efficacy of the procedure, further pushing the already beneficial long-term cost-benefit curve in favor of thrombectomy.
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Journal of neurosurgery · Feb 2021
Predictors of second-sided deep brain stimulation for Parkinson's disease.
Parkinson's disease (PD) is a progressive neurological movement disorder that is commonly treated with deep brain stimulation (DBS) surgery in advanced stages. The purpose of this study was to investigate factors that affect time to placement of a second-sided DBS lead for PD when a unilateral lead is initially placed for asymmetrical presentation. The decision whether to initially perform unilateral or bilateral DBS is largely based on physician and/or patient preference. ⋯ Younger patients, those undergoing GPi-targeted unilateral DBS, and patients who responded better to the initial DBS were more likely to undergo early second-sided lead placement. Therefore, these patients, and patients who are more responsive to medication preoperatively (as a proxy for DBS responsiveness), may benefit from consideration of initial bilateral DBS.