Journal of neurosurgery
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Journal of neurosurgery · May 2023
Gene expression analysis during progression of malignant meningioma compared to benign meningioma.
Meningioma is the most common primary intracranial neoplasm. Only 1%-3% of meningiomas are malignant according to the 2016 WHO criteria (WHO grade III). High-grade meningiomas present specific gene expression signatures indicating aggressive growth or recurrence. However, changes in gene expression and in neuroinflammatory gene expression signatures in WHO grade III meningiomas and during progression from WHO grade I or II to grade III are unknown. ⋯ The authors found gene expression changes in low-grade meningiomas that predated histological transformation to grade III meningiomas. Neuroinflammation genes distinguished grade III from grade I meningiomas.
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Journal of neurosurgery · May 2023
Nerve transfers for brachial plexus injuries: grading of volitional control.
After brachial plexus injuries (BPIs), nerve transfers are used to restore lost muscle function. Brain plasticity underlies the process of regaining volitional control, which encompasses disconnection of the original donor nerve-related programs and reconnection to acceptor nerve programs. To the authors' knowledge, the levels of disconnection and reconnection have never been studied systematically. In this study, the authors developed a novel 4-point plasticity grading scale (PGS) and assessed the degree of volitional control achieved, identifying clinical correlations with this score. ⋯ Just around 20% of the authors' patients developed a complete disconnection of the donor program along with complete independent control over the reinnervated muscle. Incomplete disconnection was present in the vast majority of the patients, and the level of disconnection and control was poor in approximately 15% of patients. Brain plasticity underlies patient ability to regain volitional control after a nerve transfer, but this capacity is limited.
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Journal of neurosurgery · May 2023
Cost-effectiveness analysis on small (< 5 mm) unruptured intracranial aneurysm follow-up strategies.
Unruptured intracranial aneurysms are frequently detected during routine clinical diagnostic processes. A significant portion are small aneurysms less than 5 mm in diameter. While follow-up of patients with small aneurysms has been advocated, the cost-effectiveness of such care and the optimal follow-up interval remain unknown. This study aimed to explore the most cost-effective follow-up interval for small (< 5 mm) unruptured intracranial aneurysms. ⋯ The most cost-effective follow-up strategy for small (< 5 mm) unruptured aneurysms using MRA is following up every 2 years. More frequent follow-up strategies or prompt preventive treatment would be more appropriate in patients with higher risk factors for growth and aneurysm rupture.
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Journal of neurosurgery · May 2023
Assessment of outcomes in consecutive patients undergoing dorsal scapular nerve decompression.
Periscapular pain has a broad differential diagnosis. Dorsal scapular neuropathy is part of that differential diagnosis but is often forgotten by clinicians, leading to delayed diagnosis, chronic pain, and potentially worse outcomes. The objective of this study was to describe our method for diagnosis, surgical technique, intraoperative findings, and outcomes in consecutive patients undergoing dorsal scapular nerve (DSN) decompression. ⋯ Surgical treatment of dorsal scapular neuropathy is associated with significant improvements in pain and disability, and these improvements are durable. Morbidity associated with surgical treatment is low.
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Journal of neurosurgery · May 2023
Feasibility of bevacizumab-IRDye800CW as a tracer for fluorescence-guided meningioma surgery.
Meningiomas are frequently occurring, often benign intracranial tumors. Molecular fluorescence can be used to intraoperatively identify residual meningioma tissue and optimize safe resection; however, currently no clinically approved agent is available for this specific tumor type. In meningiomas, vascular endothelial growth factor α (VEGFα) is upregulated, and this biomarker could be targeted with bevacizumab-IRDye800CW, a fluorescent agent that is already clinically applied for the resection of other tumors and neoplasms. Here, the authors investigated the feasibility of using bevacizumab-IRDye800CW to target VEGFα in a CH-157MN xenografted mouse model. ⋯ Bevacizumab-IRDye800CW showed meningioma specificity, as illustrated by high VEGFα-mediated uptake in the meningioma xenograft mouse model. Small tumor lesions were detected using fluorescence guidance. Thus, the next step will be to assess the feasibility of using already available clinical grade bevacizumab-IRDye800CW to optimize meningioma resection in a human trial.