Journal of neurosurgery
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Journal of neurosurgery · Feb 2022
Review Case ReportsArteriovenous malformations in the optic apparatus: systematic literature review and report of four cases.
Rare arteriovenous malformations (AVMs) of the optic apparatus account for < 1% of all AVMs. The authors conducted a systematic review of the literature for cases of optic apparatus AVMs and present 4 cases from their institution. The literature is summarized to describe preoperative characteristics, surgical technique, and treatment outcomes for these lesions. ⋯ AVMs of the optic apparatus are rare lesions. Although they reside in a highly eloquent region, surgical outcomes are generally good; the majority of patients will see improvement in their visual function postoperatively. Microsurgical technique is critical to the successful removal of these lesions, and preservation of function sometimes requires subtotal resection of the lesion.
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Journal of neurosurgery · Feb 2022
Review Meta AnalysisInsular epilepsy surgery: lessons learned from institutional review and patient-level meta-analysis.
Insular lobe epilepsy is a challenging condition to diagnose and treat. Due to anatomical intricacy and proximity to eloquent brain regions, resection of epileptic foci in that region can be associated with significant postoperative morbidity. The aim of this study was to review available evidence on postoperative outcomes following insular epilepsy surgery. ⋯ These findings may serve as a benchmark when tailoring decision-making for insular epilepsy, and may assist surgeons in their preoperative discussions with patients. Although seizure freedom rates are quite high with insular epilepsy treatment, the associated morbidity needs to be weighed against the potential for seizure freedom.
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Journal of neurosurgery · Feb 2022
Multicenter StudyBenefit of spinal cord stimulation for patients with central poststroke pain: a retrospective multicenter study.
Spinal cord stimulation (SCS) has been considered an ineffective procedure for patients with central poststroke pain (CPSP). However, recent case series that included small numbers of patients reported the possible efficacy of SCS as a treatment of CPSP. This multicenter retrospective study aimed to examine the outcomes of using SCS to treat patients with CPSP and to explore factors related to outcomes. ⋯ These findings indicate that SCS may modestly benefit patients with CPSP. SCS has therapeutic potential for patients with intractable CPSP owing to the lower invasiveness of the SCS procedure and refractory nature of CPSP. Nevertheless, trial stimulation is necessary because of the high initial failure rate.
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Journal of neurosurgery · Feb 2022
Randomized Controlled TrialComparison of 1.0 g/kg of 20% mannitol initiated at different time points and effects on brain relaxation in patients with midline shift undergoing supratentorial tumor resection: a randomized controlled trial.
Previous studies have suggested the use of 1.0 g/kg of 20% mannitol at the time of skin incision during neurosurgery in order to improve brain relaxation. However, the incidence of brain swelling upon dural opening is still high with this dose. In the present study, the authors sought to determine a better timing for mannitol infusion. ⋯ Prolonging the time interval between the start of mannitol infusion and dural incision from approximately 40 to 66 minutes can improve brain relaxation and decrease subdural ICP in elective supratentorial tumor resection.
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Journal of neurosurgery · Feb 2022
Endovascular catheter manometry reliability: a benchtop validation study.
Catheter manometry is used frequently in neuroendovascular surgery for assessing cerebrovascular pathology. The accuracy of pressure data with different catheter setups requires further validation. ⋯ Mean pressure measurements are accurate through microcatheters as small as 0.013-inch ID. Pulse pressure and waveform morphology may require a microcatheter ≥ 0.031-inch ID to achieve 90% accuracy, although the 0.027-inch ID microcatheter reached 85% accuracy. A 0.070-inch guide catheter with a microcatheter ≤ 0.042-inch outer diameter (e.g., Marksman 0.027-inch ID or smaller) allows accurate transduction of pulse pressure. Further validation of these benchtop findings is necessary before application in a clinical setting.