Anxious/depressed individuals exhibit disrupted frontotemporal synchrony during cognitive conflict encoding.

Anxiety and depressive disorders are associated with cognitive control deficits, yet their underlying neural mechanisms remain poorly understood. Here, we used high-resolution stereotactic EEG (sEEG) to determine how anxiety and/or depression modulates neural and behavioral responses when cognitive control is engaged in individuals with medically refractory epilepsy undergoing sEEG monitoring for surgical evaluation. We analyzed sEEG data recorded from frontotemporal regions of 29 participants (age range: 19-55, mean age: 35.

Neuronavigation-Specific Parameters for Selective Access of Trigeminal Rootlets in Radiofrequency Lesioning: A Cadaveric Morphometric Study.

Background And Objective: Radiofrequency lesioning (RFL) is a safe and effective treatment for medically refractory trigeminal neuralgia. Despite gaining mainstream neurosurgical acceptance in the 1970s, the technique has remained relatively unchanged, with the majority of series using lateral fluoroscopy over neuronavigation for cannula guidance. To date, there are no studies describing neuronavigation-specific parameters to help neurosurgeons selectively target individual trigeminal rootlets.

Novel System of Simulation Models for Aneurysm Clipping Training: Description of Models and Assessment of Face, Content, and Construct Validity.

Background: Aneurysm clipping simulation models are needed to provide tactile feedback of biological vessels in a nonhazardous but surgically relevant environment.

Objective: To describe a novel system of simulation models for aneurysm clipping training and assess its validity.

Methods: Craniotomy models were fabricated to mimic actual tissues and movement restrictions experienced during actual surgery.

Posterior interhemispheric occipital transtentorial approach for resection of a falcotentorial meningioma.

Falcotentorial meningiomas arise along the junction of the falx cerebri and the tentorium cerebelli. The authors present a woman in her 60s with an incidentally discovered falcotentorial meningioma, approximately 3 cm in diameter, resected with a torcular craniotomy and posterior interhemispheric approach. The galenic complex was dissected away from the tumor.

Hospital use following anterior cervical discectomy and fusion.

Most existing anterior cervical discectomy and fusion (ACDF) outcome studies omit emergency department (ED) use. To our knowledge, this study on ED use following ACDF surgery is the first to use a direct patient chart review and the first to include revision patients, 1-5 levels of ACDFs, and performance of corpectomy in the analysis. This study examines the frequency and basis of hospital service use within 30 days of ACDF surgery, specifically ED visits, hospital readmissions, and returns to the operating room.

Postoperative 30-day emergency department utilization after 7294 cranial neurosurgery procedures at a tertiary neuroscience center.

Objective: Hospital readmission and the reduction thereof has become a major quality improvement initiative in organized medicine and neurosurgery. However, little research has been performed on why neurosurgical patients utilize hospital emergency rooms (ERs) with or without subsequent admission in the postoperative setting.

Methods: This study was a retrospective, single-center review of data for all surgical cranial procedures performed from July 2013 to July 2016 in patients who survived to discharge.

Neurosurgical Management of Cancer Facial Pain.

Facial pain occurs in approximately 80% of patients with head and neck cancers. Pain in these settings may result directly from the tumor, or indirectly as a side effect of oncological treatment of the tumor. Optimizing treatment for cancer pain of the face, therefore, involves a variety of diagnostic and treatment considerations, with the development of a successful treatment algorithm dependent on accurate diagnosis of the anatomical location of the pain, its relationship to the facial pain pathway, the type of pain being treated and, finally, patient's prognosis and preference for treatment modality.

Laparoscopic-Assisted Ventriculoperitoneal Shunt Placement and Reduction in Operative Time and Total Hospital Charges.

Objective: In ventriculoperitoneal shunt (VPS) placement, distal placement of the peritoneal catheter will typically be performed by a neurosurgeon. More recently, laparoscopic-assisted (LA) placement of the distal peritoneal catheter by general surgeons has become common. The present study examined whether LA placement of a VPS (LAVPS) is associated with a reduced operative time, lower hospital costs, and fewer distal revisions.

Accuracy in Deep Brain Stimulation Electrode Placement: A Single-Surgeon Retrospective Analysis of Sterotactic Error in Overlapping and Non-Overlapping Surgical Cases.

Background: Many surgeons utilize assistants to perform procedures in more than one operating room at a given time using a practice known as overlapping surgery. Debate has continued as to whether overlapping surgery improves the efficiency and access to care or risks patient safety and outcomes.

Objective: To examine effects of overlapping surgery in deep brain stimulation (DBS) for movement disorders.

Proposal and Validation of a Simple Grading Scale (TRANSSPHER Grade) for Predicting Gross Total Resection of Nonfunctioning Pituitary Macroadenomas After Transsphenoidal Surgery.

Background: A simple, reliable grading scale to better characterize nonfunctioning pituitary adenomas (NFPAs) preoperatively has potential for research and clinical applications.

Objective: To develop a grading scale from a prospective multicenter cohort of patients that accurately and reliably predicts the likelihood of gross total resection (GTR) after transsphenoidal NFPA surgery.

Methods: Extent-of-resection (EOR) data from a prospective multicenter study in transsphenoidal NFPA surgery were analyzed (TRANSSPHER study; ClinicalTrials.

Cost Transparency in Neurosurgery: A Single-Institution Analysis of Patient Out-of-Pocket Spending in 13 673 Consecutive Neurosurgery Cases.

Background: Patient out-of-pocket (OOP) spending is an increasingly discussed topic; however, there is minimal data available on the patient financial burden of surgical procedures.

Objective: To analyze hospital and surgeon expected payment data and patient OOP spending in neurosurgery.

Methods: This is a retrospective cohort study of neurosurgical patients at a tertiary-referral center from 2013 to 2016.

Patient out-of-pocket spending in cranial neurosurgery: single-institution analysis of 6569 consecutive cases and literature review.

OBJECTIVE With drastic changes to the health insurance market, patient cost sharing has significantly increased in recent years. However, the patient financial burden, or out-of-pocket (OOP) costs, for surgical procedures is poorly understood. The goal of this study was to analyze patient OOP spending in cranial neurosurgery and identify drivers of OOP spending growth.

Analysis of overlapping surgery in patients undergoing microsurgical aneurysm clipping: acute and long-term outcomes from the Barrow Ruptured Aneurysm Trial.

OBJECTIVE Overlapping surgery is a controversial subject in medicine today; however, few studies have examined the outcomes of this practice. The authors analyzed outcomes of patients with acutely ruptured saccular aneurysms who were treated with microsurgical clipping in a prospectively collected database from the Barrow Ruptured Aneurysm Trial. Acute and long-term outcomes for overlapping versus nonoverlapping cases were compared.

Overlapping Surgeries Are Not Associated With Worse Patient Outcomes: Retrospective Multivariate Analysis of 14 872 Neurosurgical Cases Performed at a Single Institution.

Background: Overlapping surgeries have recently become a controversial topic.

Objective: To evaluate the effect of overlapping surgeries on patient outcomes.

Methods: A retrospective analysis of all neurosurgical procedures performed at a single institution from July 2013 to May 2016 was conducted.

Rater Reliability of the Hardy Classification for Pituitary Adenomas in the Magnetic Resonance Imaging Era.

 The Hardy classification is used to classify pituitary tumors for clinical and research purposes. The scale was developed using lateral skull radiographs and encephalograms, and its reliability has not been evaluated in the magnetic resonance imaging (MRI) era.  Fifty preoperative MRI scans of biopsy-proven pituitary adenomas using the sellar invasion and suprasellar extension components of the Hardy scale were reviewed.

Interrater and intrarater reliability of the Knosp scale for pituitary adenoma grading.

OBJECTIVE The goal of this study was to determine the interrater and intrarater reliability of the Knosp grading scale for predicting pituitary adenoma cavernous sinus (CS) involvement. METHODS Six independent raters (3 neurosurgery residents, 2 pituitary surgeons, and 1 neuroradiologist) participated in the study. Each rater scored 50 unique pituitary MRI scans (with contrast) of biopsy-proven pituitary adenoma.

Human substantia nigra neurons encode decision outcome and are modulated by categorization uncertainty in an auditory categorization task.

The ability to categorize stimuli - predator or prey, friend or foe - is an essential feature of the decision-making process. Underlying that ability is the development of an internally generated category boundary to generate decision outcomes. While classic temporal difference reinforcement models assume midbrain dopaminergic neurons underlie the prediction error required to learn boundary location, these neurons also demonstrate a robust response to nonreward incentive stimuli.

Radiation Necrosis Secondary to Trigeminal Nerve TomoTherapy: A Cautionary Case Study.

New radiation delivery modalities have recently challenged Gamma Knife surgery as the historic gold standard in the treatment of trigeminal neuralgia (TN). TomoTherapy, a relative newcomer, has been approved by the U.S.

Disparities in access to deep brain stimulation surgery for Parkinson disease: interaction between African American race and Medicaid use.

Importance: African American individuals experience barriers to accessing many types of health care in the United States, resulting in substantial health care disparities. To improve health care in this patient population, it is important to recognize and study the potential factors limiting access to care.

Objective: To examine deep brain stimulation (DBS) use in Parkinson disease (PD) to determine which factors, among a variety of demographic, clinical, and socioeconomic variables, drive DBS use in the United States.

Features and timing of the response of single neurons to novelty in the substantia nigra.

Substantia nigra neurons are known to play a key role in normal cognitive processes and disease states. While animal models and neuroimaging studies link dopamine neurons to novelty detection, this has not been demonstrated electrophysiologically in humans. We used single neuron extracellular recordings in awake human subjects undergoing surgery for Parkinson disease to characterize the features and timing of this response in the substantia nigra.

Unchanged safety outcomes in deep brain stimulation surgery for Parkinson disease despite a decentralization of care.

Object: Early work on deep brain stimulation (DBS) surgery, when procedures were mostly carried out in a small number of high-volume centers, demonstrated a relationship between surgical volume and procedural safety. However, over the past decade, DBS has become more widely available in the community rather than solely at academic medical centers. The authors examined the Nationwide Inpatient Sample (NIS) to study the safety of DBS surgery for Parkinson disease (PD) in association with this change in practice patterns.

Inferior short-term safety profile of endoscopic third ventriculostomy compared with ventriculoperitoneal shunt placement for idiopathic normal-pressure hydrocephalus: a population-based study.

Background: In small series, endoscopic third ventriculostomy (ETV) has been shown to potentially have efficacy similar to that of ventriculoperitoneal shunting (VPS) for idiopathic normal-pressure hydrocephalus (iNPH). Therefore, some clinicians have advocated for ETV to avoid the potential long-term complications associated with VPS. Complication rates for these procedures vary widely based on limited small series data.