Free Editor Choice: Results of Universal Protocol Implementation

Background: Although exceedingly rare, wrong-site surgery (WSS) remains a persistent problem in the United States. The incidence is thought to be 2 to 3 per 10 000 craniotomies and about 6 to 14 per 10 000 spine surgeries. In July 2004, the Joint Commission mandated the Universal Protocol (UP) for all accredited hospitals.

Objective: To assess the effect of UP implementation on the incidence of neurosurgical WSS at the University of Illinois College of Medicine at Peoria/Illinois Neurological Institute.

Methods: The Morbidity and Mortality Database in the Department of Neurosurgery was reviewed to identify all recorded cases of WSS since 1999. This was compared with the total operative load (excluding endovascular procedures) of all attending neurosurgeons to determine the incidence of overall WSS. A comparison was then made between the incidences before and after UP implementation.

Free Editor Choice with CME: Cavernous Malformation of Brainstem, Thalamus, and Basal Ganglia

Background: Cavernous malformations (CMs) in deep locations account for 9% to 35% of brain malformations and are surgically challenging.

Objective: To study the clinical features and outcomes following surgery for deep CMs and the complication of hypertrophic olivary degeneration (HOD).

Methods: Clinical records, radiological findings, operative details, and complications of 176 patients with deep CMs were reviewed retrospectively.

Free Editor Choice: Extracellular Vesicles in Neuro-oncology

The discovery that tumor-derived proteins and nucleic acids can be detected in nano-sized vesicles in the plasma and cerebrospinal fluid of patients afflicted with brain tumors has expanded opportunities for biomarker and therapeutic discovery. Through delivery of their contents to surrounding cells, exosomes, microvesicles, and other nano-sized extracellular vesicles secreted by tumors modulate their environment to promote tumor growth and survival. In this review, we discuss the biological processes mediated by these extracellular vesicles and their applications in terms of brain tumor diagnosis, monitoring, and therapy. We review the normal physiology of these extracellular vesicles, their pertinence to tumor biology, and directions for research in this field.

Free Editor Choice: In-Stent Stenosis After Stent-Assisted Coiling

Background: Neuroform and Enterprise are widely used self-expanding stents designed to treat wide-necked intracranial aneurysms.

Objective: To assess the incidence, clinical significance, predictors, and outcomes of in-stent stenosis (ISS).

Methods: Angiographic studies and hospital records were retrospectively reviewed for 435 patients treated between 2005 and 2011 in our institution. A multivariable regression analysis was conducted to determine the predictors of ISS.

Editor Choice: Syringomyelia and Spinal Arachnoiditis

Background: Disturbances of cerebrospinal fluid (CSF) flow are the commonest cause of syringomyelia. Spinal arachnopathies may lead to CSF flow obstructions but are difficult to diagnose. Consequently, associated syringomyelias are often categorized as idiopathic.

Objective: To present and analyze the diagnosis of and long-term outcomes in an observational study of patients with nontraumatic arachnopathies from 1991 to 2011.

Methods: A total of288 patients (mean age, 47 ± 15 years; follow-up, 54 ± 46 months) were evaluated. Decompression with arachnolysis, untethering, and duraplasty for restoration of CSF flow was recommended to patients with neurological progression. Neurological examinations, magnetic resonance images, and follow-up data were evaluated. Individual symptoms were analyzed during the first postoperative year, and long-term outcomes were analyzed with Kaplan-Meier statistics to determine rates of progression-free survival.