Seizure Detection and Lateralization Using Thalamic Deep Brain Stimulator Recordings.

The lack of reliable seizure detection remains a significant challenge for epilepsy care. A clinical deep brain stimulation (DBS) system provides constrained ambulatory brain recordings; however, limited data exist on the use of DBS recordings for seizure detection and lateralization. We present the case of an 18-year-old patient with drug-resistant focal epilepsy, who had seizure detection and lateralization by DBS recordings.

Intraoperative Electrical Stapedius Reflex Testing to Monitor Cochlear Nerve Integrity during Simultaneous Vestibular Schwannoma Resection and Cochlear Implantation.

Objective: To compare the utility of intraoperative electrically evoked auditory brainstem response (eABR) and electrically evoked stapedial reflex testing (eSRT) for cochlear nerve integrity monitoring during simultaneous translabyrinthine resection of vestibular schwannoma (VS) and cochlear implantation.

Study Design: Historical cohort study.

Setting: Tertiary academic referral center.

The Fate of the Frozen Bone Flap: Quantitative and Volumetric Assessment Following Cranioplasty Using the Autologous Bone Flap.

Objective: The pattern, rate, and natural history of bone flap resorption following cranioplasty with frozen, autologous bone flap has not been fully defined. The authors sought to quantify the progression and natural history of bone flap resorption.

Methods: Patients who had craniectomy and delayed cranioplasty with stored, frozen bone flap between 2012 and 2022 were included in this study.

Medially Migrating Vestibular Schwannomas: A Review of 10 Cases.

Objective: To analyze cases of medial migration of vestibular schwannomas to propose an underlying mechanism.

Study Design: Retrospective chart review.

Patients: Ten patients from one institution with sporadic vestibular schwannomas that demonstrated medial migration toward the cerebellopontine angle on serial imaging were reviewed.

Contrast Enhanced CISS/FIESTA Imaging for Increased Conspicuity of Pituitary Microadenomas in Cushing Disease.

Background And Purpose: Pituitary microadenomas can be challenging to see on MRI, particularly when they are small. The detection of microadenomas commonly relies on contrast-enhanced sequences, highlighting the adenoma that demonstrates hypoenhancement relative to the native pituitary on T1-weighted sequences. Detecting adenomas in patients with Cushing disease is crucial, as surgery is the standard of care treatment.

A Standardized Approach to MRI-Guided Stereotactic Laser Corpus Callosotomy: Technical Description and Pediatric Case Series.

Background And Objectives: Corpus callosotomy is an effective procedure approach for treating medication-resistant drop seizures, which pose a significant challenge in patients with epilepsy. Laser interstitial thermal therapy offers an alternative to open surgery for performing corpus callosotomy that may limit approach-related comorbidities. Practices vary regarding the number of laser filaments used and staging; outcome data for pediatric patients remain relatively limited.

Malignant Transformation of Previously Radiated Vestibular Schwannoma: Two-Dimensional Operative Video.

Malignant transformation of vestibular schwannomas (VSs), though rare, demands a comprehensive, multidisciplinary treatment approach to optimize patient outcomes. We present a rare case of malignant transformation in a VS after radiation treatment in a 58-year-old woman (Video 1). Initially diagnosed with a right cerebellopontine angle VS, the patient underwent CyberKnife (Accuray, Madison, Wisconsin, USA) treatment 16 years ago, receiving 18 Gy across 3 fractions.

Predictors of Durable Remission After Successful Surgery for Cushing Disease: Results From the Multicenter RAPID Registry.

Background And Objective: Cushing disease (CD) affects mortality and quality of life along with limited long-term remission, underscoring the need to better identify recurrence risk. The identification of surgical or imaging predictors for CD remission after transsphenoidal surgery has yielded some inconsistent results and has been limited by single-center, single-surgeon, or meta-analyses studies. We sought to evaluate the multicenter Registry of Adenomas of the Pituitary and Related Disorders (RAPID) database of academic US pituitary centers to assess whether robust nonhormonal recurrence predictors could be elucidated.

Case report: Bridging limbic network epilepsy with psychiatric, memory, and sleep comorbidities: case illustrations of reversible psychosis symptoms during continuous, high-frequency ANT-DBS.

The network nature of focal epilepsy is exemplified by mesial temporal lobe epilepsy (mTLE), characterized by focal seizures originating from the mesial temporal neocortex, amygdala, and hippocampus. The mTLE network hypothesis is evident in seizure semiology and interictal comorbidities, both reflecting limbic network dysfunction. The network generating seizures also supports essential physiological functions, including memory, emotion, mood, and sleep.

SupraPetrous InfraTemporal Approach: A Supplemental Approach to Supracerebellar Infratentorial for Inferior Amygdala and Hippocampal Head Access-A Cadaveric Study With Case Illustrations.

Background And Objectives: Access to the amygdala and hippocampus (A/H) is complex. To address the limitations and invasiveness of traditional approaches, including the Transsylvian, Subtemporal, and Supracerebellar infratentorial approaches, we developed the suprapetrous infratemporal (SPIT) approach. This study describes the nuances of this approach in both cadaveric studies and clinical cases.

Stereotactic depth electrode placement for chronic subthreshold cortical stimulation: surgical technique video.

Neurostimulation is an increasingly common treatment option for medically intractable epilepsy. SANTE (Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy) and Responsive Neurostimulation (RNS) System are landmark neurostimulation trials that utilized either duty cycle or a responsive stimulation paradigm. A seizure-free outcome is rarely observed with responsive and duty cycle neurostimulation devices.

A Cadaveric Feasibility Study of the Biportal Endoscopic Transfrontal Sinus Approach: A Minimally Invasive Approach to the Anterior Cranial Fossa.

Background And Objectives: The trans-sinus transglabellar and bifrontal approaches offer direct access to the anterior cranial fossa. However, these approaches present potential drawbacks. We propose the biportal endoscopic transfrontal sinus (BETS) approach, adapting endoscopic endonasal approach (EEA) techniques for minimally invasive access to the anterior fossa, reducing tissue manipulation, venous sacrifice, and brain retraction.

Improved quantification of tumor adhesion in meningiomas using MR elastography-based slip interface imaging.

Meningiomas, the most prevalent primary benign intracranial tumors, often exhibit complicated levels of adhesion to adjacent normal tissues, significantly influencing resection and causing postoperative complications. Surgery remains the primary therapeutic approach, and when combined with adjuvant radiotherapy, it effectively controls residual tumors and reduces tumor recurrence when complete removal may cause a neurologic deficit. Previous studies have indicated that slip interface imaging (SII) techniques based on MR elastography (MRE) have promise as a method for sensitively determining the presence of tumor-brain adhesion.

Multi-center study on sellar reconstruction after endoscopic transsphenoidal pituitary surgery.

Introduction: Surgical techniques for sellar reconstruction include no reconstruction, use of synthetic materials, autologous grafts, and/or vascularized flaps. The aim of this study was to conduct a multi-center study comparing the efficacy and postoperative morbidity associated with different sellar reconstruction techniques.

Methods: A retrospective chart review of patients who underwent endoscopic transsphenoidal surgery for pituitary tumors from five participating sites between January 2021 and March 2023 was performed.

Surgical treatment of cystic pituitary adenomas: literature-based definitions and postoperative outcomes.

Background And Objectives: To survey the applied definitions of 'cystic' among pituitary adenomas and evaluate whether postoperative outcomes differ relative to non-cystic counterparts.

Methods: A literature search and meta-analysis was performed using PRISMA guidelines. Studies were eligible if novel data were reported regarding the applied definition of 'cystic' and postoperative outcomes among cases of surgically treated pituitary adenomas.

The dynamic impact of location and resection on the glioma CSF proteome.

Unlabelled: While serial sampling of glioma tissue is rarely performed prior to recurrence, cerebrospinal fluid (CSF) is an underutilized longitudinal source of candidate glioma biomarkers for understanding therapeutic impacts. However, the impact of key variables to consider in longitudinal CSF samples, including anatomical location and post-surgical changes, remains unknown. To that end, pre- versus post-resection intracranial CSF samples were obtained at early (1-16 days; n=20) or delayed (86-153 days; n=11) timepoints for patients with glioma.

Skull Base CSF Leaks: Potential Underlying Pathophysiology and Evaluation of Brain MR Imaging Findings Associated with Spontaneous Intracranial Hypotension.

Background And Purpose: CSF leaks of the skull base and spine share a common process of CSF volume loss, and yet only the latter has been associated with spontaneous intracranial hypotension (SIH). Despite published claims that only spinal leaks cause SIH, no prior studies have evaluated brain MR imaging in patients with skull base leaks for findings associated with SIH, such as dural enhancement. The purpose of our study was to use a validated brain MR imaging scoring system to evaluate patients with skull base CSF leaks for findings associated with SIH.

Long-term outcome of primary clival chordomas: a single-center retrospective study with an emphasis on the timing of recurrences based on the primary treatment.

Objective: This study aimed to provide data on extended outcomes in primary clival chordomas, focusing on progression-free survival (PFS) and overall survival (OS).

Methods: A retrospective single-center analysis was conducted on patients with clival chordoma treated between 1987 and 2022 using surgery, stereotactic radiosurgery, or proton radiation therapy (PRT).

Results: The study included 100 patients (median age 44 years, 51% male).

Correlation of older age with better progression-free survival despite less aggressive resection in nonfunctioning pituitary adenomas.

Objective: Nonfunctioning pituitary adenomas (NFPAs) present at a wide range of ages; it is possible that variable outcomes are based on patient age at presentation. This study aimed to explore long-term outcomes of patients with NFPAs following endonasal transsphenoidal surgery (ETS), considering age stratification.

Methods: This retrospective study included 228 patients with NFPAs who underwent ETS, with a median follow-up period of 63 months.