Journal of neurosurgery
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Journal of neurosurgery · Jan 2025
Posterior extent of left anterior temporal lobectomy and picture naming decline.
Recent voxel-based lesion symptom mapping (VLSM) studies have identified a critical region for picture naming, located 3.4 to 6.1 cm from the temporal pole. Its resection during left temporal lobe epilepsy surgery led to postoperative decline in picture naming. However, postoperative anomia has been reported after classic left temporal lobectomy, which rarely extends so posteriorly. The aim of the present study was to evaluate patients' postoperative picture naming outcome on the basis of their precise surgical cavities in light of the recent findings from VLSM studies. ⋯ Keeping a surgical cavity anterior to the limits identified by recent VLSM studies does not protect patients from postoperative picture naming decline. Interindividual anteroposterior variability of the basal temporal language area could complete the explanation offered by VLSM.
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Journal of neurosurgery · Jan 2025
Focused ultrasound therapy as a strategy for improving glioma treatment.
The infiltrative and diffuse nature of gliomas makes complete resection unfeasible. Unfortunately, regions of brain parenchyma with residual, infiltrative tumor are protected by the blood-brain barrier (BBB), making systemic chemotherapies, small-molecule inhibitors, and immunotherapies of limited efficacy. ⋯ Furthermore, high-frequency FUS has the potential to serve as an ablative treatment option. This review aimed to summarize the benefits of FUS in the treatment of gliomas.
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Journal of neurosurgery · Jan 2025
Competing pathways of intracranial aneurysm growth: linking regional growth distribution and hemodynamics.
The complex mix of factors, including hemodynamic forces and wall remodeling mechanisms, that drive intracranial aneurysm growth is unclear. This study focuses on the specific regions within aneurysm walls where growth occurs and their relationship to the prevalent hemodynamic conditions to reveal critical mechanisms leading to enlargement. ⋯ Two primary mechanisms seem to influence aneurysm growth: high-flow impingement jets in the neck, body, and inflow zones leading to wall degeneration/thinning, mainly in ACom aneurysms; and slow, oscillatory flow conditions in the dome and central flow zones promoting wall remodeling/thickening, mainly in MCA aneurysms. This latter mechanism is also observed as secondary flows in ACom aneurysms. These findings emphasize the need to understand the distinct and sometimes concurrent mechanisms of aneurysm growth, advocating for targeted monitoring and interventions that mitigate rupture risks by considering the unique hemodynamic environments within different aneurysm regions and locations.
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Journal of neurosurgery · Jan 2025
Clinical significance of intraoperative bidirectional corticocortical evoked potential monitoring to evaluate language function.
Awake craniotomy is commonly used to resect lesions located near the language area during brain surgery. However, it is often difficult to perform language tasks due to several limitations such as difficulty in awakening during surgery and intraoperative seizures. This study investigated the clinical significance of bidirectional corticocortical evoked potential (CCEP) monitoring as a new approach to evaluate intraoperative language function. ⋯ This study indicated that bidirectional CCEP measurement may increase the precision of intraoperative language function monitoring.