Intraoperative venous air embolism during endoscopic transsphenoidal surgery: recommendations for management. Illustrative case.

Background: Venous air embolism (VAE) is a rare neurosurgical complication that occurs when air is trapped in a large, exposed vein and there is a pressure gradient that drives the air embolus from the surgical site to the right heart. This case highlights the identification and management of intraoperative VAE during transsphenoidal surgery. Additional discussion is provided on pathophysiology and best practices for reducing risk of occurrence.

Clinical and radiographic presentation and surgical outcomes of TPIT+ silent corticotroph pituitary neuroendocrine tumors: a multi-institutional experience and review of the literature.

Background: Accurate lineage identification of pituitary neuroendocrine tumors (PitNETs) is critical to inform our understanding of tumor biology and aggressiveness. While this was previously performed using immunohistochemistry for anterior pituitary hormones, the recent WHO update using lineage specific transcription factors (PIT-1, SF-1, TPIT) has led to improved classification of PitNETs. Although the identification of TPIT, a T-box pituitary transcription factor, has afforded improved classification of corticotroph PitNETs from what were previously thought to be null cell adenomas, the standardization of lineage specific transcription factor staining has yet to be fully adopted and as a result the clinical aggressivness and outcomes of these newly classified silent TPIT+ PitNETs has yet to be fully described.

Volume-staged versus dose-staged stereotactic radiosurgery, with or without embolization, in the treatment of large brain arteriovenous malformations: A systematic review and meta-analysis.

Background And Objective: While safe and effective modalities exist to treat small arteriovenous malformations (AVMs), large (>10 cm) AVMs remain difficult to cure via surgical or endovascular means. Staged stereotactic radiosurgery (SRS), either volume-staged (VS) or dose-staged (DS), has been proposed for large AVMs. The relative efficacy of these two strategies, with or without endovascular embolization, is unclear.

Pediatric Orbital and Skull Base Pathology.

Pediatric orbital and skull base pathologies encompass a spectrum of inflammatory, sporadic, syndromic, and neoplastic processes that require a broad and complex clinical approach for both medical and surgical treatment. Given their complexity and often multicompartment involvement, a multidisciplinary approach for diagnosis, patient and family counseling, and ultimately treatment provides the best patient satisfaction and clinical outcomes. Advances in minimally invasive surgical approaches, including endoscopic endonasal and transorbital approaches allows for more targeted surgical approaches through smaller corridors beyond more classic transcranial or transracial approaches.

The Impact of Obstructive Sleep Apnea on Clinical, Perioperative, and Cost Outcomes in Patients Who Underwent Posterior Cervical Decompression and Fusion: A Single-Center Retrospective Analysis From 2008 to 2016.

Background: Obstructive sleep apnea (OSA) is a pervasive problem that can result in diminished neurocognitive performance, increased risk of all-cause mortality, and significant cardiovascular disease. While previous studies have examined risk factors that influence outcomes following cervical fusion procedures, to our knowledge, no study has examined the cost or outcome profiles for posterior cervical decompression and fusion (PCDF) procedures in patients with OSA.

Methods: All cases at a single institution between 2008 and 2016 involving a PCDF were included.

Clinical Utility of Routine Postprocedural Computed Tomography of the Head Following Elective Neuroendovascular Interventions.

Background: Little evidence supports acquisition of routine head imaging after uncomplicated elective neurosurgical procedures for patients with unchanged neurological examinations; however, imaging is still performed by some neurointerventionalists. We assessed the clinical utility of routine computed tomography of the head (CTH) following elective neuroendovascular interventions, including aneurysm coiling, aneurysm stent-assisted coiling, aneurysm flow diversion, arteriovenous malformation/fistula embolization, middle meningeal artery embolization for subdural hematoma, extracranial carotid artery stenting, and venous sinus stenting.

Methods: Retrospective chart review identified patients undergoing neuroendovascular intervention from 2011 to 2021 at our institution.

De novo epilepsy after microsurgical resection of brain arteriovenous malformations.

Objective: Seizures are the second most common presenting symptom of brain arteriovenous malformations (bAVMs) after hemorrhage. Risk factors for preoperative seizures and subsequent seizure control outcomes have been well studied. There is a paucity of literature on postoperative, de novo seizures in initially seizure-naïve patients who undergo resection.

Frailty Predicts Postoperative Functional Outcomes After Microsurgical Resection of Ruptured Brain Arteriovenous Malformations in Older Patients.

Objective: To determine the effectiveness of the modified Frailty Index-5 (mFI-5) in predicting postoperative functional outcome after microsurgical resection of ruptured brain arteriovenous malformations (bAVMs).

Methods: A retrospective review was performed of patients undergoing microsurgical resection of acutely ruptured bAVMs. Demographics, bAVM characteristics, mFI-5, Ruptured Arteriovenous Malformation Grading Scale (RAGS) score, and Spetzler-Martin (S-M) grade were recorded.

Delayed Auditory Feedback Elicits Specific Patterns of Serial Order Errors in a Paced Syllable Sequence Production Task.

Purpose: Delayed auditory feedback (DAF) interferes with speech output. DAF causes distorted and disfluent productions and errors in the serial order of produced sounds. Although DAF has been studied extensively, the specific patterns of elicited speech errors are somewhat obscured by relatively small speech samples, differences across studies, and uncontrolled variables.

Bilateral Endoscopic Intracerebral Hemorrhage Evacuations at Two Separate Time Points: A Case Report.

In this case report, we describe bilateral endoscopic intracerebral hemorrhage (ICH) evacuations in patients presenting on temporally distinct occasions with separate, contralateral lesions. Two patients presented with spontaneous right-sided ICH and underwent endoscopic evacuations. Both patients achieved some degree of functional improvement postoperatively.

Complications associated with early cranioplasty for patients with traumatic brain injury: a 25-year single-center analysis.

Objective: Cranioplasty is a technically simple procedure, although one with potentially high rates of complications. The ideal timing of cranioplasty should minimize the risk of complications, but research investigating cranioplasty timing and risk of complications has generated diverse findings. Previous studies have included mixed populations of patients undergoing cranioplasty following decompression for traumatic, vascular, and other cerebral insults, making results challenging to interpret.

Time to Evacuation and Functional Outcome After Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation.

Background And Purpose: We present a retrospective analysis of patients who underwent minimally invasive endoscopic intracerebral hemorrhage (ICH) evacuation to identify variables that were associated with long-term outcome.

Methods: Minimally invasive endoscopic ICH evacuation was performed on patients with supratentorial ICH who fit prespecified clinical inclusion and exclusion criteria. Demographic, clinical, and radiographic factors previously demonstrated to impact functional outcome in ICH were included in a univariate analysis to identify factors associated with favorable outcome (modified Rankin Scale score, 0-3) at 6 months.

A Systematic Review and Meta-Analysis of Statins in Animal Models of Intracerebral Hemorrhage.

Background: Intracerebral hemorrhage (ICH) is a severe form of stroke with limited treatment options. Statins have shown promise as a therapy for ICH in animal and human studies. We systematically reviewed and assessed the quality of preclinical studies exploring statin-use after ICH to guide clinical trial decision-making and design.

Impact of surgeon rhBMP-2 cost awareness on complication rates and health system costs for spinal arthrodesis.

Objective: Recombinant human bone morphogenetic protein-2 (rhBMP-2) is used in spinal arthrodesis procedures to enhance bony fusion. Research has suggested that it is the most cost-effective fusion enhancer, but there are significant upfront costs for the healthcare system. The primary objective of this study was to determine whether intraoperative dosing and corresponding costs changed with surgeon cost awareness.

Functional Outcome After Minimally Invasive Endoscopic Evacuation of Thalamic Intracerebral Hemorrhage.

Background: Intracerebral hemorrhage (ICH) is the most devastating form of stroke, with thalamic hemorrhages carrying the worst outcomes. Minimally invasive (MIS) endoscopic ICH evacuation is a promising new therapy for the condition. However, it remains unclear whether therapy success is location dependent.

Interhospital Transfer of Intracerebral Hemorrhage Patients Undergoing Minimally Invasive Surgery: The Experience of a New York City Hospital System.

Objective: The impact of interhospital transfer (IHT) on outcomes of patients with intracerebral hemorrhage (ICH) has not been well studied. We seek to describe the protocolized IHT and systems of care approach of a New York City hospital system, where ICH patients undergoing minimally invasive surgery (MIS) are transferred to a dedicated ICH center.

Methods: We retrospectively reviewed 100 consecutively admitted patients with spontaneous ICH.

Application of Cooperative Game Theory Principles to Interpret Machine Learning Models of Nonhome Discharge Following Spine Surgery.

Study Design: Retrospective analysis of prospectively acquired data.

Objective: The aim of this study was to identify interaction effects that modulate nonhome discharge (NHD) risk by applying coalitional game theory principles to interpret machine learning models and understand variable interaction effects underlying NHD risk.

Summary Of Background Data: NHD may predispose patients to adverse outcomes during their care.

Surgical versus conservative treatment of unilateral subaxial non-subluxed facet fractures: A systematic review and meta-analysis.

Background And Objective: Unilateral subaxial non-subluxed facet fractures (USNSFF) are a pathology seen in traumatic events such as motor vehicle accidents. Management involves either rigid collar bracing or surgical intervention. There currently is no consensus on the treatment of these injuries; this review aims to examine the extant data for recommendations as to which treatment is more effective.

Assessing the Impact of Neurogenic Claudication on Outcomes Following Decompression With Lumbar Interbody Fusions in Patients With Lumbar Spinal Stenosis.

Study Design: Retrospective cohort study.

Objectives: To conduct the first comprehensive national-level study examining specific risks, outcomes, and costs surrounding surgical treatment of lumar spinal stenosis (LSS) in patients with and without neurogenic claudication (NC).

Methods: Data for patients with or without NC who underwent decompression with a lumbar interbody fusion approached anteriorly (ALIF), posteriorly (PLIF), or laterally (LLIF) for LSS was collected from the 2013-2014 National Inpatient Sample using International Classification of Disease codes.

Postoperative outcomes following glioblastoma resection using a robot-assisted digital surgical exoscope: a case series.

Introduction: Maximal extent of resection (EOR) of glioblastoma (GBM) is associated with greater progression free survival (PFS) and improved patient outcomes. Recently, a novel surgical system has been developed that includes a 2D, robotically-controlled exoscope and brain tractography display. The purpose of this study was to assess outcomes in a series of patients with GBM undergoing resections using this surgical exoscope.

Increased Risk of Transient Cerebral Ischemia After Subarachnoid Hemorrhage in Patients with Premorbid Opioid Use Disorders: A Nationwide Analysis of Outcomes.

Background: Subarachnoid hemorrhage (SAH) is the most morbid sequela of intracranial aneurysms. Although mortality from SAH has been declining, opioid use in the United States has surged, and neurosurgeons are increasingly tasked with operating on patients with opioid use disorders (OUDs). There is a deficit in the literature regarding how OUDs affect SAH outcomes, particularly transient cerebral ischemic (TCI) events.

Machine Learning With Feature Domains Elucidates Candidate Drivers of Hospital Readmission Following Spine Surgery in a Large Single-Center Patient Cohort.

Background: Unplanned hospital readmissions constitute a significant cost burden in healthcare. Identifying factors contributing to readmission risk presents opportunities for actionable change to reduce readmission rates.

Objective: To combine machine learning classification and feature importance analysis to identify drivers of readmission in a large cohort of spine patients.

Later Surgical Start Time Is Associated With Longer Length of Stay and Higher Cost in Cervical Spine Surgery.

Study Design: Retrospective study of a surgical cohort from a single, large academic institution.

Objective: The aim of this study was to investigate associations between surgical start time, length of stay, cost, perioperative outcomes, and readmission.

Summary Of Background Data: One retrospective study with a smaller cohort investigated associations between surgical start time and outcomes in spine surgery and found that early start times were correlated with shorter length of stay.