Journal of neurosurgery
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Journal of neurosurgery · Oct 2023
Review Meta AnalysisStroke management and outcomes in low-income and lower-middle-income countries: a meta-analysis of 8535 patients.
Strokes affect almost 13 million new people each year, and whereas the outcomes of stroke have improved over the past several decades in high-income countries, the same cannot be seen in low-income and lower-middle-income countries. This is the first study to identify the availability of diagnostic tools along with the rates of stroke mortality and other poststroke complications in low-income and lower-middle-income countries. ⋯ A severe healthcare disparity is present in low-income and lower-middle-income countries, where there is delayed diagnosis of strokes and increased rates of poor clinical outcomes for these patients.
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Journal of neurosurgery · Oct 2023
Multicenter Study Observational StudyEndovascular treatment as first-line therapy in Spetzler-Martin grade III brain arteriovenous malformations: a multicenter retrospective study.
The management of Spetzler-Martin grade (SMG) III brain arteriovenous malformations (bAVMs) may be challenging, whatever the exclusion treatment modality chosen. The purpose of this study was to evaluate the safety and effectiveness of endovascular treatment (EVT) as a first-line treatment of SMG III bAVMs. ⋯ EVT of SMG III bAVMs provides encouraging results but needs further improvement. When the embolization procedure performed with intent to cure appears difficult and/or risky, a combined technique (with microsurgery or radiosurgery) may be a safer and more effective strategy. In terms of safety and effectiveness, the benefit of EVT (alone or included in a multimodal management strategy) for SMG III bAVMs needs to be confirmed by randomized controlled trials.
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Journal of neurosurgery · Oct 2023
Is brain invasion sufficient as a stand-alone criterion for grading atypical meningioma?
Despite the controversy surrounding brain invasion (BI) as the sole indicator used to diagnose atypical meningioma, this criterion was still incorporated in the 2021 WHO classification scheme. In this study, the authors investigated the reproducibility of this prognostic effect and the impact of BI on the prognosis in otherwise benign meningioma (benign meningioma with BI). ⋯ The findings demonstrate that benign meningioma with BI typically has an intermediate prognosis and can be differentiated from benign meningioma and classical atypical meningioma, which suggests that the importance of the diagnostic effect of BI is insufficiently accounted for in grading of atypical meningioma. Increased emphasis on the presence of BI in patients with atypical meningioma may be helpful in postsurgical decision-making and facilitating improvements in individual therapy.
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Journal of neurosurgery · Oct 2023
Convergence of the arcuate fasciculus and third branch of the superior longitudinal fasciculus with direct cortical stimulation-induced speech arrest area in the anterior ventral precentral gyrus.
The objective was to identify the correspondence between the anterior terminations of the arcuate fasciculus (AF) and third branch of the superior longitudinal fasciculus (SLF-III) and the intraoperative direct cortical electrical stimulation (DCS)-induced speech arrest area. ⋯ This study supports the key role of the left vPCGa as the speech output node by showing convergence between speech output mapping and anterior AF/SLF-III connectivity in the vPCGa. These findings may contribute to the understanding of speech networks and could have clinical implications in preoperative surgical planning.
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Journal of neurosurgery · Oct 2023
Effects of carotid revascularization on cognitive function and brain functional connectivity in carotid stenosis patients with cognitive impairment: a pilot study.
Carotid stenosis can lead to both cognitive impairment (CI) and ischemic stroke. Although carotid revascularization surgery, which includes carotid endarterectomy (CEA) and carotid artery stenting (CAS), can prevent future strokes, its effect on cognitive function is controversial. In this study, the authors examined resting-state functional connectivity (FC) in carotid stenosis patients with CI undergoing revascularization surgery, with a particular focus on the default mode network (DMN). ⋯ These findings suggest that carotid revascularization, including CEA and CAS, might improve cognitive function based on brain FC in the DMN in carotid stenosis patients with CI.