Introducing the Neurosurgery Journal Club
Neurosurgery is pleased to announce the introduction of an exciting new feature – Journal Club. This feature will capitalize on and extend the existing practice of Journal Club common to all neurosurgical training programs where resident and fellows critically review published articles under the guidance of faculty.
The specific aims of this new feature are to:
1. Foster the education of residents and fellows and provide an enhanced opportunity for the next generation of reviewers to hone their skills.
2. Publish the best scholarly reviews by neurosurgical residents/fellows based on top-ranked articles recently published in Neurosurgery.
Quarterly, the best Journal Club review, adjudged by our dedicated Journal Club Review Panel, will be published in the print edition of Neurosurgery, and the “winning” program and institution will be prominently highlighted in the Table of Contents. The 4 runner-up reviews will be featured online.
Free Article: Endoscopy in Aneurysm Surgery
Background: Surgical clipping with complete occlusion of the aneurysm and preservation of parent, branching, and perforating vessels remains the most definitive treatment for intracranial aneurysms.
Objective: To evaluate the benefit of endoscopic application during microsurgical procedures in a retrospective study.
Methods: One hundred eighty aneurysms were microsurgically treated in 124 operations. Three different applications of endoscopic visualization were used, depending on the respective requirements: inspection before clipping, clipping under endoscopic view, and postclipping evaluation.
Article Collection: Cerebrovascular
This collection lists the top cited cerebrovascular articles published in Neurosurgery from 2009 to 2012. The list will be regularly updated to reflect new citations. All citation data has been provided by ISI Web of Science.
Ahead of Print: Silent Corticotroph Adenomas
Background: Silent corticotroph adenomas (SCA) are clinically non-functioning pituitary adenomas (NFPA) with positive staining for ACTH by immunohistochemistry. Whether SCA behave more aggressively than NFPA without ACTH-immunoreactivity (ACTH-negative) remains controversial.
Objective: To compare characteristics and outcomes of SCA with ACTH-negative NFPA and to identify predictors of aggressive outcome. Primary composite endpoint included the first of any of the following events: progression, recurrence, or death.
Methods: We reviewed all cases of SCA and all ACTH-negative macroadenomas operated between 4/1995-12/2007 by one neurosurgeon.
Response Letter to the Editor, “Corticosteroid Suppression of Vascular Endothelial Growth Factor and Recurrence of Chronic Subdural Hematoma”
We read with interest the Letter to the Editor titled Corticosteroid Suppression of Vascular Endothelial Growth Factor and Recurrence of Chronic Subdural Hematoma in response to our article “Clinical Factors Associated With Outcome in Chronic Subdural Hematoma: A Retrospective Cohort Study of Patients on Preoperative Corticosteroid Therapy.”1 We would like to address our compliments to the authors for their careful reading of our article and addition of insights about corticosteroid therapy in patients with chronic subdural hematoma (CSDH). Indeed, the mechanism(s) of action of corticosteroids in CSDH has not been fully elucidated. CSDH, having an inflammatory and angiogenic component in its pathological mechanism, may benefit from the anti-inflammatory, antiangiogenic, as well as the proresorbent effects of corticosteroids. Circumstantial evidence exists of its presumed mechanisms of action in CSDH, with key targets suggested to be, for example, vascular endothelial growth factor (VEGF), basic fibrinogenic growth factor (bFGF), and interleukins (ILs).
Editor Choice: Flash Fluorescence for MCA Bypass
Background: Distal middle cerebral artery (MCA) aneurysms frequently have nonsaccular morphology that necessitates trapping and bypass. Bypasses can be difficult because efferent arteries lie deep in the opercular cleft and may not be easily identifiable.
Objective: We introduce the “flash fluorescence” technique, which uses videoangiography with indocyanine green (ICG) dye to identify an appropriate recipient artery on the cortical surface for the bypass, enabling a more superficial and easier anastomosis.
Methods: Flash fluorescence requires 3 steps: (1) temporary clip occlusion of the involved afferent artery; (2) videoangiography demonstrating fluorescence in uninvolved arteries on the cortical surface; and (3) removal of the temporary clip with flash fluorescence in the involved efferent arteries on the cortical surface, thereby identifying a recipient. Alternatively, temporary clips can occlude uninvolved arteries, and videoangiography will demonstrate initial fluorescence in efferent arteries during temporary occlusion and flash fluorescence in uninvolved arteries during reperfusion.
