World Neurosurg
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Concussion and sports-related cranial and spine injuries recently have garnered increased attention from the media, public, and sports' governing bodies. Although concussion has been well-studied, there are minimal data on return to play for structural neurosurgical lesions. ⋯ The results presented here are the first effort to study current practice on return to play for structural neurosurgical lesions. They establish an early foundation for neurosurgical guidelines on these patients.
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The concept of human brain reorganization due to slow-growing lesions, including low-grade glioma, has been gradually and generally accepted. However, few cases have been reported in which the reorganization, especially in the topographic pure primary motor cortex, was observed during brain surgery. We report a case of slow-growing oligodendroglioma located in the pure primary motor cortex, as detected by magnetic resonance imaging that could be resected in part thanks to the brain plasticity. In addition, we describe a pitfall of topographic guidance using somatosensory-evoked potential (SEP) monitoring. ⋯ Pure primary motor cortex could be reorganized by its own lesion. In reorganized brain, topographic central sulcus defined based on SEP findings may be an inappropriate guidance to estimate true functional area. In such a condition, intraoperative direct electrical stimulation under awake craniotomy makes it feasible to resect pure primary motor cortex invaded by tumors.
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Stereotactic radiosurgery (SRS) has evolved to become an established, well-studied treatment modality for intracranial pathologies traditionally treated with more invasive neurosurgical management. As the field expands, among neurosurgeons and across multiple disciplines, resident training will become increasingly crucial. ⋯ SRS is a rapidly expanding field that requires a unique skill set and current neurosurgical resident training often does not fully prepare trainees for its use in clinical practice. Focused resident training is necessary to ensure trainees are proficient in this specialty and well equipped to become leaders in the field.