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Dural arteriovenous fistula in the setting of cerebral venous sinus thrombosis and COVID-19 infection Neurosurg. Focus (IF 4.1) Pub Date : 2024-03-01 Allison S. Liang, Michael T. Bounajem, Aaron Shoskes, Ramesh Grandhi
OBJECTIVE The aim of this study was to examine the presence of concurrent venous thrombosis and COVID-19 infections in patients with dural arteriovenous fistulas (dAVFs). METHODS An analysis of all patients diagnosed with dAVF via cerebral angiography by the senior author was conducted, with special attention given to the presence of cerebral venous sinus thrombosis (CVST) and COVID-19 infection. General
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Clinical and radiological features of parasagittal dural arteriovenous fistulas: a report of 8 cases from a single institution Neurosurg. Focus (IF 4.1) Pub Date : 2024-03-01 A. Yohan Alexander, Nitesh P. Patel, Harry J. Cloft, Giuseppe Lanzino, Waleed Brinjikji
OBJECTIVE Dural arteriovenous fistulas (dAVFs) of the superior sagittal sinus (SSS) are uncommon and represent 5%–12% of all intracranial dAVFs. SSS dAVFs can be divided into two main subtypes. The first type involves direct arterialization of the SSS, whereas the second type consists of a parasagittal arteriovenous shunt draining into a cortical vein directly lateral to the SSS and has retrograde
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Microsurgical versus endovascular treatment of ethmoidal dural arteriovenous fistulas: systematic review and meta-analysis with a single-center case series Neurosurg. Focus (IF 4.1) Pub Date : 2024-03-01 Chandler N. Berke, Anant Naik, Neil Majmundar, Sean Munier, Raphia Rahman, Ahsan Sattar, Priyank Khandelwal, James K. Liu
OBJECTIVE Ethmoidal dural arteriovenous fistulas (DAVFs) are often associated with cortical venous drainage (CVD) and a higher incidence of hemorrhage compared with DAVFs in other locations. They may be treated with open surgical disconnection or with endovascular treatment (EVT). In this systematic review and meta-analysis, the authors compare the outcomes of ethmoidal DAVFs treated with open microsurgery
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The negative impact of treatment delays on the long-term neurological outcomes of spinal dural arteriovenous fistulas: a longitudinal cohort study Neurosurg. Focus (IF 4.1) Pub Date : 2024-03-01 Victor Gabriel El-Hajj, Cornelia Daller, Alexander Fletcher-Sandersjöö, Maria Gharios, Mohamad Bydon, Michael Söderman, Pascal Jabbour, Erik Edström, Adrian Elmi-Terander, Fabian Arnberg
OBJECTIVE Dural arteriovenous fistulas are rare vascular malformations that affect the brain and spinal cord. Spinal dural arteriovenous fistulas (sdAVFs) are the most frequently encountered vascular malformation affecting the spinal cord. The object of this study was to evaluate the impact of treatment delays on the long-term neurological outcomes of either open surgical or interventional treatment
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Digital exoscope versus surgical microscope in spinal dural arteriovenous fistula surgery: a comparative series Neurosurg. Focus (IF 4.1) Pub Date : 2024-03-01 Anna Maria Auricchio, Francesco Calvanese, Ville Vasankari, Rahul Raj, Camille Louise Claudine Gallé, Mika Niemelä, Martin Lehecka
OBJECTIVE Surgical treatment of spinal dural arteriovenous fistulas (DAVFs) has been reported to be superior to endovascular treatment in terms of occlusion of the fistula. Despite the increased availability of digital 3D exoscopes, the potential benefits of using an exoscope in spinal DAVF surgery have not been studied. The purpose of this study was to report and compare the results of exoscope- and
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Safety evaluation of sinus patency after stereotactic radiosurgery for transverse–sigmoid sinus dural arteriovenous fistulas: implications of treatment options for patients with Borden type I fistulas Neurosurg. Focus (IF 4.1) Pub Date : 2024-03-01 Motoyuki Umekawa, Yuki Shinya, Hirotaka Hasegawa, Satoshi Koizumi, Atsuto Katano, Nobuhito Saito
OBJECTIVE This study aimed to assess the efficacy and safety of stereotactic radiosurgery (SRS) in treating transverse–sigmoid sinus dural arteriovenous fistulas (TSS DAVFs), and to investigate post-SRS sinus patency, focusing on the risk factors associated with treated sinus occlusion. METHODS Data from 34 patients treated with SRS between January 2006 and April 2023 were analyzed. Detailed angioarchitecture
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Treatment outcomes and the role of the DES scheme in the appropriate treatment selection for high-grade dural arteriovenous fistulas Neurosurg. Focus (IF 4.1) Pub Date : 2024-03-01 Benjamin Beyersdorf, Stefanos Voglis, Guoming Zhao, Johannes Sarnthein, Luca Regli, Menno R. Germans
OBJECTIVE Endovascular and microsurgical treatment are viable options for the majority of Borden type III dural arteriovenous fistulas (dAVFs). The aim of this study was to examine treatment outcomes in a comparative analysis of endovascular and surgical treatment modalities for Borden type III fistulas and explore clinical implications of the DES scheme in selecting ideal candidates for surgical therapy
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Evaluating the diagnostic accuracy of 3D contrast-enhanced magnetic resonance angiography versus digital subtraction angiography in spinal dural arteriovenous fistulas Neurosurg. Focus (IF 4.1) Pub Date : 2024-03-01 Adham M. Khalafallah, Joseph Yunga Tigre, Nadine Rady, Robert M. Starke, Efrat Saraf-Lavi, Allan D. Levi
OBJECTIVE Spinal dural arteriovenous fistulas (SDAVFs) often go undiagnosed, leading to irreversible spinal cord dysfunction. Although digital subtraction angiography (DSA) is the gold standard for diagnosing SDAVF, DSA is invasive and operator dependent, with associated risks. MR angiography (MRA) is a promising alternative. This study aimed to evaluate the performance of MRA as an equal alternative
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Dural arteriovenous fistulas are not observed to convert to a higher grade after partial embolization Neurosurg. Focus (IF 4.1) Pub Date : 2024-03-01 Erin Walker, Anja Srienc, Daphne Lew, Ridhima Guniganti, Giuseppe Lanzino, Waleed Brinjikji, Minako Hayakawa, Edgar A. Samaniego, Colin P. Derdeyn, Rose Du, Rosalind Lai, Jason P. Sheehan, Robert M. Starke, Adib Abla, Ahmed Abdelsalam, Bradley Gross, Felipe Albuquerque, Michael T. Lawton, Louis J. Kim, Michael Levitt, Sepideh Amin-Hanjani, Ali Alaraj, Ethan Winkler, W. Christopher Fox, Adam Polifka
OBJECTIVE Borden-Shucart type I dural arteriovenous fistulas (dAVFs) lack cortical venous drainage and occasionally necessitate intervention depending on patient symptoms. Conversion is the rare transformation of a low-grade dAVF to a higher grade. Factors associated with increased risk of dAVF conversion to a higher grade are poorly understood. The authors hypothesized that partial treatment of type
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Stereotactic radiosurgery with versus without embolization for intracranial dural arteriovenous fistulas: a systematic review and meta-analysis Neurosurg. Focus (IF 4.1) Pub Date : 2024-03-01 Seyed Farzad Maroufi, Mohammad Sadegh Fallahi, Moein Ghasemi, Jason P. Sheehan
OBJECTIVE Stereotactic radiosurgery (SRS) has been established as a safe and alternative treatment for dural arteriovenous fistulas (dAVFs). While embolization alone is the most commonly used modality for the treatment of dAVFs, the adjunctive use of embolization with SRS, with the growing use of SRS, has gained increasing interest in the past few years. However, the relative efficacy and safety of
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Long-term outcome of endovascular treatment for indirect carotid-cavernous fistulas Neurosurg. Focus (IF 4.1) Pub Date : 2024-03-01 Humain Baharvahdat, Farid Qoorchi Moheb Seraj, Amira Al-Raaisi, Raphael Blanc, Sajjad Najafi, Mohammad Hossein Mirbolouk, Hocine Redjem, Feizollah Ebrahimnia, Simon Escalard, Samira Zabihyan, Jean-Philipe Desilles, Ashkan Mowla, Willian Boisseau, Mikael Mazighi, Stanislas Smajda, Michel Piotin
OBJECTIVE Endovascular treatment (EVT) is the primary approach used to treat indirect carotid-cavernous fistulas (CCFs). In this study, the authors evaluated the immediate and long-term efficacy and safety of different endovascular techniques for indirect CCFs. METHODS The databases of two endovascular centers were retrospectively reviewed to collect the patients with indirect CCFs treated using endovascular
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Comparison between endovascular and surgical treatment of spinal dural arteriovenous fistulas: a single-center cohort and systematic review Neurosurg. Focus (IF 4.1) Pub Date : 2024-03-01 Kareem El Naamani, Anand Kaul, Nikolaos Mouchtouris, Adam Hunt, Meah T. Ahmed, Saman Sizdahkhani, Shyam Majmundar, Marc Ghanem, M. Reid Gooch, Nabeel A. Herial, Pascal Jabbour, Robert H. Rosenwasser, Stavropoula I. Tjoumakaris
OBJECTIVE With recent advancements in minimally invasive techniques, endovascular embolization has gained popularity as a first-line treatment option for spinal dural arteriovenous fistulas (sDAVFs). The authors present their institution’s case series of sDAVFs treated endovascularly and surgically, and they performed a systemic review to assess the outcomes of both modalities of treatment. METHODS
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A contemporary analysis of surgical ligation versus endovascular embolization in patients with intracranial dural arteriovenous fistulas: a propensity score–matched and mixed-effects model study Neurosurg. Focus (IF 4.1) Pub Date : 2024-03-01 Shane Shahrestani, Michelot Michel, Maria Paula Aguilera-Pena, Miguel D. Quintero-Consuegra, Nestor R. Gonzalez
OBJECTIVE Intracranial dural arteriovenous fistulas (dAVFs) are rare vascular lesions that can be asymptomatic or can lead to devastating hemorrhage based on the dAVF’s aggressiveness. Several approaches can be taken to treat dAVFs, such as endovascular embolization and surgical ligation. However, very few studies have evaluated the influence of surgery compared to endovascular approaches on patient
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Long-term treatment outcomes and natural course of low-grade intracranial dural arteriovenous fistulas Neurosurg. Focus (IF 4.1) Pub Date : 2024-03-01 Tobias Rossmann, Michael Veldeman, Elias Oulasvirta, Ville Nurminen, Philip-Rudolf Rauch, Andreas Gruber, Martin Lehecka, Mika Niemelä, Jussi Numminen, Rahul Raj
OBJECTIVE In contrast to high-grade dural arteriovenous fistula (dAVF), low-grade dAVF is mainly associated with tinnitus and carries a low risk of morbidity and mortality. It remains unclear whether the benefits of active interventions outweigh the associated risk of complications in low-grade dAVF. METHODS The authors conducted a retrospective single-center study that included all consecutive patients
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Is intraoperative mapping of music performance mandatory to preserve skills in professional musicians? Awake surgery for lower-grade glioma conducted from a meta-networking perspective Neurosurg. Focus (IF 4.1) Pub Date : 2024-02-01 Jesús Martín-Fernández, Sylvie Moritz-Gasser, Guillaume Herbet, Hugues Duffau
OBJECTIVE In surgery for lower-grade glioma (LGG) in professional musicians, for whom preserving music ability is essential, a critical question has emerged, namely, is it mandatory to include music performance during awake mapping, as proposed in several reports? In fact, music ability is subserved by a mosaic of interactive cognitive and emotional processes that rest on several networks. Therefore
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Awake intraoperative mapping for the prevention of amusia Neurosurg. Focus (IF 4.1) Pub Date : 2024-02-01 Linda Wang, Dominique Higgins, Mychael Delgardo, Cory Chang, Marla J. Hamberger, Guy M. McKhann
The authors describe the awake surgical mapping of music skills for patients who require resection in brain areas that may support musical abilities. A 65-year-old man was diagnosed with an anterolateral right temporal nonenhancing lesion, likely a diffusely infiltrating glioma, after presenting with several episodes of altered taste and smell and one episode of loss of consciousness. The patient specializes
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Awake brain mapping paradigms for nondominant hemisphere gliomas Neurosurg. Focus (IF 4.1) Pub Date : 2024-02-01 Justyna O. Ekert, David S. Sabsevitz, Isabel Martin del Campo, Anshit Goyal, Conor S. Gillespie, Erik H. Middlebrooks, Kaisorn L. Chaichana, Keng Siang Lee, Jesus E. Sanchez-Garavito, Alfredo Quiñones-Hinojosa
OBJECTIVE Traditionally, resection of nondominant hemisphere brain tumors was performed under general anesthesia. An improved understanding of right-lateralized neural networks has led to a paradigm shift in recent decades, where the right or nondominant hemisphere is no longer perceived as "functionally silent." There is an increasing interest in awake brain mapping for nondominant hemisphere resections
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The role of preoperative [11C]methionine PET in defining tumor-related epilepsy and predicting short-term postoperative seizure control in temporal lobe low-grade gliomas Neurosurg. Focus (IF 4.1) Pub Date : 2024-02-01 Beatrice C. Bono, Gaia Ninatti, Marco Riva, Luca Raspagliesi, Edoardo M. Barbieri, Pierina Navarria, Elena Clerici, Letterio S. Politi, Matteo Simonelli, Marcello Rodari, Martina Sollini, Arturo Chiti, Federico Pessina
OBJECTIVE Surgery is the mainstay of treatment for low-grade glioma (LGG)–related epilepsy. However, the goal of achieving both oncological radical resection and seizure freedom can be challenging. PET with [ C]methionine (MET) has been recently introduced in clinical practice for the management of patients with LGGs, not only to monitor the response to treatments, but also as a preoperative tool to
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Radiographic growth rate as a predictor of aggressiveness of diffuse gliomas without 1p19q codeletion Neurosurg. Focus (IF 4.1) Pub Date : 2024-02-01 Arthur Leclerc, Alexandre Roux, Angela Elia, Sophie Peeters, Oumaima Aboubakr, Aziz Bedioui, Martin Planet, Joseph Benzakoun, Giorgia Antonia Simboli, Arnault Tauziede-Espariat, Alessandro Moiraghi, Pascale Varlet, Fabrice Chrétien, Catherine Oppenheim, Marc Zanello, Johan Pallud
OBJECTIVE The 2021 WHO classification of CNS tumors has refined the definition of adult-type diffuse gliomas without 1p19q codeletion. Nevertheless, the aggressiveness of gliomas is based exclusively on histomolecular criteria performed on a limited sample of the tumor. The authors aimed to assess whether the spontaneous radiographic tumor growth rate is associated with tumor aggressiveness and allows
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Suppression of antitumor immune signatures and upregulation of VEGFA as IDH-mutant gliomas progress to higher grade Neurosurg. Focus (IF 4.1) Pub Date : 2024-02-01 Eric P. Grewal, Leland G. K. Richardson, Jing Sun, Rishab Ramapriyan, Maria Martinez-Lage, Julie J. Miller, Daniel P. Cahill, Bryan D. Choi, William T. Curry
OBJECTIVE Several studies have compared the immune microenvironment of isocitrate dehydrogenase (IDH)–wildtype glioma versus IDH-mutant glioma. The authors sought to determine whether histological tumor progression in a subset of IDH-mutant glioma was associated with concomitant alterations in the intratumoral immune microenvironment.METHODS The authors performed bulk RNA sequencing on paired and unpaired
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Assessing views and attitudes toward the use of extended reality and its implications in neurosurgical education: a survey of neurosurgical trainees Neurosurg. Focus (IF 4.1) Pub Date : 2024-01-01 Nithin Gupta, Nikki M. Barrington, Nicholas Panico, Nolan J. Brown, Rohin Singh, Redi Rahmani, Randy S. D’Amico
OBJECTIVE Extended reality (XR) systems, including augmented reality (AR), virtual reality (VR), and mixed reality, have rapidly emerged as new technologies capable of changing the way neurosurgeons prepare for cases. Thus, the authors sought to evaluate the perspectives of neurosurgical trainees on the integration of these technologies into neurosurgical education. METHODS A 20-question cross-sectional
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Students’ perspectives regarding needs for and opportunities with mixed-reality education in neurosurgery at German medical schools Neurosurg. Focus (IF 4.1) Pub Date : 2024-01-01 Johannes Wach, Dirk Winkler, Martin Vychopen, Fabian Kropla, Ronny Grunert, Erdem Güresir
OBJECTIVE Despite mixed reality being an emerging tool for tailored neurosurgical treatment and safety enhancement, the use of mixed reality in the education of German medical students is not established in the field of neurosurgery. The present study aimed to investigate medical students’ perspectives on the use of mixed reality in neurosurgical medical education. METHODS Between July 3, 2023, and
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The role of extended reality in eloquent area lesions: a systematic review Neurosurg. Focus (IF 4.1) Pub Date : 2024-01-01 Salvatore Marrone, Roberta Costanzo, Benedetta Maria Campisi, Chiara Avallone, Felice Buscemi, Luigi Maria Cusimano, Lapo Bonosi, Lara Brunasso, Gianluca Scalia, Domenico Gerardo Iacopino, Rosario Maugeri
OBJECTIVE The surgical approach to lesions near eloquent areas continues to represent a challenge for neurosurgeons, despite all of the sophisticated tools currently used. The goal of surgery in eloquent areas is to maintain a good oncofunctional balance, that is, to preserve neurological function and ensure maximum tumor resection. Among all the available tools, extended reality (used to describe
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Mixed reality compared to the traditional ex cathedra format for neuroanatomy learning: the value of a three-dimensional virtual environment to better understand the real world Neurosurg. Focus (IF 4.1) Pub Date : 2024-01-01 Abiram Sandralegar, Florian Bernard, Samuel Khatchatourov, Insa Janssen, Karl Schaller, Philippe Bijlenga, Julien Haemmerli
OBJECTIVE Neuroanatomy comprehension is a keystone of understanding intracranial surgeries. Traditionally taught to students during ex cathedra courses, neuroanatomy is described as complex. Mixed reality (MxR) opens new perspectives in the learning process. This study aims to compare MxR-based courses with traditional ex cathedra lectures for neuroanatomy education. METHODS Two lectures describing
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Innovations in craniovertebral junction training: harnessing the power of mixed reality and head-mounted displays Neurosurg. Focus (IF 4.1) Pub Date : 2024-01-01 Akshay Ganeshkumar, Varidh Katiyar, Prachi Singh, Ravi Sharma, Amol Raheja, Kanwaljeet Garg, Shashwat Mishra, Vivek Tandon, Ajay Garg, Franco Servadei, Shashank Sharad Kale
OBJECTIVE The objective of this study was to analyze the potential and convenience of using mixed reality as a teaching tool for craniovertebral junction (CVJ) anomaly pathoanatomy. METHODS CT and CT angiography images of 2 patients with CVJ anomalies were used to construct mixed reality models in the HoloMedicine application on the HoloLens 2 headset, resulting in four viewing stations. Twenty-two
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Accuracy of routine external ventricular drain placement following a mixed reality–guided twist-drill craniostomy Neurosurg. Focus (IF 4.1) Pub Date : 2024-01-01 Sangjun Eom, Tiffany S. Ma, Neha Vutakuri, Tianyi Hu, Aden P. Haskell-Mendoza, David A. W. Sykes, Maria Gorlatova, Joshua Jackson
OBJECTIVE The traditional freehand placement of an external ventricular drain (EVD) relies on empirical craniometric landmarks to guide the craniostomy and subsequent passage of the EVD catheter. The diameter and trajectory of the craniostomy physically limit the possible trajectories that can be achieved during the passage of the catheter. In this study, the authors implemented a mixed reality–guided
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An evaluation of physical and augmented patient-specific intracranial aneurysm simulators on microsurgical clipping performance and skills: a randomized controlled study Neurosurg. Focus (IF 4.1) Pub Date : 2024-01-01 Philippe Dodier, Lorenzo Civilla, Ammar Mallouhi, Lukas Haider, Anna Cho, Philip Lederer, Wei-Te Wang, Christian Dorfer, Arthur Hosmann, Karl Rössler, Markus Königshofer, Ewald Unger, Maria-Chiara Palumbo, Alberto Redaelli, Josa M. Frischer, Francesco Moscato
OBJECTIVE In the era of flow diversion, there is an increasing demand to train neurosurgeons outside the operating room in safely performing clipping of unruptured intracranial aneurysms. This study introduces a clip training simulation platform for residents and aspiring cerebrovascular neurosurgeons, with the aim to visualize peri-aneurysm anatomy and train virtual clipping applications on the matching
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IMAGINER: improving accuracy with a mixed reality navigation system during placement of external ventricular drains. A feasibility study Neurosurg. Focus (IF 4.1) Pub Date : 2024-01-01 Ronny Grunert, Dirk Winkler, Johannes Wach, Fabian Kropla, Sebastian Scholz, Martin Vychopen, Erdem Güresir
OBJECTIVE The placement of a ventricular catheter, that is, an external ventricular drain (EVD), is a common and essential neurosurgical procedure. In addition, it is one of the first procedures performed by inexperienced neurosurgeons. With or without surgical experience, the placement of an EVD according to anatomical landmarks only can be difficult, with the potential risk for inaccurate catheter
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Improving mixed-reality neuronavigation with blue-green light: a comparative multimodal laboratory study Neurosurg. Focus (IF 4.1) Pub Date : 2024-01-01 Salvatore Marrone, Gianluca Scalia, Lidia Strigari, Sruthi Ranganathan, Mario Travali, Rosario Maugeri, Roberta Costanzo, Lara Brunasso, Lapo Bonosi, Salvatore Cicero, Domenico Gerardo Iacopino, Maurizio Salvati, Giuseppe Emanuele Umana
OBJECTIVE This study aimed to rigorously assess the accuracy of mixed-reality neuronavigation (MRN) in comparison with magnetic neuronavigation (MN) through a comprehensive phantom-based experiment. It introduces a novel dimension by examining the influence of blue-green light (BGL) on MRN accuracy, a previously unexplored avenue in this domain. METHODS Twenty-nine phantoms, each meticulously marked
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Creation of a microsurgical neuroanatomy laboratory and virtual operating room: a preliminary study Neurosurg. Focus (IF 4.1) Pub Date : 2024-01-01 Gökberk Erol, Abuzer Güngör, Umut Tan Sevgi, Beste Gülsuna, Yücel Doğruel, Hakan Emmez, Uğur Türe
OBJECTIVE A comprehensive understanding of microsurgical neuroanatomy, familiarity with the operating room environment, patient positioning in relation to the surgery, and knowledge of surgical approaches is crucial in neurosurgical education. However, challenges such as limited patient exposure, heightened patient safety concerns, a decreased availability of surgical cases during training, and difficulties
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Mixed reality in neurosurgery: redefining the paradigm for arteriovenous malformation planning and navigation to improve patient outcomes Neurosurg. Focus (IF 4.1) Pub Date : 2024-01-01 Edinson Najera, Gavin Lockard, Miguel Saez-Alegre, Keaton Piper, Walter C. Jean
OBJECTIVE Brain arteriovenous malformations (AVMs) present significant challenges in neurosurgery, requiring detailed planning and execution. In this study, the authors aimed to evaluate the efficacy of mixed reality (MxR), a synergistic application of virtual reality (VR) and augmented reality (AR), in the surgical management of AVMs. METHODS A retrospective review was conducted on 10 patients who
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Navigating the calvaria with mobile mixed reality–based neurosurgical planning: how feasible are smartphone applications as a craniotomy guide? Neurosurg. Focus (IF 4.1) Pub Date : 2024-01-01 Ihsan Dogan, Halit Anil Eray, Onur Ozgural, Ozan Tekneci, Savas Hasimoglu, Macit Terzi, Emre Bahir Mete, Yusuf Cem Kuzukiran, Hasan Elmas, Ozgur Orhan, Bilal Abbasoglu, Eyup Bayatli, Murat Zaimoglu, Sukru Caglar
OBJECTIVE Virtual simulation and imaging systems have evolved as advanced products of computing technology over the years. With advancements in mobile technology, smartphones, and tablets, the quality of display and processing speed have gradually improved, thanks to faster central processing units with higher capacity. Integrating these two technologies into the fields of healthcare and medical education
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The Enhanced Recovery After Surgery protocol for the surgical management of craniosynostosis: Lausanne experience Neurosurg. Focus (IF 4.1) Pub Date : 2023-12-01 Amani Belouaer, Giulia Cossu, Soulayma Al-Tayyari, Adela Bubenikova, Catalina Caliman, Fabio Agri, Maria-Helena Perez, Vivianne Chanez, Yann Boegli, Caroline Mury, Roy Thomas Daniel, Mahmoud Messerer
OBJECTIVE Over the past decade, the Enhanced Recovery After Surgery (ERAS) program has demonstrated its effectiveness and efficiency in improving postoperative care and enhancing recovery across various surgical fields. Preliminary results of ERAS protocol implementation in craniosynostosis surgery are presented. METHODS An ERAS protocol was developed and implemented for cranial pediatric neurosurgery
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Applications of enhanced recovery after surgery protocols for unruptured anterior circulation aneurysms in tertiary-level healthcare institutions: a national study Neurosurg. Focus (IF 4.1) Pub Date : 2023-12-01 Fatih Yakar, Batuhan Bakirarar, Çağrı Elbir, Emrah Egemen, Şahin Hanalioğlu, Ümit Akın Dere, Serkan Civlan, Çağhan Tönge, Barış Albuz, Mehmet Erdal Coşkun, Mehmet Erhan Türkoğlu
OBJECTIVE Enhanced recovery after surgery (ERAS) protocols are standardized perioperative care that reduce patients’ stress response during hospitalization and improve hospitalization time, complication rates, costs, and readmission rates. This study aimed to investigate the application rate of protocols for elective craniotomy in the surgery of unruptured anterior circulation aneurysms (AnCAs) at
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Early versus delayed mobilization after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of efficacy and safety Neurosurg. Focus (IF 4.1) Pub Date : 2023-12-01 *Alberto Morello, Antonio Spinello, Victor E. Staartjes, Enrico Lo Bue, Diego Garbossa, Menno R. Germans, Luca Regli, Carlo Serra
OBJECTIVE A central tenet of Enhanced Recovery After Surgery (ERAS) is evidence-based medicine. Survivors of aneurysmal subarachnoid hemorrhage (aSAH) constitute a fragile patient population prone to prolonged hospitalization within neurointensive care units (NICUs), prolonged immobilization, and a range of nosocomial adverse events. Potentially, well-monitored early mobilization (EM) could constitute
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An institutional experience in applying quality improvement measures to pituitary surgery: clinical and resource implications Neurosurg. Focus (IF 4.1) Pub Date : 2023-12-01 Panayiotis E. Pelargos, Aamr Hasanjee, Benjamin Lee, Audrey Grossen, Kiana Y. Prather, Xiaochun Zhao, Prince Ohene-Nyako, Matthew P. Baier, Amanda Kate McDaniel, Kibwei A. McKinney, Christopher S. Graffeo, Edward El Rassi, Ian F. Dunn
OBJECTIVE The aim of this study was to report the authors’ experience developing a Lean Six Sigma clinical care pathway (CCP) for endoscopic endonasal transsphenoidal operations. METHODS Using Lean Six Sigma quality improvement principles—including the define, measure, analyze, improve, and control framework—the authors developed a CCP for endoscopic endonasal transsphenoidal operations, incorporating
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The Enhanced Recovery After Surgery protocol for the perioperative management of pituitary neuroendocrine tumors/pituitary adenomas Neurosurg. Focus (IF 4.1) Pub Date : 2023-12-01 Giulia Cossu, Amani Belouaer, Julie Kloeckner, Catalina Caliman, Fabio Agri, Roy Thomas Daniel, John G. Gaudet, Georgios E. Papadakis, Mahmoud Messerer
OBJECTIVE Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care pathway that has radically modified the management of patients in multiple surgical specialties. Until now, no ERAS Society guidelines have been formulated for the management of cranial pathologies. During the process of ERAS certification for their neurosurgical department, the authors formulated an ERAS protocol for
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Same-day discharge after craniotomy for brain tumor resection: enhancing patient selection through a prognostic scoring system Neurosurg. Focus (IF 4.1) Pub Date : 2023-12-01 Adam S. Levy, Martin A. Merenzon, Shovan Bhatia, Meredith C. Costello, Long Di, Victor M. Lu, Alexis A. Morell, Lekhaj Daggubati, Ashish H. Shah, Ricardo J. Komotar, Michael E. Ivan
OBJECTIVE Neurosurgery, among other surgical fields, is amid a shift in patient management with enhanced recovery and same-day discharge (SDD) protocols slowly becoming more popular and feasible. While such protocols reduce the risk of nosocomial complications and improve patient satisfaction, appropriate patient selection remains an area of debate. The authors aimed to better quantify selection criteria
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Effect of the enhanced recovery protocol in patients with brain tumors undergoing elective craniotomies: a systematic review and meta-analysis Neurosurg. Focus (IF 4.1) Pub Date : 2023-12-01 Suchada Supbumrung, Anukoon Kaewborisutsakul, Chanatthee Kitsiripant, Wilairat Kankuan Kaewborisutsakul, Chaitong Churuangsuk
OBJECTIVE Enhanced recovery after surgery, or the enhanced recovery protocol (ERP), introduces a contemporary concept for perioperative care within neurosurgery. In recent years, mounting evidence has highlighted the significant impact of this approach on brain tumor surgery. The authors conducted a systematic review and meta-analysis of current publications, with a primary focus on assessing the efficiency
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Enhanced recovery and same-day discharge after brain tumor surgery under general anesthesia: initial experience with Hospital-at-Home–based postoperative follow-up Neurosurg. Focus (IF 4.1) Pub Date : 2023-12-01 Cristina A. Pelaez-Sanchez, Marcos Pajaron-Guerrero, Angelina Rodríguez-Caballero, Cristina Ruiz Calderón, Carla Mora, Rubén Martín-Láez, Isabel Sampedro, Carlos Velásquez
OBJECTIVE The objective of this study was to describe the outcomes of outpatient oncological neurosurgery (OON) in a European clinical setting and to compare them with the conventional inpatient protocol. METHODS Patients who had undergone OON (either tumor removal or biopsy) at the authors’ center since 2019 were analyzed. A matched cohort of patients was selected from patients undergoing tumor surgery
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Enhanced recovery after brain tumor surgery: pilot protocol implementation in a large healthcare system Neurosurg. Focus (IF 4.1) Pub Date : 2023-12-01 Walavan Sivakumar, Jian Guan, Jean-Philippe Langevin, Garni Barkhoudarian, Daniel F. Kelly, Neil Martin
OBJECTIVE Enhanced recovery after surgery (ERAS) protocols have been used in numerous specialties to improve the safety, efficiency, and cost of surgical interventions. Despite these successes, implementation of ERAS in cranial neurosurgery remains limited. In this study, a comprehensive ERAS protocol was implemented at two pilot sites within the Providence Health & Services system, and groundwork
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Development and implementation of an Enhanced Recovery After Cranial Surgery pathway following supratentorial tumor resection at a tertiary care center Neurosurg. Focus (IF 4.1) Pub Date : 2023-12-01 Hammad A. Khan, Travis C. Hill, Carter M. Suryadevara, Camiren C. Carter, Alexander N. Eremiev, Akshay V. Save, John G. Golfinos, Donato Pacione
OBJECTIVE Controlling length of stay (LOS) reduces rates of nosocomial infections and falls, facilitates earlier return to daily activities, and decreases strain on the healthcare system. Complications following supratentorial tumor resection present early in the postoperative period, thereby enhancing the prospect of safe, early discharge. Here, the authors describe their initial experience with the
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Theory-based implementation of an enhanced recovery protocol for cranial surgery Neurosurg. Focus (IF 4.1) Pub Date : 2023-12-01 Aimun A. B. Jamjoom, Olivier J. J. Sluijters, Thomas C. H. Yeung, Jack Wildman, George P. Malcolm, Constantinos Charalambides, Venkat Iyer, Neil U. Barua
OBJECTIVE There is growing evidence for the use of enhanced recovery protocols (ERPs) in cranial surgery. As they become widespread, successful implementation of these complex interventions will become a challenge for neurosurgical teams owing to the need for multidisciplinary engagement. Here, the authors describe the novel use of an implementation framework (normalization process theory [NPT]) to
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Gender diversity in neurosurgical training: an analysis of trends and resident program characteristics Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Grace R. Fassina, Emily E. Nguyen, Helen H. Shi, Caple A. Spence
OBJECTIVE Recent trends have shown more women entering neurosurgery, but large gender gaps in the number of female trainees continue to persist. A previous study on the gender diversity of residents and faculty in neurosurgery training programs found that only 18.2% of residents and 8.7% of faculty at neurosurgical training programs were female. The goal of this study was to better understand program
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Healthcare disparities in pituitary surgery: a systematic review Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Mohammadmahdi Sabahi, Seyed Farzad Maroufi, Adrianna Wierzbicka, Lana Maniakhina, Badih Adada, Hamid Borghei-Razavi
OBJECTIVE Pituitary surgery is a frequent neurosurgical procedure for the management of pituitary adenomas, but little research has been done on the impact of healthcare disparities on surgical results. Healthcare inequity/disparity in terms of race and socioeconomic status (SES), in addition to age and gender, was evaluated in this study to see if they affect the results of pituitary surgery. METHODS
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Reducing implicit bias in the neurosurgery application and interview process: a single-institution experience Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Georgia M. Wong, Kelsey Cobourn, Kitara Smith, Michael M. Covell, Ehsan Dowlati, Jeffrey M. Breton, Gnel Pivazyan, M. Nathan Nair
OBJECTIVE The neurosurgical match is a challenging process for applicants and programs alike. Programs must narrow a wide field of applicants to interview and then determine how to rank them after limited interaction. To streamline this, programs commonly screen applicants using United States Medical Licensing Examination (USMLE) Step scores. However, this approach removes nuance from a consequential
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The role of limited access to students from more diverse nonfeeder medical schools in creating diversity inequities in neurosurgical residency Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Benjamin R. Klein, Mareshah N. Sowah, Allan D. Levi
OBJECTIVE Improving racial/ethnic diversity in neurosurgery is a long-standing issue that needs to be addressed. The positive correlation between medical students with home neurosurgery programs and successful matriculation into neurosurgical residency is well documented. In this article, the authors explored the relationship between decreased racial/ethnic diversity in neurosurgery residency programs
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County-level disparities in care for patients with glioblastoma Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Rishab Ramapriyan, Tarun Ramesh, Hao Yu, Leland G. Richardson, Brian V. Nahed, Bob S. Carter, Fred G. Barker, William T. Curry, Bryan D. Choi
OBJECTIVE Racial and socioeconomic disparities in neuro-oncological care for patients with brain tumors remain underexplored. This study aimed to analyze county-level disparities in glioblastoma (GBM) care in the United States, focusing on access to surgery and the use of adjuvant temozolomide chemotherapy and radiation therapy. METHODS Using repeated cross-sectional data from the Surveillance, Epidemiology
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Racial and gender disparities in traumatic brain injury clinical trial enrollment Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Momodou G. Bah, Anant Naik, Umaru Barrie, Rajiv Dharnipragada, Sonia V. Eden, Paul M. Arnold
OBJECTIVE Despite the increasing number of women and racial/ethnic minorities sustaining traumatic brain injuries (TBIs), they are underrepresented in TBI clinical trials. This study aimed to evaluate gender and racial diversity in enrolled cohorts of TBI clinical trials to identify trends and predictors of increased disparity over time. METHODS The authors reviewed TBI clinical trials with reported
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Assessing the state of LGBTQ+ diversity and inclusion in neurosurgery Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Brian D. Foresi, Karolina Pellot, Saif S. Quadri, Logan Muzyka, Sarah White, Cynthia Uzoukwu, Susan C. Pannullo
OBJECTIVE The aim of this study was to assess the diversity of neurosurgeons in terms of lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+) gender and sexual minority status using the Graduation Questionnaire (GQ) as the single nationalized source of LGBTQ+ identification. Additionally, inclusivity was assessed through interviews by residents and attendings in the field. METHODS First, a PRISMA
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The neurosurgeon workforce: a geographical gender-focused analysis of the trends in representation of neurosurgeons and choices in training over 70 years Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Alexander D. Smith, Alexa R. Lauinger, Maxine Arnush, Annabelle Shaffer, Aliya Siddiqui, Ashutosh Nayak, Paul M. Arnold, Suguna Pappu, Albert Yu, Ann Stroink, Wael Hassaneen
OBJECTIVE Neurosurgeons frequently move throughout their careers, with moves driven by personal and professional factors. In this study, the authors analyzed these migration trends through a dynamic migratory map and statistical review, with a particular focus on differences in education and practice patterns between male and female neurosurgeons. METHODS A list containing all board-certified and -affiliated
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Utility of the material community deprivation index as a metric to identify at-risk children for severe traumatic brain injury Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Amber L. Gaulden, Stephen Trinidad, Suzanne Moody, Meera Kotagal, Francesco T. Mangano, Smruti K. Patel
OBJECTIVE Pediatric traumatic brain injury (TBI) is a significant cause of morbidity and mortality with lasting effects including neurological deficits and psychological comorbidities. Recent studies have shown that social determinants of health are key factors that impact clinical outcomes in other pediatric traumatic injuries, suggesting that these health disparities may have a significant impact
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Greater improvement in Neck Disability Index scores in women after surgery for cervical myelopathy: an analysis of the Quality Outcomes Database Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Arati Patel, Sravani Kondapavulur, Gray Umbach, Andrew K. Chan, Vivian P. Le, Erica F. Bisson, Mohamad Bydon, Dean Chou, Steve D. Glassman, Kevin T. Foley, Christopher I. Shaffrey, Eric A. Potts, Mark E. Shaffrey, Domagoj Coric, John J. Knightly, Paul Park, Michael Y. Wang, Kai-Ming Fu, Jonathan Slotkin, Anthony L. Asher, Michael S. Virk, Regis W. Haid, Oren Gottfried, Scott Meyer, Cheerag D. Upadhyaya
OBJECTIVE There is a high prevalence of cervical myelopathy that requires surgery; as such, it is important to identify how different groups benefit from surgery. The American Association of Neurological Surgeons launched the Quality Outcomes Database (QOD), a prospective longitudinal registry, that includes demographic, clinical, and patient-reported outcome data to measure the safety and quality
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Racial disparities in incidence, treatment, and survival in adult brain metastases: a 10-year national database analysis Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Sam H. Jiang, Mounika Bhaskara, Daniel Deysher, Morteza Sadeh, John Souter, Ankit I. Mehta
OBJECTIVE The aim of this study was to assess demographic and racial disparities in incidence, treatment, and survival of adults with metastatic malignancy to the brain. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) Program database, the authors identified adults with nonprimary brain metastases between 2010 and 2019. Incidence was calculated for all 10 years while data from
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Effect of online public domain representation in neurosurgical resident recruitment and decision-making Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Cierra N. Harper, Sonia Eden, William W. Ashley
OBJECTIVE Over the past 20 years, female representation in neurosurgical residency programs has steadily increased. Still, the number of Black women and Black neurosurgical residents overall has remained stagnant. The authors aimed to understand the factors that led to this stagnation and how online public domain representation informs current and upcoming resident recruitment and decision-making.
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Gender concordance and publication productivity within Neurosurgical Focus: a 10-year review (2013–2022) Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Joanna M. Roy, Aaron Segura, Georgios P. Skandalakis, Kavelin Rumalla, Emily Estes, Javed Iqbal, Muhammad Asjad Riaz, Rachel Sidebottom, Meic H. Schmidt, Christian A. Bowers
OBJECTIVE The "leaky academic pipeline" describes how female representation in leadership positions has remained stagnant despite an increase in the number of female trainees. Female mentorship to female mentees, and female role models at higher academic positions have been shown to positively influence academic productivity. To the authors’ knowledge, the impact of female editorial board representation
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Scoping review on the state of racial disparities literature in the treatment of neurosurgical disease: a call for action Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Edwin Owolo, Andreas Seas, Brandon Bishop, Jacob Sperber, Zoey Petitt, Alissa Arango, Seeley Yoo, Sharrieff Shah, Julia B. Duvall, Eli Johnson, Nancy Abu-Bonsrah, Samantha Kaplan, Sonia Eden, William W. Ashley, Theresa Williamson, C. Rory Goodwin
OBJECTIVE Racial disparities are ubiquitous across medicine in the US. This study aims to assess the evidence of racial disparities within neurosurgery and across its subspecialties, with a specific goal of quantifying the distribution of articles devoted to either identifying, understanding, or reducing disparities. METHODS The authors searched the MEDLINE, EMBASE, and Scopus databases by using keywords
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A decade of diversity: using statistical indices to compare neurosurgery to other surgical specialties. Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Elijah M Persad-Paisley,Sarah A Uriarte,Ziqi Wang,Owen P Leary,Jay R Gopal,Mariah Balmaceno-Criss,Albert E Telfeian,Deus J Cielo
OBJECTIVE Studies have demonstrated the benefits of diversity in neurosurgery. However, recruitment of minoritized groups within the neurosurgical workforce consistently lags other surgical specialties. While racial and gender demographics of neurosurgical residents are well documented, there has been minimal exploration into the multidimensional nature of diversity. The current study will evaluate
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Introduction. Diversity, equity, and inclusion and the goal of reducing healthcare disparities in neurosurgery. Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 William W Ashley,Sonia Eden,Richard T Benson,Jeffrey L Nadel,William A McDade,Wale Sulaiman,Sandra Elizabeth Ford
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Letter to the Editor. Tonsillectomy in Chiari malformation type I: is it always the right choice? Neurosurg. Focus (IF 4.1) Pub Date : 2023-11-01 Francesca Rizzo,Raffaele De Marco,Gianluca Piatelli,Marco Pavanello