EDITOR’S CHOICES
July/August 2013
COMING IN SEPTEMBER/OCTOBER 2013
Tibial Artery Autografts: Alternative Conduits for High FlowCerebral Revascularizations
Dinesh Ramanathan, Benjamin Starnes,
Thomas Hatsukami, Louis J. Kim, Salvatore Di Maio,
Laligam Sekhar
Endoscopic Endonasal Transsphenoidal Removal of Recurrentand Regrowing Pituitary Adenomas: Experience on a 59-Patient
SeriesLuigi M. Cavallo, Domenico Solari, Anastasia Tasiou,
Felice Esposito, Michelangelo de Angelis,
Alfonso Iodice D’Enza, Paolo Cappabianca
Gamma Knife Radiosurgery for Resectable Brain MetastasisZhiyuan Xu, Mohamed Elsharkawy, David Schlesinger,
Jason Sheehan
Stereotactic Radiosurgery for Trigeminal Pain Secondary toBenign Skull Base Tumors
Shota Tanaka, Bruce E. Pollock, Scott L. Stafford,
Michael J. Link
Detection of Compression Vessels in Trigeminal Neuralgia bySurface-Rendering Three-Dimensional Reconstruction of
1.5- and 3.0-T Magnetic Resonance ImagingMasahiro Shimizu, Hideaki Imai, Kaiei Kagoshima,
Eriko Umezawa, Tsuneo Shimizu, Yuhei Yoshimoto
Computed Tomography for Clearance of Cervical Spine Injury inthe Unevaluable Patient
Jonathan J. Russin, Frank J. Attenello, Arun P. Amar,
Charles Y. Liu, Michael L. J. Apuzzo, Patrick C. Hsieh
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Pages 103e112
Distal Aneurysms of Intracranial Arteries: Application of
Numerical Nomenclature, Predilection for Cerebellar
Arteries, and Results of Surgical Management
Ana Rodrıguez-Hernandez, Zsolt Zador, Ruben Rodrıguez-Mena,
Michael T. Lawton
Rodrıguez-Hernandez et al. describe the incidence and surgicalmanagement of intracranial aneurysms occurring outside thecircle of Willis and those that occur distally within the cerebellum.In their institutional series of 140 aneurysms, the incidence ofdistal cerebellar artery aneurysms was 4.3 times higher thanthose in the cerebrum, with the p2 and p3 segments of theposterior inferior cerebellar artery being the most common sites.Cerebellar artery aneurysms were more likely to present withrupture than those found distally in the cerebral circulation;however, they were found to be less likely amenable to clipligation. The authors endorse the use of standardized nomen-clature to precisely define these cerebellar artery aneurysms andnote that, while difficult, surgical management may lead to goodclinical outcomes.
Pages 113e120
Cerebral Vasospasm and Health-Related Quality of Life
After Subarachnoid Hemorrhage
Martin Tjahjadi, Ralph Konig, Christian Rainer Wirtz, Dieter Woischneck,
Thomas Kapapa
Tjahjadi et al. report on the health-related quality of life outcomesand their association with vasospasm in their group of more than230 aneurysmal subarachnoid hemorrhage patients treated overa 10-year period. Patients were divided into 2 groups: those whodid, and those who did not have clinical and radiographicallyconfirmed vasospasm. In general, health-related quality of lifeoutcomes were impaired across the cohort. There did not appearto be any significant difference in outcomes between thosepatients who did or did not experience cerebral vasospasm. Theauthors conclude that because they did not find any difference inoutcomes in the 2 groups, health-related quality of life improve-ments cannot be used as an argument to treat cerebralvasospasm.
Pages 120e126
In Vitro Studies for Stent-Assisted Coiling of Terminus
Aneurysms By Straight-On Intra-Aneurysmal Stent
Deployment
Shih-Wei Hsu, John C. Chaloupka, Mitsuyuki Fujitsuka
Hsu et al. describe the feasibility and biomechanics of analternative technique in the deployment of a Neuroformmicrostent (NFM) straight on into a terminus of an aneurysm.Using an in vitro silicon model of a wide-neck aneurysm, theauthors report relative ease using the technique in placementof the NFM followed by Gugliemi Detachable Coil emboliza-tion. The coil mass was stable, and less coil mass protrudinginto the parent vessel was apparent compared to the tradi-tional cross-stent deployment technique. The straight-ondeployment technique also had a larger supporting force fromcompression testing on the NFM compared to the side-wallradial force. The authors also describe potential complicationsof this alternative strategy in treating wide-neck aneurysms,including difficulty retrieving a partially deployed coil.
WORLD NEUROSURGERY
Pages 134e141
Targeted Cell Uptake of a Noninternalizing
Antibody Through Conjugation to Iron Oxide
Nanoparticles in Primary Central Nervous
System Lymphoma
Tingzhong Wang, Forrest M. Kievit, Omid Veiseh,
Hamed Arami, Zachary R. Stephen, Chen Fang, Yunhui Liu,
Richard G. Ellenbogen, Miqin Zhang
Wang et al. describe the in vitro use of iron oxidenanoparticles as a way to deliver effective drug doses topatients with primary central nervous systemlymphoma. The authors created a 70-nm nanoparticlecoated with an anti-CD20 fusion protein and opticallyactivated with Oregon Green 488. The authors demon-strated the stability of this molecule in biological mediafor over a week, as well as selective binding and intra-cellular uptake of this molecule in vitro. The authorsconclude that these characteristics can be furtherdeveloped to improve targeted therapy for primarycentral nervous system lymphoma.
Pages 148e159
Endoscopic Endonasal Compared with Anterior
Craniofacial and Combined Cranionasal
Resection of Esthesioneuroblastomas
Ricardo J. Komotar, Robert M. Starke, Daniel M. S. Raper,
Vijay K. Anand, Theodore H. Schwartz
Komotar et al. review the literature on the surgicaltechnique involved in resection of esthesioneuro-blastomas. Their Medline search revealed 47 studiesinvolving more than 450 patients; the authors dividedthe techniques into endoscopic, craniofacial, and cra-nionasal approaches. Gross total resection was ach-ieved in 98.1% of those patients undergoingendoscopic approaches, 100% of cranionasalapproaches, and only 81.3% of craniofacial approaches.Local recurrence was more common in the craniofacialgroup than the endoscopic group. The authors concludethat in well selected cases, cranionasal and endonasalapproaches are safe and effective; however, furtherevaluation of the risks and benefits of theseapproaches as they pertain to individual patients mustbe assessed.
Pages 178e182
Endoscopic Transventricular Selective
Amygdalohippocampectomy: Cadaveric
Demonstration of a New Operative Approach
Biji Bahuleyan, William Fisher, Shenandoah Robinson, Alan R.
Cohen
Bahuleyan et al. demonstrate the feasibility of anendoscopic transventricular resection in mesial temporal
WORLD NEUROSURGERY
structures. Using 4 silicone-injected cadaver heads, the authorsaccessed the lateral ventricle via an occipital burr hole. They wereable to evaluate the predissection anatomy of the temporal horn,hippocampus, and amygdala, as well as perform an endoscopicsub-pial resection of these structures to reveal a clear view of thebrainstem and posterior cerebral vessels. The authors discussthe potential advantages and risks of this procedure for removalof lesions in this region, as well as strategies to avoid potentialcomplications.
Pages 190e203
Analysis of Changing Paradigms of Management in 179
Patients with Spinal Tuberculosis Over a 12-Year Period
and Proposal of a New Management Algorithm
Sarat P. Chandra, Ajit Singh, Nishant Goyal, Rajender K. Laythalling,
Manmohan Singh, Sharad S. Kale, Manish S. Sharma, Ashish Suri,
Pankaj Singh, Ajay Garg, Chitra Sarkar, Manjari Tripathi, Bhawani S.
Sharma, Ashok K. Mahapatra
Chandra et al. review their series of 179 patients treated forspinal tuberculosis over a 12-year period. Their group was dividedinto those treated early in their experience (1999-2003) and late intheir experience (2004-2011) to evaluate for differences inmanagement. In their series, more than half the patients pre-sented with thoracic spine disease, and nearly all patients hadsome element of sensory-motor deficit (93.5%) and pain (87%).Ninety-two patients had already undergone one round of medicaltherapy for their tuberculosis. The more recent group hada higher incidence of cord compression and paraplegia and wasmore likely to undergo instrumented surgeries. Based on theirexperience, the authors suggest a management paradigm forspinal tuberculosis that involves Frankel grade, significance ofdeformity, and severity of pain.
Pages 208e212
A Comparison of Acute Hospital Charges After Tubular
versus Open Microdiskectomy
Kevin S. Cahill, Allan D. Levi, Matthew D. Cummock, Wensheng Liao,
Michael Y. Wang
Kahill et al. review their series of open versus tubular lumbarmicrodiskectomies to evaluate differences in the hospital-associ-ated costs of these procedures. Over the course of 3 years, thesenior authors performed 76 lumbar microdiskectomies, 33 ofwhich were done in the “open” fashion. They found that inflation-adjusted hospital charges were on average more than $5000 lessfor procedures involving a “minimally invasive” approach (P ¼0.02). While there were no significant differences in operativetimes or complications between the 2 groups, mean length of staywas approximately a half-day shorter (and therefore more likely tobe an outpatient procedure) in those patients undergoing thetubular approach (P¼ 0.01). The authors conclude that, due to thedecreased postoperative resource utilization in patients under-going a tubularmicrodiskectomy, associated hospital chargesmaybe lower compared with a traditional open approach.
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