Journal of neurosurgery
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Journal of neurosurgery · Aug 2023
Percutaneous CT-guided trigeminal tractotomy-nucleotomy under general anesthesia for intractable craniofacial pain.
When used to treat craniofacial pain, CT-guided trigeminal tractotomy-nucleotomy (TR-NC) is usually performed with local anesthesia. Unfortunately, local anesthesia is insufficient for patients with such severe pain that they cannot tolerate the required head positioning while awake. This study aimed to contextualize previous findings associated with TR-NC performed under general anesthesia. The authors examined clinical and operative factors that could impact postoperative pain outcomes. ⋯ These results suggest that CT-guided TR-NC performed under general anesthesia is safe and effective. Postoperative outcomes were found to be associated with a number of clinical and operative factors. Such associations should be further explored and evaluated in the context of future, better-powered analyses.
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Journal of neurosurgery · Aug 2023
Predicting glioblastoma molecular subtypes and prognosis with a multimodal model integrating convolutional neural network, radiomics, and semantics.
The aim of this study was to build a convolutional neural network (CNN)-based prediction model of glioblastoma (GBM) molecular subtype diagnosis and prognosis with multimodal features. ⋯ The authors propose a novel multimodal model integrating C3D, radiomics, and semantics, which had a great performance in predicting IDH1, ATRX, and MGMT molecular subtypes and the 1-year prognosis of GBM.
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Journal of neurosurgery · Aug 2023
Observational StudyPerioperative risk factors associated with unplanned neurological intensive care unit readmission following elective supratentorial brain tumor resection.
The aim of this study was to describe the clinical and procedural risk factors associated with the unplanned neurosurgical intensive care unit (NICU) readmission of patients after elective supratentorial brain tumor resection and serves as an exploratory analysis toward the development of a risk stratification tool that may be prospectively applied to this patient population. ⋯ A predictive model that included age, lesion type, KPS < 70 at admission, duration of surgery, retention of endotracheal intubation on NICU entry, and NICU LOS after surgery had an acceptable ability to identify elective supratentorial brain tumor resection patients at high risk for an unplanned NICU readmission. These risk factors and this prediction model may facilitate better resource allocation in the NICU and improve patient outcomes.
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Journal of neurosurgery · Aug 2023
Comparative StudyA comparative analysis of the Hospital Frailty Risk Score in predicting postoperative outcomes among intracranial tumor patients.
In recent years, frailty indices such as the 11- and 5-factor modified frailty indices (mFI-11 and mFI-5), American Society of Anesthesiologists (ASA) physical status classification, and Charlson Comorbidity Index (CCI) have been shown to be effective predictors of various postoperative outcomes in neurosurgical patients. The Hospital Frailty Risk Score (HFRS) is a well-validated tool for assessing frailty; however, its utility has not been evaluated in intracranial tumor surgery. In the present study, the authors investigated the accuracy of the HFRS in predicting outcomes following intracranial tumor resection and compared its utility to those of other validated frailty indices. ⋯ The study findings suggest that the HFRS is an effective predictor of postoperative outcomes in intracranial tumor patients and more effectively predicts adverse outcomes than other frailty indices. The HFRS may serve as an important tool for reducing patient morbidity and mortality in intracranial tumor surgery.
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Journal of neurosurgery · Aug 2023
A novel needle holder for suturing in a deep and narrow surgical field: a technical note.
Microvascular anastomosis is a standard procedure in neurosurgery that is applied to various lesions, such as those of ischemic disease and moyamoya disease. The depth of an anastomosis can be superficial or deep. At deeper sites, the procedure becomes challenging, as the operative field is usually narrow. ⋯ There is a mechanism for opening, closing, and rotating the holder via the surgeon's finger without moving the holder. Based on suture experiments in simulated blood vessels while using the holder, some situations may necessitate the use of this needle holder. This novel smart device may assist in deep vascular anastomosis in microsurgery, suturing of the carotid artery in carotid endarterectomy, and dural repair in endoscopic surgery.