Creating a predictive model and online calculator for high-value care outcomes following glioblastoma resection: incorporating neighborhood socioeconomic status index.

Purpose: Social determinants of health including neighborhood socioeconomic status, have been established to play a profound role in overall access to care and outcomes in numerous specialized disease entities. To provide glioblastoma multiforme (GBM) patients with high-quality care, it is crucial to identify predictors of hospital length of stay (LOS), discharge disposition, and access to postoperative adjuvant chemoradiation. In this study, we incorporate a novel neighborhood socioeconomic status index (NSES) and develop three predictive algorithms for assessing post-operative outcomes in GBM patients, offering a tool for preoperative risk stratification of GBM patients.

Optimal treatment regimen for very elderly patients with atypical meningioma: an analysis of survival outcomes using the National Cancer Database (NCDB).

Purpose: We assess the efficacy of different surgical resection types, radiotherapy, systemic therapy on overall survival in very elderly patients (age > 80) with intracranial atypical meningioma in contrast with their elderly (65-80) counterparts.

Methods: Patients > 65 years old with intracranial atypical meningiomas surgically resected and catalogued via the National Cancer Database were included. Cox proportional hazards models were developed to assess the association between surgical resection type, radiotherapy and systemic therapy with OS while controlling for sex, race, ethnicity, facility type, income, tumor size and CDCC score.

Evaluating the atherosclerosis cardiovascular disease risk score in patients with brain metastases: Associations with overall survival and high-value care outcomes.

Objective: Brain metastases (BM) constitute the most common intracranial tumor in adults. Prior literature indicates the 10-year atherosclerotic cardiovascular disease (ASCVD) risk score is associated with increased risk of cancer, potentially attributable to shared risk factors. Understanding the role of ASCVD risk scores in BM may help optimize their care and inform clinical decision-making.

Promoting durable well-being among healthcare professionals via an interactive, online, wellness initiative.

Burnout is recognized as a negative contributor to well-being within healthcare. The purpose of this study was to evaluate whether participation in the Peace Education Program (PEP), a 10-week wellness course, promoted durable improvement of burnout and wellness in a large academic medical center. We deployed PEP virtually through a series of free, interactive, online wellness sessions focusing on 10 domains: peace, appreciation, inner strength, self-awareness, clarity, understanding, dignity, choice, hope, and contentment.

Hospital frailty risk score predicts high-value care outcomes following brain metastasis resection.

Objective: Brain metastases (BM) are the most common adult intracranial tumors, representing a significant source of morbidity in patients with systemic malignancy. Frailty indices, including 11- and 5-factor modified frailty indices (mFI-11 and mFI-5), American Society of Anesthesiologists (ASA) physical status classification, and Charlson Comorbidity Index (CCI), have recently demonstrated an important role in predicting high-value care outcomes in neurosurgery. This study aims to investigate the efficacy of the newly developed Hospital Frailty Risk Score (HFRS) on postoperative outcomes in BM patients.

Outcomes After Definitive Surgery for Spinal and Sacral Chordoma in 101 Patients Over 20 Years.

Background And Objectives: Spinal chordomas are primary bone tumors where surgery remains the primary treatment. However, their low incidence, lack of evidence, and late disease presentation make them challenging to manage. Here, we report the postoperative outcomes of a large cohort of patients after surgical resection, investigate predictors for overall survival (OS) and local recurrence-free survival (LRFS) times, and trend functional outcomes over multiple time periods.

Case report: Avoidant/restrictive food intake disorder after tonsillectomy.

Background: Avoidant Restrictive Food Intake Disorder (ARFID) is a newly classified eating disorder that requires further understanding of its presentation. There is no previous report of ARFID in a child post-tonsillectomy. ARFID may be a potential negative outcome for children following oropharyngeal surgery.

Longitudinal Pulse-Synchronous Bouncing During Catheter Angiography-A Phenomenon Specific to Spinal Hemangioblastomas.

Background: Spinal hemangioblastomas are often evaluated with catheter angiography for both workup and treatment planning. We report a unique longitudinal pulse-synchronous bouncing phenomenon observed during their angiographic evaluation and consider the association of pulse-synchronous bouncing with syringomyelia, another pathologic feature associated with hemangioblastomas.

Methods: Preoperative spinal angiograms and associated magnetic resonance imagings (MRIs) obtained over a 16-year period at a single institution were retrospectively evaluated.

Operative Corridors in Endoscopic Skull Base Tumor Surgery.

Advances in technology, instrumentation, and reconstruction have paved the way for extended endoscopic approaches to skull base tumors. In the sagittal plane, the endonasal approach may safely access pathologies from the frontal sinus to the craniocervical junction in the sagittal plane, the petrous apex in the coronal plane, and extend posteriorly to the clivus and posterior cranial fossa. This review article describes these modular extended endoscopic approaches, along with crucial anatomic considerations, illustrative cases, and practical operative pearls.

Initial institutional experience using a robotic arm-enabled 4K 3D exoscope in neurosurgical operations.

The extracorporeal telescope (exoscope) presents a novel digital camera system as a versatile alternative to traditional optical microscopy for microsurgery and minimally invasive neurosurgical operations. Recent innovations in exoscope technology offer 4K-definition multiscreen outputs, pneumatic robot arms, 3-dimensional depth perception, and greater illumination, focus, and magnification powers for enhanced intraoperative visualization. The authors present their initial institutional experience using a robotic arm-enabled 4K 3D exoscope in a variety of cranial and spinal neurosurgical operations, namely Chiari decompression, microvascular decompression for trigeminal neuralgia, anterior cervical discectomy, and lumbar decompressions.

Exoscope Use in Spine Surgery: A Systematic Review of Applications, Benefits, and Limitations.

Background: Exoscopes were recently developed as an alternative to the operative microscope (OM) and endoscope for intraoperative visualization during neurosurgery. Prior reviews studying mixed cranial and spinal surgical cohorts reported advantages with exoscope use, including improved ergonomics and teaching. In recent years, there has been an increase in exoscope research, with no updated systematic review focused exclusively on the benefits and limitations of exoscope use in spine surgery.

Individual differences and creative ideation: neuromodulatory signatures of mindset and response inhibition.

This study addresses the modulatory role of individual mindset in explaining the relationship between response inhibition (RI) and divergent thinking (DT) using transcranial direct current stimulation (tDCS). Forty undergraduate students (22 male and 18 female), aged between 18 and 23 years (average age = 19 years, SD = 1.48), were recruited.

Prophylactic removal of a migratory missile from the cerebral ventricles: case report.

Background And Importance: Nonpowder firearm injuries to the head pose major health risks, with retained fragments potentially causing harmful sequelae that require neurosurgical intervention.

Clinical Presentation: We report the case of 2-year-old girl who sustained an accidental gunshot wound to the head. She sustained a penetrating ballistic intracranial injury caused by a BB shot from a rifle.

Less might be more: 1 mA but not 1.5 mA of tDCS improves tactile orientation discrimination.

Background: Transcranial direct current stimulation (tDCS) is a frequently used brain stimulation method; however, studies on tactile perception using tDCS are inconsistent, which might be explained by the variations in endogenous and exogenous parameters that influence tDCS.

Objectives: We aimed to investigate the effect of one of these endogenous parameters-the tDCS amplitude-on tactile perception.

Methods: We conducted this experiment on 28 undergraduates/graduates aged 18-36 years.

Reduction of cervicothoracic spondyloptosis in an ambulatory patient: when traction fails.

Introduction: Cervical spondyloptosis is a rare complication of high-energy trauma which often results in significant patient morbidity and mortality. The authors present a case of spondyloptosis of C7 over T1 with minimal radicular symptoms and otherwise complete spinal cord sparing. This case highlights the surgical challenges faced with cervical spondyloptosis and the techniques used when traction fails.

Cerebrospinal Fluid Drainage in Patients with Acute Spinal Cord Injury: A Multi-Center Randomized Controlled Trial.

Objective: The secondary phase of spinal cord injury (SCI) is characterized by ischemic injury. Spinal cord perfusion pressure (SCPP), calculated as the difference between mean arterial pressure (MAP) and intrathecal pressure (ITP), has arisen as a therapeutic target for improving outcomes. Cerebrospinal fluid drainage (CSFD) may reduce ITP and thereby increase SCPP.

Contemporary Trends in Minimally Invasive Sacroiliac Joint Fusion Utilization in the Medicare Population by Specialty.

Background And Objectives: Sacroiliac (SI) joint dysfunction constitutes a leading cause of pain and disability. Although surgical arthrodesis is traditionally performed under open approaches, the past decade has seen a rise in minimally invasive surgical (MIS) techniques and new federally approved devices for MIS approaches. In addition to neurosurgeons and orthopedic surgeons, proceduralists from nonsurgical specialties are performing MIS procedures for SI pathology.

Development and External Validation of the Spinal Tumor Surgery Risk Index.

Background: Patients undergoing surgical procedures for spinal tumors are vulnerable to major adverse events (AEs) and death in the postoperative period. Shared decision making and preoperative optimization of outcomes require accurate risk estimation.

Objective: To develop and validate a risk index to predict short-term major AEs after spinal tumor surgery.

Delays in Presentation After Traumatic Spinal Cord Injury-A Systematic Review.

Background: Prompt surgical decompression after traumatic spinal cord injury (TSCI) may be associated with improved sensorimotor outcomes. Delays in presentation may prevent timely decompression after TSCI.

Objective: To systematically review existing studies investigating delays in presentation after TSCI in low- and middle-income countries (LMICs) and high-income countries (HICs).

High resolution 3D magnetic resonance imaging of Gruber's ligament: a pilot study.

Introduction: Gruber's ligament (GL), a surgical landmark, extends from the lateral upper clivus to the petrous apex (PA), forming the superior boundary of Dorello's canal (DC). It overlies the interdural segment of the abducens nerve (CN VI). High-resolution 3D skull base MRI (SB-MRI) demonstrates anatomic details visible to the surgeon, but not well seen on traditional cross-sectional imaging.

Adoption of awake spine surgery - trends from a national registry over 14 years.

Background Context: Awake spine surgery is growing in popularity, and may facilitate earlier postoperative recovery, reduced cost, and fewer complications than spine surgery conducted under general anesthesia (GA). However, trends in the adoption of awake (ie, non-GA) spine surgery have not been previously studied.

Purpose: To investigate temporal trends in non-GA spine surgery utilization and outcomes in the United States.