Journal of neurosurgery
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Journal of neurosurgery · Jan 2025
Development and validation of a radiomics-visual evoked potential nomogram for preoperative prediction of visual outcome after endoscopic craniopharyngioma resection.
Craniopharyngiomas are rare, benign brain tumors that are primarily treated with surgery. Although the extended endoscopic endonasal approach (EEEA) has evolved as a more reliable surgical alternative and yields better visual outcomes than traditional craniotomy, postoperative visual deterioration remains one of the most common complications, and relevant risk factors are still poorly defined. Hence, identifying risk factors and developing a predictive model for postoperative visual deterioration is indeed necessary. However, there is still a lack of research on these topics. Therefore, the authors used the largest known case series of EEEA for craniopharyngioma to determine pertinent risk factors and develop a nomogram for the noninvasive preoperative prediction of visual outcome. ⋯ Intraoperative VEP monitoring was proven to help reduce postoperative visual deterioration, while tight adherence and larger maximum tumor diameter were confirmed as independent risk factors. The radiomic model allowed a noninvasive prediction of the adherence strength between the optic nerves and craniopharyngioma. The nomogram showed a promising performance for noninvasively predicting postoperative visual deterioration and may serve as a useful tool for clinical decision-making and patient counseling.
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Journal of neurosurgery · Jan 2025
Impact of disease duration and surgical intervention on arousal networks in temporal lobe epilepsy.
Epilepsy is a common neurological disease affecting nearly 1% of the global population, and temporal lobe epilepsy (TLE) is the most common type. Patients experience recurrent seizures and chronic cognitive deficits that can impact their quality of life, ability to work, and independence. These cognitive deficits often extend beyond the temporal lobe and are not well understood. It has been proposed in the extended network inhibition hypothesis that repeated spread of seizure activity to the ascending reticular activating system (ARAS) may contribute to these deficits. Disease duration has been associated with other network changes in patients with TLE, but few studies have investigated the relationship between disease duration, ARAS connectivity, and cognitive deficits in TLE. Furthermore, epilepsy surgery can result in seizure freedom and cognitive improvement in some patients, but it is unclear how the surgery affects ARAS connectivity. ⋯ These findings suggest that recurrent seizures may contribute to isolation of critical subcortical activating structures, possibly impacting cognitive function. Furthermore, some ARAS functional connectivity abnormalities can be reversed if seizure freedom is achieved after epilepsy surgery. These results provide support for the extended network inhibition hypothesis, may lend insight into the progressive effect of recurrent seizures on arousal networks, and may lead to improved interventions to halt or reverse network impairments in patients with TLE.
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Journal of neurosurgery · Jan 2025
Efficacy comparison and outcome predictors of GPi- and STN-targeted deep brain stimulation for Meige syndrome: a systematic review of individual patient data.
The aim of this study was to evaluate outcomes of deep brain stimulation (DBS) for Meige syndrome, compare the efficacy of globus pallidus internus (GPi) and subthalamic nucleus (STN) as targets, and identify potential outcome predictors. ⋯ DBS significantly improves motor symptoms and disability in patients with Meige syndrome, with GPi and STN targets providing comparable efficacy. The efficacy of DBS diminishes with longer disease duration, underscoring the importance of early intervention.
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Journal of neurosurgery · Jan 2025
Auricular vagus nerve stimulation for mitigation of inflammation and vasospasm in subarachnoid hemorrhage: a single-institution randomized controlled trial.
Inflammation contributes to morbidity following subarachnoid hemorrhage (SAH). The authors of this study evaluate how applying noninvasive transauricular vagus nerve stimulation (taVNS) can target this deleterious inflammatory response following SAH and reduce the rate of radiographic vasospasm. ⋯ taVNS is a noninvasive method of neuro- and systemic immunomodulation. This trial supports the finding that taVNS following SAH can mitigate the inflammatory response, reduce radiographic vasospasm, and potentially improve functional and neurological outcomes.
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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.