Journal of neurosurgery
-
Journal of neurosurgery · Nov 2022
A taxonomy for brainstem cavernous malformations: subtypes of pontine lesions. Part 1: basilar, peritrigeminal, and middle peduncular.
Brainstem cavernous malformations (BSCMs) are complex, difficult to access, and highly variable in size, shape, and position. The authors have proposed a novel taxonomy for pontine cavernous malformations (CMs) based upon clinical presentation (syndromes) and anatomical location (findings on MRI). ⋯ The neurological symptoms and key localizing signs associated with a hemorrhagic pontine subtype can help to define that subtype clinically. The proposed taxonomy for pontine CMs meaningfully guides surgical strategy and may improve patient outcomes.
-
Journal of neurosurgery · Nov 2022
The spectrum of brachial plexopathy from perineural spread of breast cancer.
Perineural spread of breast cancer to the brachial plexus can lead to pain, sensory alterations, and upper-extremity weakness. Although rare, perineural spread is an often-misdiagnosed long-term complication following breast cancer diagnosis. The objective of this study was to critically review the clinical, radiological, and pathological findings of biopsy-proven perineural spread of breast cancer to the brachial plexus. ⋯ Perineural spread should be considered in patients with a history of breast cancer, even 10 years after primary diagnosis, especially in patients who present with arm pain, weakness, and/or sensory changes. Further diagnostic workup with electrodiagnostic studies; brachial plexus MRI, PET/CT, or PET/MRI; and possibly nerve biopsy is warranted to ensure accurate diagnosis.
-
Journal of neurosurgery · Nov 2022
ReviewThalamic stereoelectroencephalography in epilepsy surgery: a scoping literature review.
Stereoelectroencephalography (sEEG) is a well-established surgical method for defining the epileptogenic network. Traditionally reserved for identifying discrete cortical regions for resection or ablation, sEEG in current practice is also used for identifying more broadly involved subcortical epileptic network components, driven by the availability of brain-based neuromodulation strategies. In particular, sEEG investigations including thalamic nuclei are becoming more frequent in parallel with the increase in therapeutic strategies involving thalamic targets such as deep brain stimulation (DBS) and responsive neurostimulation (RNS). The objective to this study was to evaluate existing evidence and trends regarding the purpose, techniques, and relevant electrographic findings of thalamic sEEG. ⋯ Inclusion of thalamic coverage during sEEG evaluation in drug-resistant epilepsy is a growing practice and is amenable to various methods of electrographic data analysis. Further study is required to establish well-defined criteria for thalamic implantation during invasive investigations as well as safety and ethical considerations.
-
Journal of neurosurgery · Nov 2022
A population-normalized tractographic fiber atlas of the anterior limb of the internal capsule: relevance to surgical neuromodulation.
The anterior limb of the internal capsule (ALIC) is a white matter highway that connects several subcortical structures to the prefrontal cortex. Although surgical interventions in the ALIC have been used to treat a number of psychiatric illnesses, there is significant debate regarding what fibers are targeted for intervention. This debate is partially due to an incomplete understanding of connectivity in the region. ⋯ These results are important for understanding and targeting of neuromodulatory therapies in the ALIC and may help explain why differences in therapeutic effect are observed for different areas of the ALIC.