Journal of neurosurgery
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Journal of neurosurgery · Feb 2025
Radiographic and neurological outcomes of Gamma Knife radiosurgery for lower cranial nerve schwannomas: a single-institution experience.
Gamma Knife radiosurgery (GKRS) is widely used for treating small- to medium-sized or postoperative residual, recurrent lower cranial nerve schwannomas (LCNSs). This study aimed to evaluate the radiographic and neurological outcomes of GKRS for LCNS. ⋯ GKRS is an alternative treatment option for LCNS that reduces surgical morbidity and enhances tumor control. However, GKRS can potentially lead to neurological deterioration, necessitating extreme caution throughout the procedure, specifically for JFSs.
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Journal of neurosurgery · Feb 2025
Functional mapping of movement and speech using task-based electrophysiological changes in stereoelectroencephalography.
Stereoelectroencephalography (SEEG) has become the predominant method for intracranial seizure localization. When imaging, semiology, and scalp EEG findings are not in full agreement or definitively localizing, implanted SEEG recordings are used to test candidate seizure onset zones (SOZs). Discovered SOZs may then be targeted for resection, laser ablation, or neurostimulation. If an SOZ is eloquent, resection and ablation are both contraindicated, so identifying functional representation is crucial for therapeutic decision-making. The authors present a novel functional brain mapping technique that utilizes task-based electrophysiological changes in SEEG during behavioral tasks and test this in pediatric and adult patients. ⋯ Task-based electrophysiological mapping using broadband changes in the SEEG signal reliably identifies movement and speech representation in pediatric and adult epilepsy patients.
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Journal of neurosurgery · Jan 2025
Noncontrast imaging for the surveillance of treated and untreated meningiomas.
Patients with meningiomas require serial MRI for surveillance of tumor size and growth rate. The cost and resource requirements for contrast-enhanced MRI include intravenous cannulation, the contrast agent, risk of adverse reaction, and the time needed to acquire, review, and report the additional sequences. With repeated doses, gadolinium is known to accumulate in neural tissues. The authors compared the correlation and accuracy of axial T2-weighted imaging (T2WI) sequences alone for assessing tumor growth, dimensions, and dural venous sinus invasion compared with the current clinical practice of assessing both contrast-enhanced T1-weighted imaging (CE-T1WI) and T2WI sequences. ⋯ In patients with treated and untreated meningiomas, unenhanced T2WI can assess tumor dimensions, detect growth, and detect venous invasion with comparable reliability and accuracy to the current clinical practice of using both CE-T1WI and T2WI.
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Journal of neurosurgery · Jan 2025
The effect of delayed-release antibiotics on the rate of postoperative wound infection for implanted neuromodulatory devices.
Implanted neuromodulatory devices are important for the surgical management of pain, epilepsy, movement disorders, and spasticity. These devices are surgically implanted, but many must be periodically explanted and replaced as batteries deplete or devices fail. Replacement surgery risks further infections that require device explantation, incur large financial costs, and reduce patient quality of life. To reduce infection rates, a single surgeon began using vancomycin-impregnated absorbable calcium sulfate delayed-response beads with neuromodulatory device and intrathecal pump primary implantations and replacements. The infection rates when using vancomycin-impregnated beads were compared with previously published rates from the same surgeon. ⋯ The use of vancomycin-impregnated absorbable calcium sulfate beads was associated with a reduced rate of postoperative infection rates with implantable devices, and specifically for DBS primary implantation and replacement surgeries.