World Neurosurg
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Although outcomes for many brain tumors, especially glioblastomas, remain poor, there have been significant advances in clinical and scientific understanding of neuro-oncologic disease. Tumor molecular profiling has become a critical component of clinical practice, allowing more accurate pathologic diagnosis and enhanced clarity of the pathogenesis of both primary and metastatic brain tumors. ⋯ New adaptive trial platforms have been developed to rapidly test therapies and biomarkers with good scientific rationale. Lastly, growth and development of neuro-oncology clinical care teams aim to further improve patients' outcomes and symptoms, especially at the end of life.
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Surgical treatment of idiopathic normal pressure hydrocephalus (iNPH) by ventriculoperitoneal (VP) or lumboperitoneal (LP) shunting can achieve long-term recovery of activities of daily living; however, in a subset of patients, maintenance of independence lasted for <6 months. This study examined positive preoperative predictive factors of short-term outcome for shunted iNPH patients. ⋯ Mild preoperative iNPH severity, shorter preoperative symptom duration, good tap test response, and complete DESH were associated with good short-term postoperative outcome at 1 year. These positive factors may be useful for prediction of short-term surgical outcome in iNPH patients.
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The coronavirus disease-19 (COVID) pandemic has presented a significant challenge to health care providers. Neurosurgical patients are often critically ill and at particularly high risk for COVID, and the pandemic has produced ever-shifting circumstances to allow their continued care. This study explores the psychologic impact of the pandemic on neurosurgical residents at a single institution. ⋯ There were no significant changes in perceived stress or depressive symptoms among neurosurgical residents during the pandemic.
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The medial occipital lobe, composed of the lingual gyrus and cuneus, is necessary for both basic and higher level visual processing. It is also known to facilitate cross-modal, nonvisual functions, such as linguistic processing and verbal memory, after the loss of the visual senses. A detailed cortical model elucidating the white matter connectivity associated with this area could improve our understanding of the interacting brain networks that underlie complex human processes and postoperative outcomes related to vision and language. ⋯ The medial occipital lobe is an extremely interconnected system, supporting its ability to perform coordinated basic visual processing, but also serves as a center for many long-range association fibers, supporting its importance in nonvisual functions, such as language and memory. The presented data represent clinically actionable anatomic information that can be used in multimodal navigation of white matter lesions in the medial occipital lobe to prevent neurologic deficits and improve patients' quality of life after cerebral surgery.
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Case Reports Observational Study
Evaluation of the effectiveness of lumbar punctures in aneurysmal subarachnoid hemorrhage patient with external ventricle drainage.
For aSAH patients with external ventricular drainage (EVD) because of hydrocephalus, the consensus on application of CSF drainage from the lumbar cistern is mixed owing to concerns about its safety and questionable effectiveness. This study evaluated the additional effectiveness of CSF drainage from the lumbar cistern in aSAH patients with EVD. ⋯ For aSAH patients with EVD, serial LPs can accelerate clearance of toxic products from the subarachnoid space.