World Neurosurg
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Lesioning the Forel field or the subthalamic region is considered a possible treatment for tremoric patients with Parkinson disease, essential tremor, and other diseases. This surgical treatment was performed in the 1960s to 1970s and was an alternative to thalamotomy. Recently, there has been increasing interest in the reappraisal of stimulating and/or lesioning these targets, partly as a result of innovations in imaging and noninvasive ablative technologies, such as magnetic resonance-guided focused ultrasonography. ⋯ Based on the significant breakthrough that magnetic resonance-guided focused ultrasonography has meant in the neurosurgical world, some classic targets such as the pallidothalamic tract, Forel field, and posterior subthalamic area may be reconsidered as surgical alternatives for patients with movement disorders.
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This study set out to investigate the relationships between the neutrophil-to-albumin ratio (NAR) in the early stages of aneurysmal subarachnoid hemorrhage (aSAH) and the occurrence of delayed cerebral ischemia (DCI). ⋯ NAR, in positive correlation with the severity of hemorrhage, appears to be a novel predictive biomarker of DCI after aSAH.
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Intravenous glyburide has demonstrated safety when used for attenuation of cerebral edema, although safety data are lacking for enteral glyburide when used for this indication. We aimed to determine the prevalence of and risk factors for hypoglycemia in neurocritical care patients receiving enteral glyburide. ⋯ Hypoglycemic episodes are common following enteral glyburide in neurocritical care patients. Both patients with and without diabetes mellitus are at risk of hypoglycemia. Elevated admission serum creatinine may increase the risk of hypoglycemia when utilizing glyburide for prevention or treatment of cerebral or spinal cord edema.
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Publication metrics such as the author-level h-index are often used to evaluate and compare research productivity in academia. The h-index, however, is not a field-normalized statistic and has been criticized as inappropriate for comparison of authors from different fields. For example, fields such as internal medicine have a larger audience and thus afford publications a higher likelihood of increased citations compared with a perhaps equally impactful paper in a smaller field such as neurosurgery. The National Institutes of Health (NIH) has developed a new field-normalized article-level metric called the relative citation ratio (RCR) that can be used to more accurately compare author productivity between fields. Spine represents a distinct subset of neurosurgery with a designated fellowship and distinct differences in the RCR metrics. The authors look to analyze the unique results found in the academic spine neurosurgeon RCR values compared with all academic neurosurgeons. ⋯ Current academic spine neurosurgeons have high median RCR values relative to the NIH standard RCR value of 1.0. Relative to the field of neurological surgery overall, RCR values for the spine subspecialty are comparable. These data offer a more accurate means for self-evaluation of academic neurosurgeons as well as evaluation of faculty by institutional and departmental leaders.
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Decisions to treat unruptured intracranial aneurysms remain challenging, as the risk of rupture needs to be balanced with risk of intervention. In 2015, the Unruptured Intracranial Aneurysm Treatment Score (UIATS) was introduced to assist physicians in the decision making process. As its reliability is still debated, we retrospectively applied UIATS to a multicenter cohort of aneurysmal subarachnoid hemorrhage patients to test its performance in suggesting treatment in patients with known natural history. ⋯ In our study, UIATS would have failed to provide a clear recommendation to treat in up to 72.6% of patients whose aneurysm eventually ruptured. In agreement with previous reports, we provide additional evidence that some unruptured intracranial aneurysms may elude UIATS sensitivity. Further long-term prospective studies are necessary to assess UIATS reliability in real-world clinical practice.