Journal of neurosurgery
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Journal of neurosurgery · Jul 2024
Association of socioeconomic status with the management outcome of unruptured intracranial arteriovenous malformation.
The longitudinal management of unruptured brain arteriovenous malformation (bAVM) is crucial. To date, no study in the United States has evaluated the impact of socioeconomic status (SES) on bAVM outcome. Herein, the authors aimed to clarify the impact of SES, as indicated by the area deprivation index (ADI), on bAVM outcome. ⋯ This study revealed that relatively disadvantaged patients with unruptured bAVMs are more likely to experience nonindependent outcomes at the last follow-up, after adjusting for confounding variables. An emphasis on social support may be beneficial for patients with a lower SES.
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The number of women graduating from United States medical schools has reached parity with that of men. However, persistent inequalities and barriers have slowed the pace toward equity in application and representation in neurosurgery residency despite initiatives to increase female representation. The objective of the present study was to assess the advancement of gender parity within neurosurgery residency programs. Additionally, the study aimed to analyze the pipeline dynamics by investigating the effects of attrition on women in neurosurgery, as well as exploring the patterns of female applications to neurosurgery residency programs versus other surgical specialties. ⋯ Neurosurgery continues to struggle with the recruitment of female medical students even as parity has been reached for female medical school matriculants. Greater effort is needed to recruit and retain female applicants to neurosurgery, including increased transparency in match and attrition metrics.
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Journal of neurosurgery · Jul 2024
Basal vein of Rosenthal classification: the key to venous outflow of the deep sylvian fissure.
Mastery of sylvian fissure dissection is essential to access lesions within the deep basal cisterns. The deep sylvian vein and its tributaries play a major role during access to and beyond the carotid cistern through the sylvian fissure and determine the complexity of microdissection. Preserving the venous outflow during sylvian fissure dissection is the best reliable strategy to prevent postoperative venous strokes or venous hypertension. The authors report the role of the basal vein of Rosenthal (BVR) in the venous outflow pattern of the deep sylvian cistern. ⋯ Preoperative assessment of the BVR anatomy is key to predict the deep sylvian venous pattern. The authors provide objective evidence supporting the reciprocal relationship between the type of BVR and the presence of a middle sylvian vein and the deep sylvian venous outflow. An immature BVR should alert the neurosurgeon of the high likelihood of finding a complex deep venous pattern, which may drive surgical planning.
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Journal of neurosurgery · Jul 2024
The correlation of cerebral arteriovenous malformation flow measured by quantitative MR angiography on MR-detected arteriovenous malformation microhemorrhage.
The objective of this study was to assess the relationship of arteriovenous malformation (AVM) blood flow measured by quantitative MR angiography (QMRA) in nonruptured AVMs with MR-detected microhemorrhage. ⋯ This study represents the first to examine the association between flow measurements on QMRA with microhemorrhage in unruptured AVMs. Higher AVM flow, venous anomaly, arterial ectasia, and diffuse AVM nidus were related to a higher likelihood of AVM microhemorrhage. Higher AVM flow was present in AVMs with venous anomalies, a diffuse nidus, and arterial ectasia, indicating a possible interaction between these angioarchitectural findings, AVM flow, and microhemorrhage. These findings suggest a relationship between higher AVM flow and the risk of microhemorrhage.
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Journal of neurosurgery · Jul 2024
Impact of collagen matrix on reconstructive material selection and postoperative complications in endoscopic endonasal skull base surgery.
The aim of this study was to investigate the impact of collagen matrix on reconstructive material selection and postoperative complications in endoscopic endonasal skull base surgery. ⋯ Collagen matrix implementation significantly decreased autologous graft harvesting without increasing postoperative CSF leakage, contributing to less invasive surgery.