Journal of neurosurgery
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Journal of neurosurgery · Feb 2023
Multicenter StudyStereotactic radiosurgery for Koos grade IV vestibular schwannoma: a multi-institutional study.
Though stereotactic radiosurgery (SRS) is an established safe treatment for small- and medium-sized vestibular schwannomas (VSs), its role in the management of Koos grade IV VS is still unclear. In this retrospective multicenter study, the authors evaluated tumor control and the patient outcomes of primary, single-session SRS treatment for Koos grade IV VS. ⋯ SRS is a safe and effective method of obtaining tumor control in patients with Koos grade IV VS presenting with non-life-threatening or debilitating symptoms, especially those with surgical comorbidities that contraindicate resection. To decrease the incidence of post-SRS facial palsy, a prescription dose < 13 Gy is recommended.
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Journal of neurosurgery · Feb 2023
Words matter: using natural language processing to predict neurosurgical residency match outcomes.
Narrative letters of recommendation (NLORs) are considered by neurosurgical program directors to be among the most important parts of the residency application. However, the utility of these NLORs in predicting match outcomes compared to objective measures has not been determined. In this study, the authors compare the performance of machine learning models trained on applicant NLORs and demographic data to predict match outcomes and investigate whether narrative language is predictive of standardized letter of recommendation (SLOR) rankings. ⋯ NLORs and demographic data similarly discriminate whether applicants will or will not match into a neurosurgical residency program. However, NLORs potentially provide further insight regarding applicant fit. Because words used in NLORs are predictive of both match outcomes and SLOR rankings, continuing to include narrative evaluations may be invaluable to the match process.
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Journal of neurosurgery · Feb 2023
Serum assessment of traumatic axonal injury: the correlation of GFAP, t-Tau, UCH-L1, and NfL levels with diffusion tensor imaging metrics and its prognosis utility.
Diagnosis of traumatic axonal injury (TAI) is challenging because of its underestimation by conventional MRI and the technical requirements associated with the processing of diffusion tensor imaging (DTI). Serum biomarkers seem to be able to identify patients with abnormal CT scanning findings, but their potential role to assess TAI has seldomly been explored. ⋯ UCH-L1 and NfL seem to be the biomarkers more specific to detect TAI. The concentration of NfL combined with the FA of the CC might help predict long-term outcome.
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Journal of neurosurgery · Feb 2023
A standardized infection prevention bundle for reduction of CSF shunt infections in adult ventriculoperitoneal shunt surgery performed without antibiotic-impregnated catheters.
Ventriculoperitoneal (VP) shunt insertion and revision surgeries are some of the most common procedures that are performed by neurosurgeons. Shunt infections within the adult population are associated with significant morbidity and mortality and rates remain high. The objective of the current study was to use quality improvement (QI) methodology to create a standardized infection prevention bundle aimed at reducing the rate of shunt infections. ⋯ The implementation of a standardized shunt infection prevention bundle within the adult population, without the use of antibiotic-impregnated catheters, significantly reduced the rate of shunt infections which was sustained over many years. The use of 2% chlorhexidine gluconate in 70% isopropyl alcohol for preoperative antisepsis may have played a significant role. Multicenter studies should be completed to verify the effectiveness of the authors' protocol.
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Journal of neurosurgery · Feb 2023
Median trans-atlanto-occipital membrane microsurgical approach to the posterior cranial fossa without craniotomy.
Minimally invasive approaches are becoming increasingly popular and contributing to improving the results of the surgical treatment of a wide variety of intracranial pathologies. Fifteen patients with posterior cranial fossa tumors underwent microsurgery through the atlanto-occipital membrane without resection of any bone structures. Tumors were localized in the brainstem in 8 patients and in the fourth ventricle in 7 patients. ⋯ Total tumor resection was performed in 10 patients, subtotal resection in 2 patients, partial resection in 1 patient, and open biopsy in 2 patients. Surgical complications occurred in only 1 patient (meningoencephalitis). This minimally invasive trans-atlanto-occipital membrane approach for posterior cranial fossa tumors provides adequate visualization of the caudal part of the fourth ventricle and brainstem when the anthropometric parameters of the patient are suitable.