Antiepileptic Drugs in the Management of Cerebral Metastases.

Seizures represent a common and debilitating complication of central nervous system metastases. The use of prophylactic antiepileptic drugs (AEDs) in the preoperative period remains controversial, but the preponderance of evidence suggests that it is not helpful in preventing seizure and instead poses a significant risk of adverse events. Studies of postoperative seizure prophylaxis have not shown substantial benefit, but this practice remains widespread.

Image guidance in spine tumor surgery.

Beginning with basic stereotactic operative methods in neurosurgery, intraoperative navigation and image guidance systems have since become the norm in that field. Following the introduction of image guidance into spinal surgery, there has been a dramatic increase in its utilization across disciplines and pathologies. Spine tumor surgery encompasses a wide range of complex surgical techniques and treatment strategies.

Pediatric neurosurgical bellwether procedures for infrastructure capacity building in hospitals and healthcare systems worldwide.

Purpose: Quantifying the global burden of pediatric neurosurgical disease-and current efforts addressing it-is challenging, particularly in the absence of uniform terminology. We sought to establish bellwether procedures for pediatric neurosurgery, in order to standardize terminology, establish priorities, and facilitate goal-oriented capacity building.

Methods: Members of international pediatric neurosurgical and pediatric surgical societies were surveyed via the Research Electronic Data Capture (REDCap) platform.

Clinical prognostic value of the isocitrate dehydrogenase 1 single-nucleotide polymorphism rs11554137 in glioblastoma.

The presence of the single-nucleotide polymorphism (SNP) rs11554137:C>T in the IDH1 gene is associated with a significantly lower survival in acute myeloid leukemia patients. The impact of its presence in glioblastoma on patient survival is unclear. We retrospectively reviewed 171 adult (> 18 years of age) patients treated at a single, tertiary academic center for supratentorial glioblastoma (WHO grade IV) between 2013 and 2017.

The influence of pregnancy on women with adolescent idiopathic scoliosis.

Purpose: The study's aim was to address three fundamental questions related to pregnancy and adolescent idiopathic scoliosis (AIS), and provide clinically applicable answers to spine specialists and general practitioners alike.

Methods: The authors performed a systematic literature review using MEDLINE, EMBASE, Google Scholar, and Cochrane Database of Systematic Reviews to identify articles published between 1980 and 2015 that described pregnancy-related characteristics and outcomes in AIS patients. The search was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and evidence was classified according to the Oxford CEBM (Centre for Evidence-Based Medicine) appraisal tool.

Decreased survival in glioblastomas is specific to contact with the ventricular-subventricular zone, not subgranular zone or corpus callosum.

The clinical effect of radiographic contact of glioblastoma (GBM) with neurogenic zones (NZ)-the ventricular-subventricular (VSVZ) and subgranular (SGZ) zones-and the corpus callosum (CC) remains unclear and, in the case of the SGZ, unexplored. We investigated (1) if GBM contact with a NZ correlates with decreased survival; (2) if so, whether this effect is associated with a specific NZ; and (3) if radiographic contact with or invasion of the CC by GBM is associated with decreased survival. We retrospectively identified 207 adult patients who underwent cytoreductive surgery for GBM followed by chemotherapy and/or radiation.

Cost-effectiveness of cell saver in short-segment lumbar laminectomy and fusion (≤3 levels).

Study Design: Mixed retrospective-prospective cohort study.

Objective: To characterize practice patterns for the use of Cell Saver at our institution, investigate its cost-effectiveness, and propose a new tool for patient selection.

Summary Of Background Data: Blood loss is an exceedingly common complication of spine surgery, and Cell Saver intraoperative cell salvage has been used to decrease reliance on allogeneic blood transfusions for blood volume replacement.

Electrophysiologic deterioration in surgery for thoracic disc herniation: impact of mean arterial pressures on surgical outcome.

Objective: Severe thoracic disc herniation leads to increased pressure in adjacent neural structures, which in turn can require an increase in mean arterial pressure (MAP) to maintain adequate spinal cord perfusion. We report a case series of three patients with severe thoracic disc herniation that experienced deteriorations in motor-evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs) following induction of general anesthesia, but prior to decompression of the neural elements.

Methods: In-depth chart reviews were completed for each patient from their initial presentation to long-term post-operative course.

Evidence-based cerebral vasospasm surveillance.

Subarachnoid hemorrhage related to aneurysmal rupture (aSAH) carries significant morbidity and mortality, and its treatment is focused on preventing secondary injury. The most common-and devastating-complication is delayed cerebral ischemia resulting from vasospasm. In this paper, the authors review the various surveillance technologies available to detect cerebral vasospasm in the days following aSAH.

Response to acute concussive injury in soccer players: is gender a modifying factor?

Object: Several studies have suggested a gender difference in response to sports-related concussion (SRC). The Concussion in Sport group did not include gender as a modifying factor in SRC, concluding that the evidence at that point was equivocal. In the present study the authors endeavored to assess acute neurocognitive and symptom responses to an SRC in equivalent cohorts of male and female soccer players.

Use of endovascular embolization to treat a ruptured arteriovenous malformation in a pregnant woman: a case report.

Introduction: Pregnancy has been linked to increased rates of arteriovenous malformation rupture. This link remains a matter of debate and very few studies have addressed the management of arteriovenous malformation in pregnancy. Unruptured arteriovenous malformations in pregnant woman generally warrant conservative management due to the low rupture risk.

Anticoagulation risk in spine surgery.

Study Design: Systematic review.

Objective: To determine the high-risk populations for thromboembolic events in spine surgery patients, the risk of anticoagulation in spine surgery patients by type of anticoagulation, and whether there is a safe perioperative window of nonanticoagulation for these high-risk patients.

Summary Of Background Data: Thromboembolic complications after major spinal surgery is a significant risk for patients.

Vertebroplasty and kyphoplasty.

Percutaneous vertebroplasty and kyphoplasty provide minimally invasive options for the management of osteoporotic and osteolytic vertebral compression fractures. These techniques provide substantial pain relief and support without requiring long periods of recumbency, and have an acceptable complication rate. Vertebral augmentation techniques such as vertebroplasty and kyphoplasty provide pain relief and improvement in quality of life in the highly selected patient.

Thoracic microendoscopic discectomy.

Thoracic microendoscopic discectomy is a safe effective treatment for surgical removal of herniated thoracic intervertebral discs. This approach allows access through a minimally invasive muscle-splitting posterolateral approach that does not place the contents of the thoracic cavity at risk. In the lumbar spine, this approach has been proven effective, with a shorter length of hospital stay, less postoperative pain, decreased blood loss, and shorter recovery time.

Preoperative localization of the carotid bifurcation for carotid endarterectomy using magnetic resonance angiography without tomography: technical note.

Objective: Carotid endarterectomy without angiography is becoming increasingly common. Magnetic resonance imaging accurately demonstrates vascular anatomy and the degree of stenosis but may not localize the cervical carotid bifurcation for incision planning without tomography. We report a method for preoperative localization of the bifurcation using the relatively constant axial coplanar relationship between the horizontal petrous (C2) segment of the internal carotid artery and the external auditory canal (EAC).

Intrauterine myelomeningocele repair.

Preliminary studies have suggested that IUMR reduces the incidence of shunt-dependent hydrocephalus and the severity of the Chiari malformation. An RCT is in progress to confirm these results. Future efforts will revolve around refinement of the procedure with the goal of reducing risk.