Journal of neurosurgery
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Journal of neurosurgery · Apr 2024
Longitudinal treatment outcomes of recurrent clival chordomas: a single-center retrospective study.
The objective of this study was to clarify the detailed clinical course of recurrent clival chordoma and the outcomes of each treatment modality. ⋯ Despite the aggressive nature of recurrent chordoma, 14 of 29 patients (48%) survived for more than 5 years after the initial recurrence using combined therapies. Multiple treatment options may contribute to the long-term survival of patients with this intractable tumor.
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Journal of neurosurgery · Apr 2024
Sodium fluorescein uptake by the tumor microenvironment in human gliomas and brain metastases.
Intravenous sodium fluorescein (SF) is increasingly used during surgery of gliomas and brain metastases to improve tumor resection. Currently, SF is believed to permeate the brain regions where the blood-brain barrier (BBB) is damaged and to accumulate in the extracellular space but not in tumor or healthy cells, making it possible to demarcate tumor margins to guide resection. By evaluating the immune contexture of a number of freshly resected gliomas and brain metastases from patients undergoing SF-guided surgery, the authors recurrently observed fluorescence-positive cells. Therefore, the aim of this study was to determine if SF accumulates inside the cells of the tumor microenvironment (TME), and if so, in which type of cells, and whether incorporation can also be observed in the leukocytes of peripheral blood. ⋯ SF is not just a marker of BBB damage, but its intracellular detection suggests that it selectively accumulates intracellularly. Future efforts should target the mechanisms of its differential uptake by the different TME cell types in depth.
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Journal of neurosurgery · Apr 2024
Flow diverters versus stent-assisted coiling in unruptured intracranial vertebral artery dissecting aneurysms.
Flow diverters (FDs) have been used in unruptured intracranial vertebral artery dissecting aneurysms (IVADAs) with seemingly more favorable outcomes compared with stent-assisted coiling (SAC). However, the benefits of FDs over SAC in unruptured IVADAs need further evaluation. ⋯ In unruptured IVADAs and compared with SAC, FDs provide comparable rates of periprocedural cerebrovascular complications, favorable clinical outcomes, and follow-up complete occlusion, lower rates of immediate complete occlusion and follow-up recanalization, and likely higher rates of in-stent stenosis.
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Journal of neurosurgery · Apr 2024
Healthcare disparities in deep brain stimulation access and utilization: a systematic review.
Since FDA approval of deep brain stimulation (DBS) for essential tremor over 2 decades ago, indications and utilization of this modality have rapidly expanded worldwide. However, certain patient populations are known to be underrepresented among those undergoing DBS for various indications. ⋯ As the indications and utilization continue to grow, addressing healthcare disparities related to DBS has become increasingly important. The authors suggest that increasing patient and provider education, expanding the role of telemedicine within DBS care, and improving support services for DBS patients may improve access and utilization.
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Journal of neurosurgery · Apr 2024
Nonenhancing motor eloquent gliomas: navigated transcranial magnetic stimulation oncobiological signature.
Preoperative grading of nonenhancing motor eloquent gliomas is hampered by a lack of specific imaging surrogates. Tumor grading is crucial for the informed consent discussion before tumor resection. In this paper, the authors hypothesized that navigated transcranial magnetic stimulation (nTMS)-derived metrics could provide significant information to distinguish between high- and low-grade motor eloquent gliomas that present as nonenhancing tumors and therefore contribute to improving patient counseling, timing of treatment, preoperative planning, and intraoperative strategies. ⋯ Nonenhancing motor eloquent gliomas have a different impact on both anatomical and functional reorganization of motor areas according to their WHO grading.