World Neurosurg
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Standard translaminar approaches for intradural extramedullary (IDEM) tumors require extensive soft tissue dissection and partial facet removal. Ventral lesions may necessitate wider bone resection with subsequent possible spinal instability. Any manipulation of an already compromised spinal cord may lead to neurological injury. We describe an image-guided minimal access technique for IDEM tumor resection. ⋯ Image merge tailored access resection appears to be at least equivalent in terms of tumor resection, blood loss, and complications to other tubular techniques. It may reduce risks of neurological deficit and spine instability. Image merge tailored access resection is a novel application of merging intraoperative fluoroscopic images with preoperative magnetic resonance images for tailored IDEM resection.
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Although ventriculoperitoneal shunt (VPS) surgery is the most frequent surgical treatment for patients with hydrocephalus, modern rates of complications in adults are uncertain. ⋯ Complications are not infrequent after VPS surgery; however, most complications appear to be clustered in the first year after VPS insertion.
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Prophylactic use of antiepileptic drugs (AEDs) for patients undergoing brain tumor surgery is common practice despite lack of clear evidence. We hypothesized that prophylactic AED (pAED) use did not affect seizure rates in patients with brain tumor who underwent craniotomy for tumor resection. ⋯ pAEDs did not significantly reduce postoperative seizures in patients with brain tumor in this analysis. In addition, pAED was often continued once prescribed even if the patient remained seizure free.
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Neurosurgery residency is becoming an increasingly competitive match. The process of screening and ranking applicants is a multifactorial process that lacks uniformity across residency programs. A significant factor is the applicant's performance on the United States Medical Licensing Examination (USMLE) Step 1. USMLE Step 1 scores are often used to project future success in residency and performance on specialty boards like the American Board of Neurological Surgery (ABNS) examination. The authors of this study investigate the strength of correlations between USMLE Step 1 and ABNS scores. ⋯ USMLE Step 1 and ABNS scores are directly correlated. USMLE Step 1 scores will continue to be a valuable measure of projected success on ABNS written examinations, but more sophisticated measures are needed.
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Magnetic resonance-guided laser-induced thermotherapy (MR-LITT) is a minimally invasive technique that shows promise in neuro-oncology because of its superiority in delivering precise minimally invasive thermal energy with minimal collateral damage. In this analysis, we investigate initial data on the effect of MR-LITT on dural-based lesions. ⋯ MR-LITT is a promising technology for dural-based lesion treatment. This initial study demonstrates that MR-LITT is safe and offers several advantages over open surgical treatment. Randomized studies are needed to evaluate its role as a treatment adjunct.