Development of brain metastases in non-small-cell lung cancer: high-risk features.

Brain metastases (BM) are a common site of disease progression and treatment failure in non-small-cell lung cancer (NSCLC) and can be identified in up to 30-50% of patients. Although they are common, there is no standardized screening protocol for development of BM in NSCLC. Multiple clinical variables predict increased BM occurrence, and, when present, should be used to initiate screening MRI.

"Mail-slot" Technique for Minimally Invasive Placement of Subdural Grid Electrodes: A Single-institution Experience.

Background: In the management of multi-drug-resistant focal epilepsies, intracranial electrode implantation is used for precise localization of the ictal onset zone. In select patients, subdural grid electrode implantation is utilized. Subdural grid placement traditionally requires large craniotomies to visualize the cortex prior to mapping.

Microsurgical intraluminal obliteration of type IV perimedullary arteriovenous fistula with an in situ hemostatic agent: illustrative case.

Background: Spinal arteriovenous fistulas (SAVFs) are underdiagnosed entities that can lead to severe morbidity from spinal cord dysfunction or hemorrhage. Treatment options include endovascular embolization or direct surgical obliteration at the level of the arteriovenous shunt. The authors present a case of intraluminal microsurgical access for occlusion with a hemostatic agent of a type IV SAVF near the conus medullaris as an alternative to clip occlusion to avoid nerve root compromise.

Posterior fossa ischemic infarction: single-center retrospective review of non-surgical and surgical cases.

Cerebellar ischemic stroke (CIS) is a morbid neurological event, with potentially fatal consequences. There is currently no objective standard of care regarding when surgical procedures are required for this entity. We retrospectively reviewed 763 patients with CIS, 247 patients of which had a stroke larger than 1 cm in greatest dimension on cranial imaging.

Use of balloon-assisted nasal access to augment endoscopic endonasal transsphenoidal approach: illustrative case.

Background: Pituitary adenoma is a neurosurgical pathology commonly resected via endoscopic endonasal approach. Septal and nasal passage anatomy can affect the surgical corridor and may require septoplasty or other techniques for expansion.

Observations: The authors presented a case of pituitary macroadenoma with septal deviation with use of balloon-assisted nasal access for surgery.

Delayed ischemic neurologic deficit with vasospasm in aneurysmal subarachnoid hemorrhage after negative post-bleed day 7 angiography.

Objective: Routine post-bleed day 7 (PBD7) angiography has been utilized to evaluate for vasospasm in aneurysmal subarachnoid hemorrhage (SAH). We sought to assess the rate of delayed-cerebral ischemia (DCI) associated with angiographic vasospasm following negative PBD7 angiography.

Methods: Retrospective review of 178 aneurysmal SAH patients was performed.

Neuropathologic changes associated with stereoelectroencephalography depth electrode placement.

Background: The aim of this study was to detail the neuropathologic changes resulting from the surgical placement of stereoelectroencephalography (SEEG) leads in an initial small group of epilepsy cases and to raise awareness of this iatrogenic pathology, especially to those medical providers who specialize in the care of epilepsy patients.

Methods: Five consecutive patients who underwent epilepsy resection surgery following SEEG monitoring at OSF Saint Francis Medical Center were included in our report. Resection specimens were examined grossly and entirely submitted for microscopic evaluation by a neuropathologist.

Chyle leak occurring after vagal nerve stimulator implantation in a child.

Vagus nerve stimulation is a therapy indicated for some patients with medically-refractory epilepsy. Typical risks of this procedure include infection, hoarseness, vocal cord dysfunction, and hardware malfunction. Chyle leak via injury to the thoracic duct is a known complication of thoracic and head and neck surgeries-though less so in the neurosurgical literature.

Hemodynamic Changes Associated with Lateralized Periodic Discharges: A Near-Infrared Spectroscopy and Continuous EEG Study.

Background: Lateral periodic discharges (LPDs) have been recognized as a common electroencephalographic (EEG) pattern in critically ill patients. However, management decisions in these patients are still a challenge for clinicians. This study investigates hemodynamic changes associated with LPDs and evaluates if this pattern is likely to represent an ictal, interictal, or ictal-interictal continuum phenomenon via non-invasive near infra-red spectroscopy (NIRS) with concurrent with continuous EEG.

Risk factors for surgical site infections and assessment of vancomycin powder as a preventive measure in patients undergoing first-time cranioplasty.

OBJECTIVE Craniectomy is often performed to decrease intracranial pressure following trauma and vascular injuries. The subsequent cranioplasty procedures may be complicated by surgical site infections (SSIs) due to prior trauma, foreign implants, and multiple surgeries through a common incision. Several studies have found that intrawound vancomycin powder (VP) is associated with decreased risk of SSIs after spine operations.

Induction of calcitonin gene-related peptide expression in rats by cortical spreading depression.

Objective: The neuropeptide calcitonin gene-related peptide (CGRP) has now been established as a key player in migraine. However, the mechanisms underlying the reported elevation of CGRP in the serum and cerebrospinal fluid of some migraineurs are not known. A candidate mechanism is cortical spreading depression (CSD), which is associated with migraine with aura and traumatic brain injury.

Isolated Supratentorial Intraventricular Recurrence of Medulloblastoma.

Medulloblastoma is a common pediatric tumor typically diagnosed before the age of fifteen. Initial therapy includes surgical resection and radiation of the entire neuro-axis. Recurrence is common and typically occurs within 2 years of initial diagnosis.

Malignant peripheral nerve sheath tumor arising in the setting of cervical nerve root schwannomas.

We present a 23-year-old woman who was diagnosed with a malignant peripheral nerve sheath tumor (MPNST), 17 months following the resection of a schwannoma. MPNST is rare and is usually associated with neurofibromatosis. The typical treatment of resection and radiation is difficult to achieve in the spine.

Intraventricular foramen of Monro cavernous malformation.

We present a 64-year-old woman who was evaluated after being found unresponsive. Imaging revealed a foramen of Monro cavernoma resulting in hydrocephalus. Supratentorial cavernomas are most frequently found in the cerebral cortex, and although ventricular cavernomas do occur, they are rarely located in the foramen of Monro.