Journal of neurosurgery
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Journal of neurosurgery · Jan 2024
IDH-mutant grade 4 astrocytoma: a comparison integrating the clinical, pathological, and survival features between primary and secondary patients.
IDH-mutant grade 4 astrocytomas (AIDHmut/G4) are divided into primary de novo (pAIDHmut/G4) and secondary with a history of prior lower-grade gliomas (LGGs; sAIDHmut/G4). The mutational spectrum and DNA methylation patterns are homogeneous within de novo pAIDHmut/G4 and evolved sAIDHmut/G4, but the two groups have different diagnoses, management, and outcomes. This study sought to systematically compare the clinical, pathological, and survival characteristics between them. ⋯ The different clinical characteristics, survival, and risk factors between sAIDHmut/G4 and pAIDHmut/G4 provide a reference to guide treatment decisions in AIDHmut/G4.
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Journal of neurosurgery · Jan 2024
Neurosurgery residency match for international medical graduates in the United States.
Training of international medical graduates (IMGs) offers opportunities for the US neurosurgery community to engage the global talent pool and impact national and international healthcare. Here, the authors analyzed the time trend of IMGs matching into US neurosurgery programs and identified potential opportunities for enhancing IMG engagement. ⋯ The number of IMGs matching successfully in neurosurgery has increased marginally during the past decade. The authors outline the challenges that IMGs encounter in this process and suggest strategies for considerations of IMG training in NRMP-associated institutions.
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Journal of neurosurgery · Jan 2024
Case ReportsResponsive neurostimulation as a treatment for super-refractory focal status epilepticus: a systematic review and case series.
Super-refractory status epilepticus (SRSE) has high rates of morbidity and mortality. Few published studies have investigated neurostimulation treatment options in the setting of SRSE. This systematic literature review and series of 10 cases investigated the safety and efficacy of implanting and activating the responsive neurostimulation (RNS) system acutely during SRSE and discusses the rationale for lead placement and selection of stimulation parameters. ⋯ This case series offers preliminary evidence that RNS is a safe and potentially effective treatment option for SRSE in patients with 1-2 well-defined seizure-onset zone(s) who meet the eligibility criteria for RNS. The unique features of RNS offer multiple benefits in the SRSE setting, including real-time electrocorticography to supplement scalp EEG for monitoring SRSE progress and response to treatment, as well as numerous stimulation options. Further research is indicated to investigate the optimal stimulation settings in this unique clinical scenario.
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Journal of neurosurgery · Jan 2024
High signal intensity of the intraaneurysmal sac on T1 CUBE imaging as a predictor of aneurysm stability after coil embolization.
Histopathological studies of aneurysms after coil embolization showed that thrombus formation during the first month after endovascular treatment (EVT) played an important role in the healing process. The authors hypothesized that dedicated T1-weighted imaging may be used to predict stable aneurysms by visualizing the thrombus status within coil-treated aneurysms. Therefore, this study investigated the relationship between the signal intensity (SI) of the intraaneurysmal sac after coil embolization and aneurysm stability. ⋯ RSIcoiled was associated with postcoiling aneurysm stability. High RSIcoiled might imply intraaneurysmal thrombus formation associated with the healing process of coil-treated aneurysms.
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Journal of neurosurgery · Jan 2024
ReviewComputational modeling of whole-brain dynamics: a review of neurosurgical applications.
A major goal of modern neurosurgery is the personalization of treatment to optimize or predict individual outcomes. One strategy in this regard has been to create whole-brain models of individual patients. Whole-brain modeling is a subfield of computational neuroscience that focuses on simulations of large-scale neural activity patterns across distributed brain networks. ⋯ The resulting personalized whole-brain models have translational potential in neurosurgery, allowing investigators to simulate the effects of virtual therapies (such as resections or brain stimulations), assess the effect of brain pathology on network dynamics, or discern epileptic networks and predict seizure propagation in silico. The information gained from these simulations can be used as clinical decision support, guiding patient-specific treatment plans. Here the authors provide an overview of the rapidly advancing field of whole-brain modeling and review the literature on neurosurgical applications of this technology.