February 2013

COMING IN MARCH/APRIL 2013

A Primer on Brain-Machine Interfaces, Concepts andTechnology: A Key Element in the Future of Functional

Neurorestoration:Brian Lee, Charles Y. Liu, Michael J. Apuzzo

Rationale for Treating Unruptured Intracranial Aneurysms:Actuarial Analysis of Natural History Risk versus TreatmentRisk for Coiling or Clipping Based on 14,050 Patients in the

Nationwide Inpatient Sample Database:Matthew F. Lawson, Daniel W. Neal, J Mocco,

Brian L. Hoh

Characteristics of Brain Arteriovenous Malformations in PatientsPresenting with Nonhemorrhagic Neurologic Deficits:

Xianli Lv, Youxiang Li, Xinjian Yang, Chuhan Jiang,Zhongxue Wu

Comparisons of 30-Day Mortalities and 90-Day FunctionalRecoveries After First and Recurrent Primary Intracerebral

Hemorrhage Attacks: A Multiple-Institute Retrospective Study:Kyu Hong Kim, Hyung Dong Kim, Young Zoon Kim

Seizure Control for Patients Undergoing Meningioma Surgery:Kaisorn L. Chaichana, Courtney Pendleton,

Hasan Zaidi, Alessandro Olivi, Jon D. Weingart,Gary L. Gallia, Michael Lim, Henry Brem,

Alfredo Quinones-Hinojosa

Neurotrauma Outside the High-Income Setting: A Review ofAudit and Data-Collection Strategies:

Holly A. Sitsapesan, Timothy P. Lawrence,Clare Sweasey, Knut Wester

Pages 296-307

Health-Related Quality of Life After Spontaneous

Subarachnoid Hemorrhage Measured in a Recent

Patient Population

Martin Tjahjadi, Christian Heinen, Ralph König, Eckhard Rickels,

Christian Rainer Wirtz, Dieter Woischneck, Thomas Kapapa

Tjahjadi et al. retrospectively analyze health related quality oflife (HRQOL) data in a group of patients with spontaneoussubarachnoid hemorrhage (SAH). Over a 10-year period, theauthors treated 601 patients for SAH, and recorded responseson HRQOL from 253 individuals. The authors report on datafrom the Short-Form 36 and Short-Form-12 health surveys, aswell as a group of nonstandardized questions. Tjahjadi et al.report that HRQOL is considerably reduced by SAH,specifically in the physical and mental domains at upwards of10 years after the event. Factors at the time of the initialhospitalization that correlated most closely with poor HRQOLincluded Hunt-Hess Scale, Glasgow Outcome Scale, andpresence of seizures. The authors conclude that earlydocumentation of HRQOL in patients with SAH may be usefulin better evaluating outcomes and directing appropriaterehabilitation efforts.

Pages 307-312

Rebleeding After Aneurysmal Subarachnoid

Hemorrhage: A Literature Review

Carl Christian Larsen and Jens Astrup

Larsen and Astrup review the literature pertaining to rebleedingafter aneurysmal subarachnoid hemorrhage (SAH) in order todetermine specific risk factors. They report that the incidenceof rebleeding after SAH varies from 6% to 23% within the first72 hours, and that 50% to 90% of these events occur withinthe first 6 hours of primary bleeding. These events areassociated with significant morbidity and mortality. The authorsfound that the risk factors for rebleeding are quite complex,with many risk factors being both proposed by one study anddenied by others. Larsen and Astrup suggest that coagulationfactors must be involved in the process, as only administrationof antifibrinolytics has been shown to have a reducing effect ofearly rebleeding. The authors conclude that further studies arewarranted to better elucidate the mechanisms involved in earlySAH rebleeding.

Pages 313-319

Low-Level Amplification of Oncogenes Correlates

Inversely with Age for Patients with Nontypical

Meningiomas

Marie E. Beckner, Raghuram Sampath, Ashley B. Flowers, Kristopher

Katira, Dwain D’Souza, Shashikant Patil, Raj B. Patel, Mary L. Nordberg,

Anil Nanda

Beckner et al. describe how genetic changes seen innontypical meningiomas have an inverse correlation to patientage. The group examined DNA samples from 15 histologicallyor biologically atypical tumors resected at a single institution.This DNA was compared with commercially available normalDNA to demonstrate differences in copy numbers (CN) of

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known oncogenes associated with nontypical meningiomas.The authors discovered characteristic gene losses (i.e., 22q11)in more than 50% of the atypical samples. They alsodemonstrate that certain oncogenes are amplified in thesesamples, and that these amplifications (CN ratios) aresignificantly higher in patients under the age of 55 comparedwith the older cohort. The authors conclude that low levelamplification of certain oncogenes was higher in youngerindividuals, and that this may suggest a genetic basis forprevious studies demonstrating increased biologicalaggressiveness in early tumor development.

Pages 327-330

Pituitary Metastases: Role of Surgery

Matteo Zoli, Diego Mazzatenta, Marco Faustini-Fustini,

Ernesto Pasquini, Giorgio Frank

Zoli et al. review their series of surgically managed metastaticlesions to the pituitary gland. Over the course of nearly 20years, 15 patients with pituitary metastases (PM) weresurgically treated at a single center, compromising 1% of thepituitary lesions treated there. All but one of the patients hadvisual impairment at presentation; 11 had endocrinedisturbances. Metastatic disease was suspected preoperativelyin approximately half of the patients. After transsphenoidalsurgery, visual symptoms improved in 12 of the patients, whileendocrine dysfunction remained unchanged. No surgicalcomplications were identified; however, the mean survival ratein this series was 11.8 months. The authors conclude thatdespite poor survival data, surgical intervention should beconsidered for palliative treatment in patients with PM andreasonable performance status.

Pages 331-336

Pituitary Tumor Surgery: Review of 3004 Cases

Mauro Loyo-Varela, Tenoch Herrada-Pineda, Francisco Revilla-Pacheco,

Salvador Manrique-Guzman

Loyo-Varela et al. report on their 38-year single-institutionexperience of pituitary surgery in Mexico City. During this time,the authors performed transsphenoidal surgery in 3004patients; 3000 through a translabial approach, and theremaining through a transnasal approach. Of these patients,approximately half of the tumors were not biologically active,510 were prolactinomas, 822 were growth-hormone producing,and 62 presented with Cushing’s disease. The authors report acure rate for prolactin producing microadenomas to be 82%,and only 9% for macroadenomas; cure rates for growth-hormone producing tumors were similar. In this series, theauthors report that there were no cures for adrenocorticotropichormone-producing tumors. In this large series, the overallmortality rate was 1.6%, and the main complications includedcerebrospinal fluid leak, diabetes insipidus, and meningitis. Theauthors conclude that the transsphenoidal approach is a safeand effective modality to treat pituitary adenomas (except for

pharmacologically responsive prolactinomas) when combinedwith multidisciplinary workup and treatment.

Pages 346-358

Lessons Learned from War: A Comprehensive Review

of the Published Experiences of the Iranian

Neurosurgeons During the Iraq-Iran Conflict and

Review of the Related Literature

Vafa Rahimi-Movaghar, Seyed Behzad Jazayeri, Marjan Alimi,

Kazem Abbassioun, Abbas Amirjamshidi

Rahimi-Moyaghar et al. review the literature pertaining tomanagement of penetrating head wounds (PHW) by Iranianneurosurgeons during recent conflict with Iraq. Based on thereview of 28 papers, the authors identified 2 major surgicalstrategies in treating PHW: radical surgery and minimaldebridement. In these reports, the overall central nervoussystem infection rate was 10%, and the incidence of traumaticaneurysms was 6%. Based on review of the literature, theauthors recommend rapid transport to well equipped facilitiesand broad use of antibiotics for patients with PHW in wartime.Furthermore, appropriate triage by qualified neurosurgeonswith use of anatomic and vascular imaging is necessary todetermine appropriate surgical treatment on an individual basis.In addition, the authors suggest that conservativemanagement, when clinically appropriate, must be judiciouslyprescribed in order to effectively utilize limited resourcesduring such traumatic times.

Pages 369-374

Is External Cervical Orthotic Bracing Necessary After

Posterior Atlantoaxial Fusion with Modern

Instrumentation: Meta-Analysis and Review of

Literature

Robert E. Elliott, Omar Tanweer, Akwasi Boah, Amr Morsi, Tracy Ma,

Anthony Frempong-Boadu, Michael L. Smith

Elliott et al. review the literature on the use of external cervicalorthoses (EOS) after instrumented atlantoaxial fusions topromote bony fusion. Fifty-one English-language articles fromthe past 25 years describe over 2300 patients treated witheither screw-rod constructs or transarticular screws. Theauthors applied meta-analysis techniques to estimate rates offusion with and without ECO use. No studies directlycompared outcomes with the use of ECO; all studies providedClass III evidence at best. The authors did not find anysignificant difference in the rates of successful bony fusionbetween patients treated with or without ECO in this patientpopulation. Furthermore, the authors did not find anycorrelation between duration of ECO treatment and fusion.Elliott et al. suggest that ECO use after instrumentedatlantoaxial fusion may be unnecessary to achieve bony fusionbased on Class III evidence, and that further prospectivestudies with validated outcome measures are necessary tomake evidence-based guidelines.

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