Journal of neurosurgery
-
Journal of neurosurgery · Feb 2025
Meta Analysis Comparative StudyAwake versus asleep deep brain stimulation for Parkinson's disease: a comprehensive systematic review and meta-analysis.
Deep brain stimulation (DBS) has become an effective and safe treatment in patients with Parkinson's disease (PD) not responding to conventional treatments. With the growing body of literature regarding the use of DBS in different movement disorders, there remain controversies regarding performing awake or asleep DBS. This systematic review provides the most comprehensive review of the literature comparing the two techniques from various aspects in detail. ⋯ These findings suggest comparable clinical outcomes between the two DBS approaches. The two methods had their salient differences in terms of lead passes and specific adverse events. The decision to perform awake or asleep DBS should be based on the patient's preference, the surgeon's experience, the availability of advanced intraoperative imaging, and the patient's tolerance for specific adverse events.
-
Journal of neurosurgery · Feb 2025
ReviewGenetics and molecular pathophysiology of normal pressure hydrocephalus.
Idiopathic normal pressure hydrocephalus (iNPH) is characterized by dilation of the cerebral ventricles without increased cerebral pressure. Patients typically present with cognitive impairment, gait abnormalities, and urinary incontinence. ⋯ Familial cases and genomic studies of iNPH have recently suggested an underappreciated role of genetics in disease pathogenesis, implicating mechanisms ranging from dysregulated CSF dynamics to underlying neurodegenerative or neuroinflammatory processes. In this paper, the authors provide a brief review of genetic insights and candidate genes for iNPH, highlighting the continued importance of integrated genetic analysis and clinical studies to advance iNPH management.
-
Journal of neurosurgery · Feb 2025
Case ReportsEarly diagnosis to avoid invasive treatment in cardiac migration of a ventriculoperitoneal catheter: a qualitative systematic review and Weibull analysis of case reports.
The migration of distal catheter after ventriculoperitoneal shunt placement is a rare but significant complication. Especially in a case of cardiac migration, open-heart surgery or catheter intervention may be required. The authors encountered a case of cardiac migration that fortunately could be treated by withdrawal. A systematic review of cardiac migration was performed to clarify when and how migration was diagnosed and why invasive treatments were required. Based on the collected cases, a Weibull analysis of the latency until diagnosis was performed to examine whether cardiac migration is caused by an initial factor and to compare the result with the other migration sites such as gastrointestinal tract or urinary tract. ⋯ In light of the previous reports, the latency until diagnosis of cardiac migration was associated with the rate of thrombosis and adhesion, which resulted in escalation to invasive treatment. Early diagnosis will prevent invasive treatment because most cases are caused by initial factors, as the Weibull analysis showed.
-
Cerebral bypass surgery is one of the most complex and elegant procedures in neurosurgery. It involves several meticulous steps that test the skills of even the most prepared neurosurgeons. This surgery has transcended its traditional role in arterial stenosis and atherosclerosis, expanding its applications to include flow preservation techniques for complex conditions such as aneurysms, tumors, and vascular malformations. ⋯ Also, revascularization in moyamoya vasculopathy is an effective strategy for preventing ischemic and hemorrhagic events in both children and adults. Additionally, innovations in the technique, such as the flow-regulated bypass and intraoperative flow assessment, aim to minimize perioperative morbidity. Despite bypass surgery being less performed in this current era, the teaching and development of these skills are still encouraged for future neurosurgeons, as a role for bypass will exist for the foreseeable future.
-
Journal of neurosurgery · Jan 2025
Meta Analysis Comparative StudyComparing surgical clipping with endovascular treatment for unruptured middle cerebral artery aneurysms: a systematic review and updated meta-analysis.
Unruptured middle cerebral artery aneurysm (uMCAA) has traditionally been treated with open surgical clipping (SC). Endovascular treatments (EVTs) were designed to reduce surgical risks in these cases. Nevertheless, despite its potential benefits, many surgeons favor SC for uMCAA. This updated meta-analysis aimed to compare the safety, efficacy, and clinical outcomes of SC and EVT for uMCAA. ⋯ This systematic review and meta-analysis identified a lower likelihood of complete occlusion at last follow-up and lower likelihood of good clinical outcomes in patients treated with EVT when compared with SC. Furthermore, a higher likelihood of minor complications was identified in patients who underwent EVT when compared with SC. The findings reinforce that, based on the currently available data, SC should be considered the primary approach for treating uMCAA. However, EVT is an evolving approach, and this study's findings represent a synthesis of observational studies. Randomized trials are warranted to elucidate which approach should be the mainstay for uMCAA and to identify the nuances that determine whether SC or EVT is more or less indicated for addressing uMCAA with consideration of the individuality of each patient and aneurysm.