Journal of neurosurgery
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Journal of neurosurgery · Mar 2024
Laser interstitial thermal therapy for new and recurrent meningioma: a prospective and retrospective case series.
Meningiomas are the most common primary brain tumors in adults and a subset are aggressive lesions resistant to standard therapies. Laser interstitial thermal therapy (LITT) has been successfully applied to other brain tumors, and recent work aims to explore the safety and long-term outcome experiences of LITT for both new and recurrent meningiomas. The authors' objective was to report safety and outcomes data of the largest cohort of LITT-treated meningioma patients to date. ⋯ This cohort study supports the safety of the procedure for this tumor type. LITT can offer a much-needed treatment option, especially for patients with multiply recurrent meningiomas who have limited remaining alternatives.
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Journal of neurosurgery · Mar 2024
The natural history of aneurysms incompletely occluded by placement of a flow diverter: a multiinstitutional study.
Treatment of intracranial aneurysms by flow diversion is safe and effective and is increasingly popular. However, the correct treatment paradigm for aneurysms incompletely treated by initial placement of a flow diverter has not been established, nor have the subsequent natural history and occlusion rates of such aneurysms. The authors sought to outline the natural history of such aneurysms, which to date have been considered partially treated. ⋯ Aneurysms that have been incompletely treated by flow diversion have a benign natural history with progression toward occlusion over time, with or without retreatment.
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Journal of neurosurgery · Mar 2024
Preclinical assessment of a noncooled MR thermometry-based neurosurgical laser therapy system.
MRI-guided laser interstitial thermal therapy (MRgLITT) has recently gained interest as an ablative stereotactic procedure for intractable epilepsy, movement disorders, and brain tumors. Conventionally, a LITT system consists of a laser generator and cooled laser applicator, which is a fiber optic core surrounded by a sheath through which cooled fluid is pumped. However, this footprint can make the system bulky and nonmobile, limit the maximum depth of targeting, and increase the chances of breakdown. Herein, the authors conduct a preclinical assessment of a noncooled MRgLITT system in a porcine model. ⋯ This preclinical assessment showed that the noncooled LITT system was able to precisely reach the target and create well-defined lesions within a margin of safety, without any adverse effects. MR thermometry software provided an accurate near-real-time temperature of the brain tissue, and dimensions of the lesion as visualized by the software correlated well with histopathological findings. Further studies to test the system's efficacy and safety in human subjects are in progress.
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Journal of neurosurgery · Mar 2024
Comparative effectiveness of stereotactic, subdural, or hybrid intracranial EEG monitoring in epilepsy surgery.
Surgical intervention can be curative or palliative for drug-resistant focal epilepsy. However, if the seizure onset zone (SOZ) cannot be adequately localized via noninvasive tests, intracranial EEG (iEEG) recordings are often carried out to develop surgical plans in appropriate candidates. Stereotactic EEG (SEEG), subdural EEG (SDE), and SDE with depth electrodes (hybrid) are major tools used for investigation, but there is no class 1 or 2 evidence comparing the effectiveness of these modalities. ⋯ Patients in the SEEG group were more likely to have their SOZ localized and patients in the SDE group were more likely to undergo resection, but they did not differ with respect to seizure outcomes.
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Journal of neurosurgery · Mar 2024
The role of medical illustration in the evolution of transsphenoidal pituitary surgery.
Medical illustration played a crucial, yet often overlooked, role in the evolution of pituitary surgery. From the late 1800s to the present, many preeminent surgeons, in partnership with their surgical illustrator collaborators, developed and then shifted the paradigm of pituitary surgery, from an open procedure with high mortality and morbidity, to an endonasal approach with high success rates that is widely utilized today. This work aims to highlight the role of surgical illustrators as partners to their physician colleagues, creating artistically accessible road maps that shaped the development of the transsphenoidal approach.