Journal of neurosurgery
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Journal of neurosurgery · Dec 2022
Impact of collateral flow on cost-effectiveness of endovascular thrombectomy.
Acute ischemic stroke patients with large-vessel occlusion and good collateral blood flow have significantly better outcomes than patients with poor collateral circulation. The purpose of this study was to evaluate the cost-effectiveness of endovascular thrombectomy (EVT) based on collateral status and, in particular, to analyze its effectiveness in ischemic stroke patients with poor collaterals. ⋯ EVT treatment in the early time window for good outcome after ischemic stroke is cost-effective irrespective of the quality of collateral circulation, and patients should not be excluded from thrombectomy solely on the basis of collateral status. Despite relatively lower benefits of EVT in patients with poor collaterals, even smaller differences in better outcomes have significant long-term financial implications that make EVT cost-effective.
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Journal of neurosurgery · Dec 2022
Centromedian thalamic deep brain stimulation for drug-resistant epilepsy: single-center experience.
Neuromodulation of the centromedian nucleus of the thalamus (CM) has unclear effectiveness in the treatment of drug-resistant epilepsy. Prior reports suggest that it may be more effective in the generalized epilepsies such as Lennox-Gastaut syndrome (LGS). The objective of this study was to determine the outcome of CM deep brain stimulation (DBS) at the authors' institution. ⋯ CM DBS was an effective treatment for drug-resistant generalized and bifrontal epilepsies. Additional studies and analyses may investigate whether CM DBS is best suited for specific epilepsy types, and the relationship of lead location to outcome in different epilepsies.
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Journal of neurosurgery · Dec 2022
Utility of intraoperative neuromonitoring for decompression of Chiari type I malformation in 93 adult patients.
There is currently a lack of consensus on the utility of intraoperative neuromonitoring (IONM) for decompression of Chiari type I malformation (CM-I). Commonly used monitoring modalities include somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), and brainstem auditory evoked potentials (BAEPs). The purpose of this study was to evaluate the utility of IONM in preventing neurological injury for CM-I decompression. ⋯ There were no permanent complications related to intraoperative neurological injury. Transient fluctuations in IONM signals can be detected without clinical significance. The authors suggest that CM-I suboccipital decompression surgery may be performed safely without IONM. The use of IONM in patients with additional occipitocervical pathology should be left as an option to the performing surgeon on a case-by-case basis.
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Journal of neurosurgery · Dec 2022
How to dose-stage large or high-risk brain metastases: an alternative two-fraction radiosurgical treatment approach.
The authors sought to evaluate clinical outcome in patients with large, high-risk brain metastases (BMs) treated with different dose strategies by use of two-fraction dose-staged Gamma Knife radiosurgery (GKRS). ⋯ In patients with large, high-risk BMs, dose-staged GKRS treatment represents an effective local treatment method with acceptable complication risks. Different dose-strategy options are available that may be chosen according to the primary tumor histology and treatment volume but may also be tailored to the findings at GKRS2.
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Journal of neurosurgery · Dec 2022
Endoscope-assisted visualization of 5-aminolevulinic acid fluorescence in surgery for brain metastases.
Fluorescence-guided resection of cerebral metastases has been proposed as an approach to visualize residual tumor tissue and maximize the extent of resection. Critics have argued that tumor cells at the resection margins might be overlooked under microscopic visualization because of technical limitations. Therefore, an endoscope, which is capable of inducing fluorescence, has been applied with the aim of improving exposure of fluorescent tumor tissue. In this retrospective analysis, authors assessed the utility of endoscope assistance in 5-aminolevulinic acid (5-ALA) fluorescence-guided resection of brain metastases. ⋯ Fluorescence-guided endoscope assistance may overcome the technical limitations of the conventional microscopic exposure of 5-ALA-fluorescent metastases and thereby increase visualization of fluorescent tumor tissue at the margins of the resection cavity with high sensitivity and acceptable specificity.