Ahead of Print: Survival of Cerebellar Glioblastoma Patients

Background: Cerebellar glioblastoma multiforme (cGBM) is rare, and although there is a general sentiment that these tumors have worse prognosis than supratentorial GBM (sGBM), few studies have been published to support this belief.

Objective: To investigate the effect of cerebellar location on survival through a case control design comparing overall survival time between cGBM and sGBM patients.

Methods: Surveillance, Epidemiology, and End Results (SEER) registry was used to identify 132 patients with cGBM (1973-2008). Each cGBM patient was matched with an sGBM patient from among 20,848 sGBM patients on the basis of age, extent of resection, decade of diagnosis, and radiation therapy using propensity score matching.

Ahead of Print: Safety of Hybrid Electrodes for Single Neuron Recordings in Humans

Background: Intracranial in vivo recordings of individual neurons in humans are increasingly performed for a better understanding of the mechanisms of epileptogenesis and of the neurobiological basis of cognition. So far, information about the safety of stereotactic implantations and of MR imaging with hybrid depth electrodes is scarce.

Objective: To assess neurosurgical safety of implantations, recordings, and imaging using hybrid electrodes in humans.

Methods: Perioperative and long-term safety of implantation of a total of 88 hybrid depth electrodes with integrated microwires was assessed retrospectively in 25 consecutive epilepsy patients implanted from 2007 to 2011 based on electronically stored charts. Safety aspects of MR imaging are reported from both in vitro and in vivo investigations. Precision of electrode implantation is evaluated based on intraoperative computerized tomography (CT) and pre- and postoperative magnetic resonance imaging (MRI).

Ahead of Print: The Indusium Griseum

Background: Although the indusium griseum (IG) is often seen by the neurosurgeon, almost nothing exists in the literature regarding its anatomic structure. Some have postulated that this structure is a remnant of the hippocampus, and some have found memory deficits in patients following callosotomy

Objective: To further investigate the anatomy of the IG in humans through gross and histologic analysis.

Methods: The IG from 10 adult cadaveric brains underwent microdissection and immunohistochemical analysis.

Ahead of Print: Mobilization of the Sphenoparietal Sinus

Background and Importance: Bridging veins arising from the frontal base (frontobasal bridging veins, FBBVs) can pose obstacles when performing clipping of anterior communicating artery (ACoA) aneurysms via the pterional approach. While FBBVs can be generally sacrificed without critical complications to achieve an adequate retraction of the frontal lobe, neurosurgeons sometimes encounter postoperative venous infarction or contusion of the retracted frontal lobe, which may be accounted for by the damage to the venous drainage system. Thus, preservation of intracranial veins is desirable to prevent postoperative venous complications, especially when they are prominent.

Clinical Presentation: A 66-year-old female patient was revealed to have multiple unruptured aneurysms at the ACoA, bilateral middle cerebral arteries (MCAs) and the left internal carotid artery. In the first stage of the operation, clipping of the right MCA and ACoA aneurysms was performed via a right pterional approach. Because the ACoA aneurysm was located at a high position and projecting posteriorly, a transsylvian ‘lateral’ trajectory was preferred to a subfrontal ‘anterior’ trajectory. Intraoperatively, her FBBV was revealed to be so prominent that the sacrifice would be harmful. Thus, we performed posteriorward displacement of the sphenoparietal sinus extradurally, thereby achieving adequate retraction of the frontal lobe intradurally without sacrificing the FBBV. With this simple technique, the ACoA aneurysm was successfully treated.

Ahead of Print: ACDF Outcomes in Professional Athletes

Background: Significant controversy exists regarding when an athlete may return to contact sports following anterior cervical discectomy and fusion (ACDF). Return-to-play (RTP) recommendations are complicated due to a mix of medical factors, social pressures, and limited outcome data.

Objective: To characterize our diagnostic and surgical criteria, intervention, post-operative imaging results, and rehabilitation and report RTP decisions and outcomes for professional athletes with cervical spine injuries.

Methods: Fifteen professional athletes who had undergone a one-level ACDF by a single neurosurgeon were identified following a retrospective review from 2003 to 2012. Patient records and imaging studies were recorded.