Stereotactic radiosurgery for fourth ventricle brain metastases: tumor control outcomes and the need for CSF diversion. Patient series.

Background: Stereotactic radiosurgery is a favorable alternative to surgery for intracranial cerebral metastases. Fourth ventricle (V4) metastases are challenging because of the location and surrounding structures, with a high risk for obstructive hydrocephalus and brainstem compression. Here, the authors evaluate the effectiveness in terms of safety, tumor control rates, and permanent cerebrospinal fluid (CSF) diversion of primary Gamma Knife radiosurgery (GKRS) in treating V4 metastases.

Differences in Surgical Cancer Care Delivery and Outcomes Between Safety-Net and Non-Safety-Net Hospitals in the United States: A Comprehensive Systematic Review.

Background: Studies evaluating the association of safety-net hospitals (SNHs) with outcomes of surgical care in cancer patients have demonstrated mixed results. We sought to systematically investigate the association of SNH status with measures of surgical cancer care delivery and outcomes.

Methods: A comprehensive review of the literature identified from the MEDLINE/PubMed, Embase, Web of Science, and Cochrane databases was performed according to the PRISMA guidelines.

Procedural volume is linearly associated with mortality, major complications, and readmissions in patients undergoing malignant brain tumor resection.

Purpose: Improved outcomes have been noted in patients undergoing malignant brain tumor resection at high-volume centers. Studies have arbitrarily chosen high-volume dichotomous cutoffs and have not evaluated volume-outcome associations at specific institutional procedural volumes. We sought to establish the continuous association of volume with patient outcomes and identify cutoffs significantly associated with mortality, major complications, and readmissions.

CRISPRi screen of long non-coding RNAs identifies LINC03045 regulating glioblastoma invasion.

Introduction: Glioblastoma (GBM) invasion studies have focused on coding genes, while few studies evaluate long non-coding RNAs (lncRNAs), transcripts without protein-coding potential, for role in GBM invasion. We leveraged CRISPR-interference (CRISPRi) to evaluate invasive function of GBM-associated lncRNAs in an unbiased functional screen, characterizing and exploring the mechanism of identified candidates.

Methods: We implemented a CRISPRi lncRNA loss-of-function screen evaluating association of lncRNA knockdown (KD) with invasion capacity in Matrigel.

Optimizing the Postoperative Management of Children Undergoing Resection of High-Risk Abdominal Neuroblastoma.

Background: Surgical resection is a mainstay of treatment in high-risk neuroblastoma (HR-NB), but there exists wide variability in perioperative management practices. The aim of this study was to evaluate two standardized adult perioperative enhanced recovery practices (ERPs) in pediatric patients undergoing open resection of abdominal HR-NB.

Methods: All patients with abdominal HR-NB surgically resected at a free-standing children's hospital between 12/2010 and 7/2020 were retrospectively reviewed.

Association of carotid endarterectomy at low-volume centers with higher likelihood of major complications and nonroutine discharge.

Objective: Carotid artery stenosis (CAS) is associated with an annual stroke risk of 2%-5%, and revascularization with carotid endarterectomy (CEA) can reduce this risk. While studies have demonstrated that hospital CEA volume is associated with mortality and myocardial infarction, CEA volume cutoffs in studies are relatively arbitrary, and no specific analyses on broad complications and discharge disposition have been performed. In this study, the authors systematically set out to identify a cutoff at which CEA procedural volume was significantly associated with major complications and nonroutine discharge.

Frailty is a Predictor of Increased Readmissions and Increased Postoperative Complications After Elective Treatment of Unruptured Aneurysms.

Introduction: Frailty is a state of decreased physiologic reserve associated with adverse treatment outcomes across surgical specialties. We sought to determine whether frailty affected patient outcomes after elective treatment (open microsurgical clipping or endovascular therapy [EVT]) of unruptured cerebral aneurysms (UCAs).

Methods: The National Readmissions Database was queried from 2010 to 2014 to identify patients who had a known UCA and underwent elective clipping or EVT.

Myelomeningocele repair at pediatric hospitals: association with routine discharge and shorter hospital stay.

Objective: Postnatal repair for myelomeningocele (MMC) is a time-sensitive and technically challenging procedure. More experienced hospitals may provide improved outcomes for the complexity of care associated with these patients. No prior study has investigated the impact of MMC treatment at pediatric hospitals.

Pediatric patients with malignant brain tumor treated at children's hospitals: association with fewer unplanned readmissions.

Objective: Pediatric primary brain tumors are the leading cause of death among childhood cancers. Guidelines recommend specialized care with a multidisciplinary team and focused treatment protocols to optimize outcomes in this patient population. Furthermore, readmission is a key metric of patient outcomes and has been used to inform reimbursement.

Carotid artery stenting for asymptomatic stenosis is associated with decreased 30-day readmission at very high volume centers.

Endovascular carotid artery stenting (CAS) is a common treatment for carotid artery stenosis and stroke prevention. Previous studies have shown that high procedural volume centers are associated with improved patient outcomes. Unplanned 30-day readmissions, which are associated with significant expenses, are increasingly used as a metric of patient outcome.

Trauma activation patient preinjury toxicology-positive proportions and associated risk conditions: A retrospective study.

Background: Unlike prior guidelines for a positive toxicology screen, the 2022 national trauma data bank dictionary requires the exclusion of postinjury drugs. We aimed to (1) investigate the proportion of drugs in the toxicology screen that were given postinjury; (2) determine preinjury toxicology-positive associations with smoking, psychiatric, and drug abuse histories in an activation patient (ACT-Pt) cohort; and (3) explore whether ACT-Pt varied toxicology testing rates would produce similar preinjury toxicology-positive results.

Methods: In this retrospective study, the historic parent database included consecutive trauma center admissions where toxicology testing was discretionary.

Establishing an open and robotic pancreatic surgery program in a level 1 trauma center community teaching hospital and comparing its outcomes to high-volume academic center outcomes: a retrospective review.

Background: The debate of whether to centralize hepato-pancreato-biliary surgery has been ongoing. The principal objective was to compare outcomes of a community pancreatic surgical program with those of high-volume academic centers.

Methods: The current pancreatic surgical study occurred in an environment where (1) a certified abdominal transplant surgeon performed all surgeries; (2) complementary quality enhancement programs had been developed; (3) the hospital's trauma center had been verified; and (4) the hospital's surgical training had been accredited.

Interhospital transfer of pediatric patients with malignant brain tumor not associated with increased mortality, but safe routine discharge.

Objective: Interhospital transfer (IHT) to obtain a higher level of care for pediatric patients requiring neurosurgical interventions is common. Pediatric patients with malignant brain tumors often require subspecialty care commonly provided at specialized centers. The authors aimed to assess the impact of IHT in pediatric neurosurgical patients with malignant brain tumors to identify areas of improvement in treatment of this patient population.

Racial, Ethnic, and Gender Variations in Sinonasal Anatomy.

Background: Complications during endoscopic sinus surgery often result from unfavorable anatomy. The prevalence rates of such anatomic findings vary tremendously in the literature, in part due to the small, homogenous populations previously studied.

Objective: To characterize the prevalence of sinonasal anatomic variants among ethnic groups and genders seen at an academic medical center.

Interhospital transfer of patients with malignant brain tumors undergoing resection is associated with routine discharge.

Introduction: Neurosurgical patients often undergo interhospital transfer (IHT) for specialized care. While IHT is often associated with worse outcomes in emergent neurosurgical conditions, less is known about patient outcomes after IHT for urgent diagnoses such as brain tumors. We sought to evaluate patient outcomes after IHT for malignant brain tumor resection.

Indication for en bloc pancreatectomy with colectomy: when is it safe?

Introduction: Aggressive en bloc resection of adjacent organs is often necessary to resect pancreatic or colonic lesions. However, it is debated whether simultaneous pancreatectomy with colectomy (P+C) is warranted as it potentially increases morbidity and mortality (MM). We hypothesized that MM would be increased in P+C, especially in cases of pancreatitis.