DeepFocus: a transnasal approach for optimized deep brain stimulation of reward circuit nodes.

Transcranial electrical stimulation (TES) is an effective technique to modulate brain activity and treat diseases. However, TES is primarily used to stimulate superficial brain regions and is unable to reach deeper targets. The spread of injected currents in the head is affected by volume conduction and the additional spreading of currents as they move through head layers with different conductivities, as is discussed in Forssell(2021046042).

Post-operative antibiotic prophylaxis in spine surgery patients with thoracolumbar drains: A meta analysis.

Objective: Closed-suction drains are commonly placed after thoracolumbar surgery to reduce the risk of post-operative hematoma and neurologic deterioration, and may stay in place for a longer period of time if output remains high. Prolonged maintenance of surgical site drains, however, is associated with an increased risk of surgical site infection (SSI). The present study aims to examine the literature regarding extended duration (≥24 h) prophylactic antibiotic use in patients undergoing posterior thoracolumbar surgery with closed-suction drainage.

Stereoelectroencephalography in the setting of a previously implanted responsive neural stimulation device: illustrative case.

Background: Responsive neural stimulation (RNS) is a relatively novel procedure for drug-resistant epilepsy, which involves implantation of a device into the skull and brain. As more devices are implanted, there may be an increasing need to perform intracranial electrocorticography in implant patients with persistent seizures. Given the device location, imaging difficulties with implanted devices, and other technical hurdles, stereoelectroencephalography (SEEG) could be especially challenging.

Systematic Review and Meta-Analysis of Responsive Neurostimulation in Epilepsy.

Background: Neuromodulatory implants provide promising alternatives for patients with drug-resistant epilepsy (DRE) in whom resective or ablative surgery is not an option. Responsive neurostimulation (RNS) operates a unique "closed-loop" system of electrocorticography-triggered stimulation for seizure control. A comprehensive review of the current literature would be valuable to guide clinical decision-making regarding RNS.

Cross-Sectional Analysis of US Health Insurance Payer Policies for Humanitarian Device Exemption Indications for Deep Brain Stimulation.

Background: The US Food and Drug Administration (FDA) has granted deep brain stimulation (DBS) approval under the humanitarian device exemption (HDE) pathway for both dystonia and obsessive-compulsive disorder (OCD). However, recent reports from the community of functional neurosurgeons suggest that insurance authorization remains a disproportionate barrier to OCD DBS implantation despite both conditions having similar support from the FDA. This cross-sectional study of health insurance policies quantifies the current payer landscape for these two interventions.

Retrograde Suction Decompression for Clipping of a Giant Ophthalmic Internal Carotid Artery Aneurysm: 2-Dimensional Operative Video.

Microsurgical clipping of large paraclinoid aneurysms is challenging because of the complex anatomy of the dural rings, lack of easy proximal control, and wide aneurysm necks. Proximal retrograde suction decompression, or the Dallas technique, can reduce aneurysm turgor and, with aspiration of the trapped cervical and supraclinoid internal carotid arteries (ICAs), can collapse the aneurysm to aid microsurgical clipping.1-5  A woman in her late 30s presented with decreased right-eye visual acuity.

Cognitive outcomes following frontal lobe resection for treatment of epilepsy in children and adolescents.

Objective: To use reliable change indices (RCIs) developed specifically for pediatric patients with epilepsy to examine cognitive outcomes after frontal lobe resection for pharmacoresistant epilepsy.

Methods: Forty-one pediatric patients (25 male, M = 10 years) completed comprehensive neuropsychological evaluations before and an average of 6.5 months after frontal lobe resections for treatment of epilepsy.

Robot-Assisted Stereoelectroencephalography: 2-Dimensional Operative Video.

Invasive neuromonitoring is an important component of presurgical workup and seizure onset zone localization in patients with epilepsy being considered for surgical resection. In the United States, intraparenchymal stereoelectroencephalography (SEEG) electrodes have been replacing subdural grid electrodes for most cases, following a trend that has already matured in Europe. The use of robotic assistance has been shown to improve operative times and accuracy in SEEG electrode placement, as users benefit from the embedded planning software as well as the efficiency and accuracy of the robotic arm.

Anatomical Subpial Resection of Tumors in the Amygdala and Hippocampus.

Objective: Surgical techniques to achieve complete resection of mesial-basal temporal tumors should be pursued by neurosurgical oncologists. We describe the anatomical subpial amygdalohippocampectomy (SpAH) technique for tumor resection.

Methods: The key anatomical landmarks and critical steps of the SpAH technique were outlined and emphasized with medical illustrations and intraoperative photographs.

Predictors of indirect neural decompression in minimally invasive transpsoas lateral lumbar interbody fusion.

Objective: An advantage of lateral lumbar interbody fusion (LLIF) surgery is the indirect decompression of the neural elements that occurs because of the resulting disc height restoration, spinal realignment, and ligamentotaxis. The degree to which indirect decompression occurs varies; no method exists for effectively predicting which patients will respond. In this study, the authors identify preoperative predictive factors of indirect decompression of the central canal.

An evaluation of the SAFIRE grading scale as a predictor of long-term outcomes for patients in the Barrow Ruptured Aneurysm Trial.

Objective: The SAFIRE grading scale is a novel, computable scale that predicts the outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients in acute follow-up. However, this scale also may have prognostic significance in long-term follow-up and help guide further management.

Methods: The records of all patients enrolled in the Barrow Ruptured Aneurysm Trial (BRAT) were retrospectively reviewed, and the patients were assigned SAFIRE grades.

Spetzler-Martin Grade III Arteriovenous Malformations: A Multicenter Propensity-Adjusted Analysis of the Effects of Preoperative Embolization.

Background: Spetzler-Martin (SM) grade III arteriovenous malformations (AVMs) are at the boundary of safe operability, and preoperative embolization may reduce surgical risks.

Objective: To evaluate the benefits of preoperative AVM embolization by comparing neurological outcomes in patients with grade III AVMs treated with or without preoperative embolization.

Methods: All microsurgically treated grade III AVMs were identified from 2011 to 2018 at 2 medical centers.

Difficult-to-Localize Epilepsy After Stereoelectroencephalography: Technique, Safety, and Efficacy of Placing Additional Electrodes During the Same Admission.

Background: Stereoelectroencephalography (SEEG) is used to identify the epileptogenic zone (EZ) in patients with epilepsy for potential surgical intervention. Occasionally, the EZ is difficult to localize even after an SEEG implantation.

Objective: To demonstrate a safe technique for placing additional electrodes in ongoing SEEG evaluations.

COVID-19 and Neurosurgery Consultation Call Volume at a Single Large Tertiary Center With a Propensity-Adjusted Analysis.

Background: The COVID-19 pandemic has significantly affected patient care across specialties. Ramifications for neurosurgery include substantial disruptions to surgical training and changes in nonurgent patient presentations to the emergency department. This study quantifies the effects of the COVID-19 pandemic on the number of emergency department patients who were referred to the neurosurgery department for further consultation and treatment and identifies and describes trends in the characteristics of these visits.

Small intracranial aneurysms in the Barrow Ruptured Aneurysm Trial (BRAT).

Background: Treatment of small ruptured aneurysms (SRAs) remains controversial, with literature reporting difficulty with endovascular versus microsurgical approaches. This paper analyzes outcomes after endovascular coiling and microsurgical clipping among patients with SRAs prospectively enrolled in the Barrow Ruptured Aneurysm Trial (BRAT).

Method: All BRAT patients were included in this study.

Predictors of the development of takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage and outcomes in patients with intra-aortic balloon pumps.

Objective: Takotsubo cardiomyopathy (TC) in patients with aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. Previous studies have shown that female patients presenting with a poor clinical grade are at the greatest risk for developing TC. Intra-aortic balloon pumps (IABPs) are known to support cardiac function in severe cases of TC, and they may aid in the treatment of vasospasm in these patients.

Single-position prone lateral approach: cadaveric feasibility study and early clinical experience.

Objective: Lateral lumbar interbody fusion (LLIF) is a useful minimally invasive technique for achieving anterior interbody fusion and preserving or restoring lumbar lordosis. However, achieving circumferential fusion via posterior instrumentation after an LLIF can be challenging, requiring either repositioning the patient or placing pedicle screws in the lateral position. Here, the authors explore an alternative single-position approach: LLIF in the prone lateral (PL) position.

Seizure and neuropsychological outcomes in a large series of selective amygdalohippocampectomies with a minimally invasive subtemporal approach.

Objective: Debate continues over proper surgical treatment for mesial temporal lobe epilepsy (MTLE). Few large comprehensive studies exist that have examined outcomes for the subtemporal selective amygdalohippocampectomy (sSAH) approach. This study describes a minimally invasive technique for sSAH and examines seizure and neuropsychological outcomes in a large series of patients who underwent sSAH for MTLE.

Patient-Controlled Analgesia Following Lumbar Spinal Fusion Surgery Is Associated With Increased Opioid Consumption and Opioid-Related Adverse Events.

Background: Optimal postoperative pain control is critical after spinal fusion surgery. There remains significant variability in the use of postoperative intravenous opioid patient-controlled analgesia (PCA) and few data evaluating its utility compared with nurse-controlled analgesia (NCA) among patients with lumbar fusion.

Objective: To investigate the efficacy of postoperative PCA compared with NCA to improve opiate prescription practices.

Outcomes in a Case Series of Elderly Patients with Aneurysmal Subarachnoid Hemorrhages in the Barrow Ruptured Aneurysm Trial (BRAT).

Background: Aneurysmal subarachnoid hemorrhage (aSAH) is debilitating in elderly patients, but literature regarding this population is scarce, and clinical decision-making remains debated. Outcomes of elderly patients with aSAH stratified by age and clinical presentation were analyzed.

Methods: Patients treated for aSAH were retrospectively analyzed.

Laser Interstitial Thermal Therapy for Epileptogenic Periventricular Nodular Heterotopia.

Objective: Epilepsy with periventricular nodular heterotopia (PVNH) lacks a conclusive surgical treatment strategy as eloquent cortex and important white matter tracts frequently overlay the deep periventricular nodules. Our goal was to evaluate the safety and efficacy of laser interstitial thermal therapy (LITT) for the treatment of epilepsy in PVNH.

Methods: Data on demographic characteristics, complications, visual outcomes, Engel classification at last follow-up, antiepileptic drug use, morbidity, and mortality among patients who underwent this procedure were retrospectively reviewed.

Onyx embolization of skull base paragangliomas: a single-center experience.

Background: Skull base paragangliomas are highly vascular tumors that are often embolized before surgical resection; however, the safety and efficacy of preoperative embolization using an ethylene vinyl alcohol copolymer (Onyx; Medtronic, Dublin, Republic of Ireland) in these tumors is unknown. This retrospective cohort study evaluated patient outcomes after preoperative embolization of skull base paragangliomas using Onyx.

Methods: We retrospectively analyzed data from all patients with skull base paragangliomas who underwent preoperative Onyx embolization at our institution (January 01, 2005-December 31, 2017).