Superficial Temporal Artery Size Changes After Encephaloduroarteriosynangiosis for the Treatment of Moyamoya Disease.

Background And Objective: Surgery is the mainstay of stroke prevention in patients with symptomatic moyamoya disease (MMD). We present the results of a single-center retrospective study of indirect revascularization surgery for adult MMD, emphasizing angiographic outcomes, including dilation of the superficial temporal artery and formation of new collaterals.

Methods: A prospectively maintained database of procedures performed for MMD was reviewed.

The Neurovascular Disease Management Course: A Medical Student Opportunity for Early Exposure and Technical Development in Vascular Neurosurgery.

Background: As endovascular neurosurgery techniques continue to evolve, medical students in the United States have widely varying exposures to the field, particularly with respect to opportunities for hands-on experiences. Current medical school curricula could benefit from a novel and adaptive course on vascular neurosurgery to increase student exposure earlier in their training.

Methods: We launched a yearly hands-on vascular neurosurgery course for medical students and residents.

Left-Handed Palming of the Needle Driver: A Technical Report for Surgical Trainees.

Left-handed surgical trainees are uniquely challenged when learning how to suture using standard needle drivers designed for right-handed individuals and often feel disadvantaged in comparison to their right-handed peers. "Palming," a suturing technique that improves suturing mechanics and efficiency, cannot be achieved in the standard manner using the left hand. This paper proposes a previously undescribed technique for palming using the left hand that provides many of the same benefits as standard palming methods using the right hand, potentially reducing a common source of inequity in surgical training.

Surgery in octogenarians with intracranial meningiomas improves functional outcome at 1 year.

Purpose: The population is aging, and age remains an important factor in deciding surgical candidacy for intracranial tumors. The natural history and surgical behavior of meningiomas in octogenarians are not well understood. We evaluated the surgical and functional outcomes, including survival, among octogenarians with intracranial meningiomas in a single institution.

Awake Craniotomy and Intraoperative Musical Performance for Brain Tumor Surgery: Case Report and Literature Review.

Music experience and creation is a complex phenomenon that involves multiple brain structures. Music mapping during awake brain surgery, in addition to standard speech and motor mapping, remains a controversial topic. Music function can be impaired selectively, despite overlap with other neural networks commonly tested during direct cortical stimulation.

Octogenarian Brain Tumor Registry: Single-Institution Surgical Outcomes and Mortality Study.

Background: Surgical intervention for brain tumor patients aged 80 to 89 years is controversial, as the comorbidities and physiology associated with aging are often thought to increase surgical risks. Surgical outcomes, however, are not well characterized for octogenarians. This review therefore assessed the outcomes and mortality risk associated with tumor removal in octogenarians at our academic institution.

Intracranial Metastasis of Extracranial Chondrosarcoma: Systematic Review With Illustrative Case.

Background: Cerebral chondrosarcoma metastases are rare and aggressive neoplasms. The rarity of presentation has precluded rigorous analysis of diagnosis, risk factors, treatment, and survival. We analyzed every reported case through exhaustive literature review.

Predictors of extended length of stay related to craniotomy for tumor resection.

Background: Hospital length of stay (LOS) related to craniotomy for tumor resection (CTR) is a marker of neurosurgical quality of care. Limiting LOS benefits both patients and hospitals. This study examined which factors contribute to extended LOS (eLOS) at our academic center.

Targeting Accuracy of the Leksell Vantage Stereotactic System for Deep Brain Stimulation Surgery: A Retrospective Review.

Background: Compared with the Leksell G frame, the new Leksell Vantage stereotactic headframe offers many benefits during deep brain stimulation (DBS) procedures.

Objective: To define the "real-world" targeting accuracy of the Vantage frame for performing DBS lead implants.

Methods: Retrospective review of all patients who underwent DBS using the Vantage frame with our surgeon between July 2021 and May 2022.

Inhibition of the epigenetically activated miR-483-5p/IGF-2 pathway results in rapid loss of meningioma tumor cell viability.

Purpose: Meningioma is the most common primary central nervous system tumor often causing serious complications, and presently no medical treatment is available. The goal of this study was to discover miRNAs dysregulated in meningioma, and explore miRNA-associated pathways amenable for therapeutic interventions.

Methods: Small RNA sequencing was performed on meningioma tumor samples to study grade-dependent changes in microRNA expression.

Complications Related to Deep Brain Stimulation Lead Implantation: A Single-Surgeon Case Series.

Background: Deep brain stimulation (DBS) is the mainstay of surgical treatment for movement disorders, yet previous studies have shown widely varying complication rates. Given the elective nature of DBS surgery, minimizing surgical complications is imperative.

Objective: To evaluate short-term and long-term complications related to DBS lead implantation surgeries performed by an experienced surgeon and provide an updated benchmark comparison for other DBS centers and alternative therapies.

Cerebral Metastases in Appendiceal Cancer: Comprehensive Review and Report of Rare Medullary Carcinoma Histology.

Appendiceal cancer is an extremely rare malignancy, and its metastatic spread to the brain is even more unusual. We describe a 47-year-old female who presented with a rare cerebral appendiceal carcinoma metastasis, a case that is further remarkable for representing the first histologic diagnosis of primary medullary carcinoma in the appendix. Based on a comprehensive review of the English literature using PubMed, Embase, and Google Scholar, only six other cases of cerebral appendiceal metastases have been described.

Moral Distress and Moral Injury Among Attending Neurosurgeons: A National Survey.

Background: "Moral distress" describes the psychological strain a provider faces when unable to uphold professional values because of external constraints. Recurrent or intense moral distress risks moral injury, burnout, and physician attrition but has not been systematically studied among neurosurgeons.

Objective: To develop a unique instrument to test moral distress among neurosurgeons, evaluate the frequency and intensity of scenarios that may elicit moral distress and injury, and determine their impact on neurosurgical burnout and turnover.

Intracranial Malignant Peripheral Nerve Sheath Tumors Not Associated with a Cranial Nerve: Systematic Review and Illustrative Case.

Objective: Primary intracranial malignant peripheral nerve sheath tumors (MPNSTs) not associated with cranial nerves are rare and aggressive neoplasms. The rarity of presentation has precluded rigorous analysis of diagnosis, risk factors, treatment, and survival. We analyzed every reported case through exhaustive literature review.

The use of staples for external ventricular drain catheter fixation: A single-institution experience.

Background: Sutures are conventionally used for external ventricular drain (EVD) catheter fixation, but staples are an appealing alternative as they are quicker and easier to learn. We report our institutional experience with EVD fixation techniques and the patterns of catheter fixation.

Methods: We conducted a retrospective review of all aneurysmal subarachnoid hemorrhage (aSAH) patients treated in a single US center between 2007 and 2017.

A Scoping Review of Burnout in Neurosurgery.

Background: Burnout is a negative workplace syndrome of emotional exhaustion, cynicism, and perceived professional inefficacy that risks the patient-provider relationship, patient care, and physician well-being.

Objective: To assimilate the neurosurgical burnout literature in order to classify burnout among domestic and international neurosurgeons and trainees, identify contributory factors, and appraise the impact of wellness programs.

Methods: A scoping review identified the available literature, which was reviewed for key factors related to burnout among neurosurgeons.

Risk Factors for Wire Fracture or Tethering in Deep Brain Stimulation: A 15-Year Experience.

Background: In deep brain stimulation (DBS), tunneled lead and extension wires connect the implantable pulse generator to the subcortical electrode, but circuit discontinuity and wire revision compromise a significant portion of treatments.

Objective: To identify factors predisposing to fracture or tethering of the lead or extension wire in patients undergoing DBS.

Method: Retrospective review of wire-related complications was performed in a consecutive series of patients treated with DBS at a tertiary academic medical center over 15 yr.

Intramedullary-Extramedullary Breast Metastasis to the Caudal Neuraxis Two Decades after Primary Diagnosis: Case Report and Review of the Literature.

Background: Intramedullary metastases to the caudal neuraxis with exophytic extension to the extramedullary space are rare. We describe the unique case of a patient with locally recurrent breast cancer who developed an intramedullary-extramedullary metastasis to the conus medullaris and cauda equina 22 years after primary diagnosis, the longest interval between primary breast cancer and intramedullary spread to date. We also reviewed the published literature on focal breast metastases to the conus medullaris or cauda equina.

Neural Crest Cell Failure as Embryogenesis for Fusiform Aneurysm of the Anterior Communicating Artery: Case Report and Review of the Literature.

Background: Pure fusiform aneurysms of the anterior communicating artery (AcomA) are rare. We report a unique case of a patient with an AComA fusiform aneurysm in the setting of several unusual cranial neurocristopathies, including a hypoplastic internal carotid artery (ICA), persistent craniopharyngeal canal, transsphenoidal encephalocele, and ectopic, duplicated pituitary gland. We also review the literature on cranial base neurocristopathies and AComA fusiform aneurysms.

A comprehensive review of the diagnosis and management of congenital scoliosis.

Purpose: To provide the reader with a comprehensive but concise understanding of congenital scoliosis METHODS: We have undertaken to summarize available literature on the pathophysiology, epidemiology, and management of congenital scoliosis.

Results: Congenital scoliosis represents 10% of pediatric spine deformity and is a developmental error in segmentation, formation, or a combination of both leading to curvature of the spine. Treatment options are complicated by balancing growth potential with curve severity.

Secondary overtriage of pediatric neurosurgical trauma at a Level I pediatric trauma center.

The authors looked at all of the pediatric patients with a head injury who were transferred from other hospitals to their own over 12 years and tried to identify factors that would allow patients to stay closer to home at their local hospitals and not be transferred. Many patients with isolated, nondisplaced skull fractures or negative CT imaging likely could have avoided transfer. While hospitals should be cautious, this may help families stay closer to home.

Evaluation and management of adolescent idiopathic scoliosis: a review.

Adolescent idiopathic scoliosis (AIS) is a 3D spinal deformity affecting children between the ages of 11 and 18, without an identifiable etiology. The authors here reviewed the available literature to provide spine surgeons with a summary and update on current management options. Smaller thoracic and thoracolumbar curves can be managed conservatively with observation or bracing, but corrective surgery may be indicated for rapidly growing or larger curves.

The Role of Age and Initial Deformation on Final Cranial Asymmetry in Infants with Plagiocephaly Treated with Helmet Therapy.

Background/aims: To characterize the impact of cranial asymmetry and age at initiation of therapy on final cranial asymmetry in infants with deformational plagiocephaly treated with helmet orthotics.

Methods: We conducted a single-center retrospective review of 45 pediatric patients <12 months of age with deformational plagiocephaly who underwent STARband cranial orthotic helmet treatment. Cranial asymmetry was measured using a 3-dimensional laser surface scanner and defined as a cranial vault asymmetry index (CVAI) >3.

Factors associated with spinal fusion after posterior fossa decompression in pediatric patients with Chiari I malformation and scoliosis.

OBJECTIVE The authors performed a study to identify clinical characteristics of pediatric patients diagnosed with Chiari I malformation and scoliosis associated with a need for spinal fusion after posterior fossa decompression when managing the scoliotic curve. METHODS The authors conducted a multicenter retrospective review of 44 patients, aged 18 years or younger, diagnosed with Chiari I malformation and scoliosis who underwent posterior fossa decompression from 2000 to 2010. The outcome of interest was the need for spinal fusion after decompression.

Mycobacterial Osteomyelitis of the Spine Following Intravesical BCG Therapy for Bladder Cancer.

Osteomyelitis is an infection of the bone that can involve the vertebral column. A rare cause of vertebral osteomyelitis is Mycobacterium bovis after intravesical Bacillus Calmette-Guerin (BCG) therapy for transitional cell carcinoma of the bladder. In this report, we describe the case of a 64-year-old male presenting with constitutional symptoms, progressive thoracic kyphosis, and intractable T11 and T12 radiculopathies over the proceeding six months.