Endoscopic third ventriculostomy in hydrocephalus patients with functioning ventriculoperitoneal shunts: challenging the dictum that shunts treat all types of hydrocephalus. Patient series.

Background: Although ventriculoperitoneal shunting is standard for hydrocephalus, shunting may not be ideal for aqueductal stenosis. A cohort of patients with aqueductal stenosis displayed symptoms of over- and underdrainage, despite a patent ventriculoperitoneal shunt (VPS) and optimized valve settings. Endoscopic third ventriculostomies (ETVs) were performed in a subset of these patients with successful treatment of their underlying hydrocephalus, despite a functioning shunt.

Occipital-interhemispheric transtentorial pineal mass resection.

The occipital approach for pineal tumors was first described by James Poppen in 1966. Since then, it has been widely used for accessing deep-seated tumors as it offers a wider surgical view than the supracerebellar transtentorial approach. This video demonstrates the technical nuances of the occipital transtentorial approach and the exoscopic dissection of a pineal gland tumor in a 66-year-old male.

The Utility of the 5 Factor Modified Frailty Index in Outcome Prediction for Patients with Chronic Subdural Hematoma Treated with Surgical Drainage.

Objective: Increasing frailty is a significant determinant of perioperative morbidity and mortality within neurosurgical literature. This study investigates the predictive value of the modified frailty index 5 (mFI-5) for postoperative morbidity and mortality following surgical drainage of chronic subdural hematoma (cSDH).

Methods: A retrospective cohort study was performed on patients who underwent surgical evacuation of a cSDH.

Nontraumatic Neurosurgical Emergencies.

Most neurosurgical emergencies involve management of intracranial pressure, decompression of brain parenchyma, or diversion of cerebrospinal fluid. These interventions aim to prevent progression and reverse damage to neural structures. The pathologies that require emergent treatment either develop acutely or may progress over days until they reach a critical point causing decompensation.

The neurosurgical marriage: evaluating the interplay of work life and home life from the perspective of partners of neurosurgical residents.

Objective: Burnout and work-life balance have been noted to be problems for residents across all fields of medicine, including neurosurgery. No studies to date have evaluated how these factors may contribute to issues outside of the hospital, specifically residents' home lives. This study aimed to evaluate the interplay between home life and work life of neurosurgical residents, specifically from the point of view of residents' significant others.

Real-time vessel segmentation and reconstruction for virtual fixtures for an active handheld microneurosurgical instrument.

Purpose: Complications related to vascular damage such as intra-operative bleeding may be avoided during neurosurgical procedures such as petroclival meningioma surgery. To address this and improve the patient's safety, we designed a real-time blood vessel avoidance strategy that enables operation on deformable tissue during petroclival meningioma surgery using Micron, a handheld surgical robotic tool.

Methods: We integrated real-time intra-operative blood vessel segmentation of brain vasculature using deep learning, with a 3D reconstruction algorithm to obtain the vessel point cloud in real time.

A Rare Third Ventricular Dermoid Cyst in an Adult With Imaging Characteristics Consistent With a Colloid Cyst.

A 64-year-old male presented with spontaneous intracerebral hemorrhage and obstructive hydrocephalus without evidence of a third ventricular mass in 2019. The patient was lost to follow-up and re-admitted one year later for hydrocephalus secondary to a third ventricular mass. Imaging characteristics were consistent with a colloid cyst, which was the presumptive diagnosis.

Single Fraction Frameless Stereotactic Radiosurgery on the Gamma Knife Icon for Patients With Brain Metastases: Time to Abandon the Frame?

Purpose: The latest version of the Gamma Knife, the Icon, allows for immobilization with a mask in lieu of the traditional frame during stereotactic radiosurgery. There have been some concerns regarding extent of immobilization during single fraction frameless treatment and potential effect on outcomes. As such, we reviewed outcomes in patients with brain metastases treated in a single fraction using either a frame or mask on the Gamma Knife Icon at our institution.

It's not always the shunt: Microthombi formation in venous collaterals causing symptoms of shunt failure in the setting of shunted hydrocephalus.

We present a patient with a history of shunted hydrocephalus due to neonatal iatrogenic thoracic venous occlusion with subsequent interval development of spontaneous thoracic venous collateral occlusion as a young adult presenting with symptoms of ventriculoperitoneal shunt failure. Though the patient's presenting symptoms were suggestive of shunt failure in the setting of known shunt dependent hydrocephalus, specific ophthalmologic findings, including venous engorgement, retinal and subconjunctival hemorrhages as well as periorbital edema in conjunction with papilledema, led to the correct diagnosis of cranio-orbital congestion secondary to microthrombi formation in the venous collateral anomalies of her chest wall. This pathology was successfully managed with warfarin.

A Deep Learning Model for Automated Classification of Intraoperative Continuous EMG.

Objective: Intraoperative neurophysiological monitoring (IONM) is the use of electrophysiological methods during certain high-risk surgeries to assess the functional integrity of nerves in real time and alert the surgeon to prevent damage. However, the efficiency of IONM in current practice is limited by latency of verbal communications, inter-rater variability, and the subjective manner in which electrophysiological signals are described.

Methods: In an attempt to address these shortcomings, we investigate automated classification of free-running electromyogram (EMG) waveforms during IONM.

Impact of Coronavirus Disease 2019 Shutdown on Neurotrauma Volume in Pennsylvania.

Objective: The 2020 coronavirus disease 2019 (COVID-19) pandemic resulted in state-specific quarantine protocols and introduced the concept of social distancing into modern parlance. We assess the impact of the COVID-19 pandemic on neurotrauma presentations in the first 3 months after shutdown throughout Pennsylvania.

Methods: The Pennsylvania Trauma Systems Foundation was queried for registry data from the Pennsylvania Trauma Outcomes Study between March 12 and June 5 in each year from 2017 to 2020.

Medicine and surgery residents' perspectives on the impact of COVID-19 on graduate medical education.

The COVID-19 crisis has had an unprecedented impact on resident education and well-being: social distancing guidelines have limited patient volumes and forced virtual learning, while personal protective equipment (PPE) shortages, school/daycare closures, and visa restrictions have served as additional stressors. Our study aimed to analyze the effects of COVID-19 crisis-related stressors on residents' professional and personal lives. In April 2020, we administered a survey to residents at a large academic hospital system in order to assess the impact of the pandemic on residency training after >6 weeks of a modified schedule.

An anatomical study of the foramen of Monro: implications in management of pineal tumors presenting with hydrocephalus.

Background: For pineal tumors presenting with hydrocephalus, simultaneous endoscopic third ventriculostomy (ETV) and tumor biopsy is commonly used as the initial step in management. To analyze the restriction which the foramen of Monro poses to this procedure, one must start with a detailed description of the microsurgical anatomy of the foramen in living subjects. However, the orientation and shape of the foramen of Monro make this description difficult with conventional imaging techniques.

Iron Oxide Nanoparticles with Grafted Polymeric Analogue of Dimethyl Sulfoxide as Potential Magnetic Resonance Imaging Contrast Agents.

Novel water-dispersible hybrid iron oxide nanoparticles grafted with a polymeric analogue of dimethyl sulfoxide (DMSO) were prepared. Superparamagnetic iron oxide nanoparticles with immobilized atom-transfer radical polymerization (ATRP) initiators were prepared via an in situ method using 12-(2-bromoisobutyramido)dodecanoic acid as a surface ligand/initiator. The initiator-functionalized particles were employed in a surface-initiated initiator for continuous activator regeneration ATRP to graft poly(2-(methylsulfinyl)ethyl acrylate) (a polyacrylate analogue of DMSO) from the surface.

Spontaneous intraventricular rupture of a craniopharyngioma cyst: A case report.

Intraventricular rupture of craniopharyngioma cysts is an unusual event which is associated with a high risk of loculated or communicating hydrocephalus. A 75-year-old woman presented at the Emergency Department of our hospital with mental status deterioration due to chemical ventriculitis and acute hydrocephalus following the intraventricular rupture of a craniopharyngioma cyst. The patient was treated with stress-dose steroid therapy.

Case Report of a Primary Pituitary Abscess and Systematic Literature Review of Pituitary Abscess with a Focus on Patient Outcomes.

Background: Pituitary abscess is a rare but potentially life-threatening condition with an incidence of 0.2%-1.1% of operative pituitary lesions.

Use of the Swiveling Technique for Endoscopic Removal of a Colloid Cyst of the Third Ventricle: A Technical Note.

Colloid cysts are considered benign brain tumors and usually occur in the anterior third ventricle. The clinical presentation may be nonspecific and heterogeneous including headaches, visual changes, nausea, and vomiting. The symptomatology is frequently associated with the development of hydrocephalus.

Patient variables and referral paradigms associated with osteoporosis screening and treatment in neurosurgical patients undergoing kyphoplasty.

OBJECT Vertebral fractures are the most common osteoporotic fracture. Bone density testing and medical treatment with bisphosphonates or parathormone are recommended for all patients with an osteoporotic fracture diagnosis. Inadequate testing and treatment of patients presenting with low-impact fractures have been reported in various specialties.

Endoscopic Third Ventriculostomy in 250 Adults With Hydrocephalus: Patient Selection, Outcomes, and Complications.

Background: Endoscopic third ventriculostomy (ETV) has been used predominantly in the pediatric population in the past. Application in the adult population has been less extensive, even in large neurosurgical centers. To our knowledge, this report is one of the largest adult ETV series reported and has the consistency of being performed at 1 center.

Neuroimaging and the clinical manifestations of Chiari Malformation Type I (CMI).

Chiari malformation type I (CMI) involves the caudal displacement of the cerebellar tonsils through the foramen magnum with resultant brainstem compression in some individuals. Due to pathophysiologic changes, secondary conditions may arise, such as syringohydromyelia (SH) and scoliosis. This disorder is unique, as the diagnosis is confirmed through radiologic findings.

The Impact of Preoperative Angiographic Identification of the Artery of Adamkiewicz on Surgical Decision Making in Patients Undergoing Thoracolumbar Corpectomy.

Study Design: Retrospective study.

Objective: To investigate the impact of spinal angiography on selection of surgical side in patients undergoing thoracolumbar corpectomy.

Summary Of Background Data: The artery of Adamkiewicz provides the major blood supply to the thoracolumbar spinal cord.

Combined use of covered stent and flow diversion to seal iatrogenic carotid injury with vessel preservation during transsphenoidal endoscopic resection of clival tumor.

Background: Transsphenoidal tumor resection can lead to internal carotid artery (ICA) injury. Vascular disruption is often treated with emergent vessel deconstruction, incurring complications in a subset of patients with poor collateral circulation and resulting in minor and major ischemic strokes.

Methods: We attempted a novel approach combining a covered stent graft (Jostent) and two flow diverter stents [Pipeline embolization devices (PEDs)] to treat active extravasation from a disrupted right ICA that was the result of a transsphenoidal surgery complication.

Imaging of Chiari type I malformation and syringohydromyelia.

Chiari malformations are anatomic anomalies that comprise a broad spectrum of neurologic conditions. The most common malformation, a Chiari type I malformation, can present with a variety of signs and symptoms, most frequently an occipital Valsalva-induced headache. Cranial and spinal magnetic resonance (MR) imaging is used to identify the degree of tonsillar descent and document the presence of syringohydromyelia.

Prospective review of a single center's general pediatric neurosurgical intraoperative and postoperative complication rates.

Object: The authors conducted a study to compare the complication rate (CR) of pediatric neurosurgical procedures in a general neurosurgery department to the CRs that are reported in the literature and to establish a baseline of CR for further targeted improvement of quality neurosurgical care.

Methods: The authors analyzed the prospectively collected data from a complication registration of 1000 consecutive pediatric neurosurgical procedures in 581 patients from the beginning of the registration in January 2004 through August 2008. A pediatric neurosurgeon was involved in 50.