Cerebrovascular Video Collection

Bypass for Complex Basilar Aneurysms

Basilar Tip Aneurysms: Video 1

Basilar Tip Aneurysms: Video 2

Hemodynamics at a Rupture Site

Trapping and Thrombectomy 3-D

ICG and LSCI Imaging

Objective: To determine whether ANNs perform better at predicting 1-year survival in a group of patients with brain metastasis compared with traditional predictive tools.

Methods: ANNs were trained on a multi-institutional data set of radiosurgery patients to predict 1-year survival on the basis of several input factors. A single ANN, an ensemble of 5 ANNs, and logistic regression analyses were compared for efficacy. Sensitivity analysis was used to identify important variables in the ANN model.

Results: A total of 196 patients were divided up into training, testing, and validation data sets consisting of 98, 49, and 49 patients, respectively. Patients surviving at 1 year tended to be female (P = .001) and of good performance status (P = .01) and to have favorable primary tumor histology (P = .001). The pooled voting of 5 ANNs performed significantly better than the multivariate logistic regression model (P = .02), with areas under the curve of 84% and 75%, respectively. The ensemble also significantly outperformed 2 commonly used prognostic indexes. Primary tumor subtype and performance status were identified on sensitivity analysis to be the most important variables for the ANN.

Conclusion: ANNs outperform traditional statistical tools and scoring indexes for predicting individual patient prognosis. Their facile implementation, robustness in the presence of missing data, and ability to continuously learn make them excellent choices for use in complicated clinical environments.

From: Predicting Survival in Patients With Brain Metastases Treated With Radiosurgery Using Artificial Neural Networks by Oermann et al.

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Objective: To determine the relationship between hearing and tumor growth in patients undergoing conservative VS management.

Methods: Patients harboring bilateral VS with at least 1 year of radiological follow-up were selected. Conservative management was proposed based on the small tumor size and/or serviceable hearing at presentation. Tumor size was calculated by using the 2-component box model and reported as mean tumor diameter. Hearing was evaluated by using pure-tone average and the American Academy of Otololaryngologists and Head and Neck Surgery classification.

Results: Forty-six patients harboring 92 VS were included. The mean clinical and radiological follow-up times were 6.0 and 4.2 years, respectively. The mean tumor diameter was 13 mm at presentation and 20 mm at the end of follow-up. Mean tumor growth rate was 1.8 mm/year. During follow-up, 17 patients (37%) underwent surgery for VS. Surgery-free rate for VS was 88% at 5 years. The number of patients with at least 1 serviceable ear was 39 (85%) at presentation and 34 (74%) at the end of follow-up, including 22 (66%) with binaural serviceable hearing maintained. There was no statistical correlation between tumor growth rate and preservation of serviceable hearing. Tumor growth rates and age at presentation were inversely correlated.

Conclusion: This study illustrates the high variability among neurofibromatosis type 2 patients regarding hearing status and VS growth rate and justifies the choice of initial conservative management in selected cases.

From: Conservative Management of Bilateral Vestibular Schwannomas in Neurofibromatosis Type 2 Patients: Hearing and Tumor Growth Results by Peyre et al.

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This video has been taken from Dura Splitting Decompression for Chiari I Malformation in Pediatric Patients: Clinical Outcomes, Healthcare Costs and Resource Utilization. It was submitted by corresponding author Nathan R Selden, MD, PhD, from the Department of Neurological Surgery at Oregon Health & Science University in Portland, Oregon.

June 2013 Operative Neurosurgery Table of Contents:

OPERATIVE NUANCES

Contemporary Surgical Management of Vestibular Schwannomas: Analysis of Complications and Lessons Learned Over the Past Decade
Nonaka, Yoichi; Fukushima, Takanori; Watanabe, Kentaro; Friedman, Allan H.; Sampson, John H.; Mcelveen, John T. Jr; Cunningham, Calhoun D. III; Zomorodi, Ali R.

Flow Diversion Radial Artery Bypass Graft Coupled With Terminal Basilar Artery Occlusion for the Treatment of Complex Basilar Apex Aneurysms: Operative Nuances
Mai, Jeffrey C.; Tariq, Farzana; Kim, Louis J.; Sekhar, Laligam N.

INSTRUMENTATION AND TECHNIQUE

Relationship Between Laser Doppler Signals and Anatomy During Deep Brain Stimulation Electrode Implantation Toward the Ventral Intermediate Nucleus and Subthalamic Nucleus
Wårdell, Karin; Zsigmond, Peter; Richter, Johan; Hemm, Simone

TECHNIQUE ASSESSMENT

Intra-arterial Injection Fluorescein Videoangiography in Aneurysm Surgery
Kuroda, Katsuhiro; Kinouchi, Hiroyuki; Kanemaru, Kazuya; Nishiyama, Yoshihisa; Ogiwara, Masakazu; Yoshioka, Hideyuki; Horikoshi, Toru

Intraoperative Visualization of Residual Tumor: The Role of Perfusion-Weighted Imaging in a High-Field Intraoperative Magnetic Resonance Scanner
Roder, Constantin; Bender, Benjamin; Ritz, Rainer; Honegger, Jürgen; Feigl, Günther; Naegele, Thomas; Tatagiba, Marcos Soares; Ernemann, Ulrike; Bisdas, Sotirios

5-Aminolevulinic Acid Fluorescence-Guided Resection of Intramedullary Ependymoma: Report of 9 Cases
Inoue, Tomoo; Endo, Toshiki; Nagamatsu, Kenichi; Watanabe, Mika; Tominaga, Teiji

Intraoperative Monitoring of an Aspect of Executive Functions: Administration of the Stroop Test in 9 Adult Patients During Awake Surgery for Resection of Frontal Glioma
Wager, Michel; Du Boisgueheneuc, Foucaud; Pluchon, Claudette; Bouyer, Coline; Stal, Veronique; Bataille, Benoit; Guillevin, Carole Menuel; Gil, Roger

3-D VIDEO

Contralateral Transcallosal Approach to Basal Ganglia Cavernous Malformation: 3-Dimensional Operative Video
Rodríguez-Hernández, Ana; Lawton, Michael T.

Microsurgical Resection of Large Medial Sphenoid Wing Meningiomas: Technique
Rey-Dios, Roberto; Cohen-Gadol, Aaron A.

SURGICAL ANATOMY AND TECHNIQUE

Deep Brain Stimulation of the Lateral Habenular Complex in Treatment-Resistant Depression: Traps and Pitfalls of Trajectory Choice
Schneider, Till M.; Beynon, Christopher; Sartorius, Alexander; Unterberg, Andreas W.; Kiening, Karl L.

The Intracranial Facial Nerve as Seen Through Different Surgical Windows: An Extensive Anatomosurgical Study
Bernardo, Antonio; Evins, Alexander I.; Visca, Anna; Stieg, Phillip E.

COMPLICATION

Iatrogenic Vascular Complications Associated With External Ventricular Drain Placement: A Report of 8 Cases and Review of the Literature
Kosty, Jennifer; Pukenas, Bryan; Smith, Michelle; Storm, Phillip B.; Zager, Eric; Stiefel, Michael; LeRoux, Peter; Hurst, Robert

Management of Operative Complications Related to Occipitocervical Instrumentation
Ahmed, Raheel; Menezes, Arnold H.

Delayed Migration of a Pipeline Embolization Device
Chalouhi, Nohra; Satti, Sudhakar R.; Tjoumakaris, Stavropoula; Dumont, Aaron S.; Gonzalez, L. Fernando; Rosenwasser, Robert; Jabbour, Pascal

TECHNICAL CASE REPORT

Simplified Azygos Anterior Cerebral Bypass: Y-Shaped Superficial Temporal Artery Interposition Graft From A2 With Double Reimplantation of Pericallosal Arteries: Technical Case Report
Mura, Jorge; Riquelme, Francisco; Cuevas, José Luis; Luna, Felipe; Vizhñay, Pablo

Solitaire FR Stent as an Adjunctive Tool for Pipeline Stent Deployment in the Treatment of Giant Intracranial Aneurysms
Clarençon, Frédéric; Wyse, Gerald; Fanning, Noel; Di Maria, Federico; Gaston, André; Chiras, Jacques; Sourour, Nader

Delayed Retraction of the Pipeline Embolization Device and Corking Failure: Pitfalls of Pipeline Embolization Device Placement in the Setting of a Ruptured Aneurysm
McTaggart, Ryan A.; Santarelli, Justin G.; Marcellus, Mary L.; Steinberg, Gary K.; Dodd, Robert L.; Do, Huy M.; Marks, Michael P.

Objective: We conducted a systemic review and meta-analysis to determine the risks and benefits of stereotactic biopsy for BSTs.

Methods: A systematic search in PubMed, Embase, and the Web of Science yielded 3766 potentially eligible abstracts. Meta-analysis was conducted on 38 studies describing 1480 biopsy procedures for BSTs. Primary outcome measures were diagnostic success and procedure-related complications. Data were analyzed according to standard meta-analytic techniques.

Results: The weighted average proportions across the analyzed studies were: 96.2% (95% confidence interval [CI]: 94.5%-97.6%) for diagnostic success, 7.8% (95% CI: 5.6%-10.2%) for overall morbidity, 1.7% (95% CI: 0.9%-2.7%) for permanent morbidity, and 0.9% (95% CI: 0.5%-1.4%) for mortality. Meta-regression revealed a significant correlation between diagnostic success rates and the number of biopsy procedures performed annually in each center (P = .011). Other factors did not affect the outcome measures.

Conclusion: Stereotactic biopsy of BSTs is safe. It allows exact histopathological diagnosis as a prerequisite for adequate treatment and opens new perspectives for the molecular characterization of these tumors as a crucial first step toward more individualized treatment concepts.

From: Diagnostic Value and Safety of Stereotactic Biopsy for Brainstem Tumors: A Systematic Review and Meta-analysis of 1480 Cases by Kickingereder et al.

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SANS Neurosurgery members can earn CME credits from this article.

Combining the power of neurosurgery’s most popular online learning resource with its most influential peer-reviewed journal, SANS Neurosurgery offers subscribers the resources to stay ahead in the rapidly moving field. Test your knowledge and neurosurgical decision-making skills with questions pulled from each issue of Neurosurgery. This SANS product provides users with the latest pearls and constantly evolving information from the latest scientific neurosurgery articles.

June 2013 Table of Contents:

SCIENCE TIMES

Competitive Kaisers: The Future of American Healthcare Is Vertically Integrated Accountable Care Organizations Where Patient Members Pay for Health Care Instead of Health Insurance
Zusman, Edie; Reagan, Rex

Putting on the Brakes: Evidence for Seizure Inhibition and Resistance in Human Microelectrode Recordings
Anderson, WS

Blood Pressure Control for Spontaneous Intracerebral Hemorrhage: Does Blood Pressure Control Cause Perihematoma Ischemia?
El Ahmadieh, Tarek Y.; El Tecle, Najib E.; Lall, Rishi R.; Park, Anne E.; Bendok, Bernard R.

The Intersection Between Genetic Engineering and Immunotherapy: Taking a BiTE out of Glioblastoma
Njoku, Innocent Jr; Boockvar, John A.

Magnetic Resonance Imaging Utility in Following Sciatica and Disc Herniation After Treatment
Chi, John H.

Genomic Analysis of Non-Neurofibromatosis Type 2 Meningiomas
Parry, Phillip V.; Engh, Johnathan A.

Inflammation Triggered by Traumatic Brain Injury May Continue to Harm the Brain for a Lifetime
Monaco, Edward A. III; Tempel, Zachary; Friedlander, Robert M.

Neuroanatomy Changes With Repetitive Mild Head Injury in Athletes
Jandial, Rahul; Duenas, Matthew J.; Chen, Mike Y.

Endovascular Therapy in Acute Ischemic Stroke
Starke, Robert M.; Komotar, Ricardo J.; Connolly, E. Sander

Abnormal Cortical Brain Rhythms in Parkinson Disease
Richardson, R. Mark

The Identification of a Nucleus Pulposus Progenitor Cell Population: A Tie to the Spinal Disc Degenerative Disease?
Lu, Yi; Wang, Michael Y.

REVIEW

Diagnostic Value and Safety of Stereotactic Biopsy for Brainstem Tumors: A Systematic Review and Meta-analysis of 1480 Cases
Kickingereder, Philipp; Willeit, Peter; Simon, Thorsten; Ruge, Maximilian I.

RESEARCH-HUMAN-CLINICAL STUDIES

Treatment of Posterior Circulation Aneurysms With the Pipeline Embolization Device
Chalouhi, Nohra; Tjoumakaris, Stavropoula; Dumont, Aaron S.; Gonzalez, L. Fernando; Randazzo, Ciro; Starke, Robert M.; Rosenwasser, Robert H.; Jabbour, Pascal

Patients With Refractory Epilepsy Treated Using a Modified Multiple Subpial Transection Technique
Ntsambi-Eba, Glennie; Vaz, Géraldo; Docquier, Marie-Agnès; van Rijckevorsel, Kenou; Raftopoulos, Christian

Proximal Junctional Kyphosis in Primary Adult Deformity Surgery: Evaluation of 20 Degrees as a Critical Angle
Bridwell, Keith H.; Lenke, Lawrence G.; Cho, Samuel K.; Pahys, Joshua M.; Zebala, Lukas P.; Dorward, Ian G.; Cho, Woojin; Baldus, Christine; Hill, Brian W.; Kang, Matthew M.

Prognostic Value of Residual Fluorescent Tissue in Glioblastoma Patients After Gross Total Resection in 5-Aminolevulinic Acid-Guided Surgery
Aldave, Guillermo; Tejada, Sonia; Pay, Eva; Marigil, Miguel; Bejarano, Bartolomé; Idoate, Miguel A.; Díez-Valle, Ricardo

Dura Splitting Decompression for Chiari I Malformation in Pediatric Patients: Clinical Outcomes, Healthcare Costs, and Resource Utilization
Litvack, Zachary N.; Lindsay, Rebecca A.; Selden, Nathan R.

Hemangioblastomas and Neurogenic Polyglobulia
Gläsker, Sven; Krüger, Marie T.; Klingler, Jan-Helge; Wlodarski, Marcin; Klompen, Julia; Schatlo, Bawarjan; Hippchen, Beate; Neumann, Hartmut P.H.; Van Velthoven, Vera

Cerebral Hyperperfusion Syndrome After Superficial Temporal Artery-middle Cerebral Artery Bypass for Severe Intracranial Steno-occlusive Disease: A Case Control Study
Teo, Kejia; Choy, David K.S.; Lwin, Sein; Ning, Chou; Yeo, Tseng Tsai; Shen, Liang; Chong, Vincent F.; Teoh, Hock L.; Seet, Raymond C.; Chan, Bernard P.L.; Sharma, Arvind K.; Sharma, Vijay K.

Predicting Survival in Patients With Brain Metastases Treated With Radiosurgery Using Artificial Neural Networks
Oermann, Eric K.; Kress, Marie-Adele S.; Collins, Brian T.; Collins, Sean P.; Morris, David; Ahalt, Stanley C.; Ewend, Matthew G.

Treatment of Ruptured Intracranial Aneurysms: Comparison of Stenting and Balloon Remodeling
Chitale, Rohan; Chalouhi, Nohra; Theofanis, Thana; Starke, Robert M.; Amenta, Peter; Jabbour, Pascal; Tjoumakaris, Stavropoula; Dumont, Aaron S.; Rosenwasser, Robert H.; Gonzalez, L. Fernando

A Case Series of Primary Central Nervous System Posttransplantation Lymphoproliferative Disorder: Imaging and Clinical Characteristics
Lake, Wendell; Chang, Julie E.; Kennedy, Tabassum; Morgan, Adam; Salamat, Shahriar; Baskaya, Mustafa K.

Analysis of Cervical Sagittal Alignment After Screw-Rod Fixation
Heary, Robert F.; Choudhry, Osamah J.; Jalan, Devesh; Agarwal, Nitin

A Simple Protocol to Prevent External Ventricular Drain Infections
Flint, Alexander C.; Rao, Vivek A.; Renda, Natalie C.; Faigeles, Bonnie S.; Lasman, Todd E.; Sheridan, William

Long-term Economic Impact of Coiling vs Clipping for Unruptured Intracranial Aneurysms
Lad, Shivanand P.; Babu, Ranjith; Rhee, Michael S.; Franklin, Robbi L.; Ugiliweneza, Beatrice; Hodes, Jonathan; Nimjee, Shahid M.; Zomorodi, Ali R.; Smith, Tony P.; Friedman, Allan H.; Patil, Chirag G.; Boakye, Maxwell

Conservative Management of Bilateral Vestibular Schwannomas in Neurofibromatosis Type 2 Patients: Hearing and Tumor Growth Results
Peyre, Matthieu; Goutagny, Stéphane; Bah, Alpha; Bernardeschi, Daniele; Larroque, Béatrice; Sterkers, Olivier; Kalamarides, Michel

An Outcome Study for Ulnar Neuropathy at the Elbow: A Multicenter Study by the Surgery for Ulnar Nerve (SUN) Study Group
Song, Jae W.; Waljee, Jennifer F.; Burns, Patricia B.; Chung, Kevin C.; Gaston, R. Glenn; Haase, Steven C.; Hammert, Warren C.; Lawton, Jeffrey N.; Merrell, Greg A.; Nassab, Paul F.; Yang, Lynda J.S.; for the Surgery for the Ulnar Nerve (SUN) Study Group

SPECIAL ARTICLE

Off-Label Use of Drugs and Devices: Role of Medical Professionals in the Establishment of Parameters for Their Use
Long, Donlin; Watts, Clark

RESEARCH-LABORATORY

Biomechanical Evaluation of the Craniovertebral Junction After Anterior Unilateral Condylectomy: Implications for Endoscopic Endonasal Approaches to the Cranial Base
Perez-Orribo, Luis; Little, Andrew S.; Lefevre, Richard D.; Reyes, Phillip R.; Newcomb, Anna G.U.S.; Prevedello, Daniel M.; Roldan, Hector; Nakaji, Peter; Dickman, Curtis A.; Crawford, Neil R.

Expression of Indoleamine 2,3-Dioxygenase and Correlation With Pathological Malignancy in Gliomas
Mitsuka, Kentaro; Kawataki, Tomoyuki; Satoh, Eiji; Asahara, Takayuki; Horikoshi, Toru; Kinouchi, Hiroyuki

CONCEPTS, INNOVATIONS AND TECHNIQUES

Distraction, Compression, and Extension Reduction of Basilar Invagination and Atlantoaxial Dislocation: A Novel Pilot Technique
Chandra, P. Sarat; Kumar, Amandeep; Chauhan, Avnish; Ansari, Abuzar; Mishra, Nalin K.; Sharma, Bhawani S.

CASE REPORT

Occipital Sinus Pericranii Superseding Both Jugular Veins: Description of Two Rare Pediatric Cases
Frassanito, Paolo; Massimi, Luca; Tamburrini, Gianpiero; Caldarelli, Massimo; Pedicelli, Alessandro; Di Rocco, Concezio

CORRESPONDENCE

Double Fascicular Nerve Transfer For Elbow Flexion: Is 2 Better Than 1?
Ladak, Adil; Spinner, Robert J.

Background

Objective: We compare the nidal contouring of AVMs using fused images of contrasted computerized tomography (CT) and magnetic resonance (MRI) with matched images of three-dimensional (3-D) cerebral angiography for Cyberknife radiosurgery (CKRS) treatment planning.

Methods: Between May 2009 and April 2012, 3-D cerebral angiography was integrated into CKRS target planning for thirty consecutive patients. The AVM nidal target volumes were delineated using fused CT and MRI scans versus fused CT, MRI, and 3-D cerebral angiography for each patient.

Results: The mean volume of the AVM nidus contoured with the addition of 3-D cerebral angiography to the CT/MRI fusion (9.09 cm3, 95% CI 5.39-12.8 cm3) was statistically smaller than the mean volume contoured with CT/ MRI fused scans alone (14.1 cm3, 95% CI 9.16-19.1 cm3), with a mean volume difference of [delta]=5.01 cm3 (p=0.001). Diffuse AVM nidus was associated with larger mean volume differences in comparison to a compact nidus ([delta]=6.51 vs. 2.11 cm3, p=0.02). The mean volume difference was not statistically associated with the patient’s gender (male [delta]=5.61, female [delta]=5.06, p=0.84), prior hemorrhage status (yes [delta]=5.69, no [delta]=5.23, p=0.86), or prior embolization status (yes [delta]=6.80, no [delta]=5.95, p=0.11).

Conclusion: For brain AVMs treated with CKRS, the addition of 3-D cerebral angiography to CT/MRI fusions for diagnostic accuracy results in a statistically significant reduction in contoured nidal volume as compared to standard CT/MRI fusion-based contouring.

From: Volumetric Analysis of Intracranial Arteriovenous Malformations Contoured for CyberKnife Radiosurgery with 3-D Rotational Angiography versus CT/MRI by Veeravagu et al.

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