March/April 2013

COMING IN MAY/JUNE 2013

Seizures After Aneurysmal Subarachnoid Hemorrhage: ASystematic Review of Outcomes:

Daniel M. S. Raper, Robert M. Starke, Ricardo J. Komotar,Rodney Allan, E. Sander Connolly, Jr.

Surgical Resection of Cavernous Malformations of theBrainstem: Evolution of a Minimally Invasive Technique:Jeffrey C. Mai, Dinesh Ramanathan, Louis J. Kim,

Laligam N. Sekhar

Surgical Treatment and Long-Term Outcomes of ThalamicCavernous Malformations:

Da Li, Junting Zhang, Shuyu Hao, Jie Tang, Xinru Xiao,Zhen Wu, Liwei Zhang

The Long-Term Outcome Predictors of Pure MicrovascularDecompression for Primary Trigeminal Neuralgia:

Heng Zhang, Ding Lei, Chao You, Bo-Yong Mao,Bo Wu, Yuan Fang

The Nervus Intermedius: A Review of Its Anatomy, Function,Pathology, and Role in Neurosurgery:

R. Shane Tubbs, Dominik T. Steck, Martin M. Mortazavi,Aaron A. Cohen-Gadol

Early versus Delayed Endoscopic Surgery for Carpal TunnelSyndrome: Prospective Randomized Study:

P. Sarat Chandra, Pankaj Kumar Singh, Vinay Goyal,Avnish Kumar Chauhan, Nirmal Thakkur,

Manjari Tripathi

Iulius Casserius and the First Anatomically Correct Depictionof the Circulus Arteriosus Cerebri (of Willis):

Matthew Bender, Alessandro Olivi, Rafael J. Tamargo

Pages 457-471

A Primer on Brain–Machine Interfaces, Concepts, and

Technology: A Key Element in the Future of Functional

Neurorestoration

Brian Lee, Charles Y. Liu, Michael J. Apuzzo

Lee et al. discuss the evolution of neurosurgical practicesfrom the primary focus of removing pathology toward thegoals of restoration of function. Advances in both neuroscienceand technology are creating opportunities for surgeons tomodulate neuronal function in patients experiencing pain,neurodegenerative disorders, epilepsy, and even paralysis. Leeet al. discuss the use of both current implantable devices, suchas deep brain stimulators and vagus nerve stimulators, as wellas the technology required for the successful development ofbrain–computer interface devices. The issues relating to thefuture development of these implantable devices and thefunctions that they will restore are discussed.

Pages 472-478

Rationale for Treating Unruptured Intracranial

Aneurysms: Actuarial Analysis of Natural History Risk

versus Treatment Risk for Coiling or Clipping Based on

14,050 Patients in the Nationwide Inpatient Sample

Database

Matthew F. Lawson, Daniel W. Neal, J Mocco, Brian L. Hoh

Lawson et al. queried the Nationwide Inpatient Sample (NIS)database to assess the risks associated with the treatment ofunruptured cerebral aneurysms. Over a 6-year period, thedatabase reported hospitalization for treatment of more than14,000 aneurysms, 53% of which were coiled. The authorsreport mortality rates for coiling and clipping to be 2.17% and2.66%, respectively. The morbidity rates for coiling andclipping were 2.16% and 4.75%, respectively. The authorsthen used actuarial analysis to demonstrate a treatment benefitfor clipping for patients younger than 70 years of age and forcoiling for patients younger than 81 years of age. These datashow benefits for treatment for ages older than previouslyreported in the International Study of Unruptured IntracranialAneurysms. The authors conclude that treatment of unrupturedaneurysms is safe when patients are below a certain age,depending on the treatment modality.

Pages 484-488

Characteristics of Brain Arteriovenous Malformations in

Patients Presenting with Nonhemorrhagic Neurologic

Deficits

Xianli Lv, Youxiang Li, Xinjian Yang, Chuhan Jiang, Zhongxue Wu

Lv et al. reviewed their institutional series of 302 consecutivepatients with arteriovenous malformations (AVMs) in order todetermine risk factors for presenting with neurologic deficits notassociated with hemorrhage. Over the course of 9 years, 24(8.4%) of their AVM patients presented with nonhemorrhagicneurologic deficit; these patients were compared to their intactcohort. The authors report that overall, factors associated withlesion architecture, including having more than 3 arterial feeders,more than 3 draining veins, and presence of venous varices, wereassociated with neurologic deficit. While AVM size (�3 cm) anddeep location were also associated with neurologic deficit, patientage and location in eloquent cortex were not.

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Pages 489-498

Comparisons of 30-Day Mortalities and 90-Day

Functional Recoveries After First and Recurrent Primary

Intracerebral Hemorrhage Attacks: A Multiple-Institute

Retrospective Study

Kyu Hong Kim, Hyung Dong Kim, Young Zoon Kim

Kim et al. review their series of nearly 1500 patients withprimary intracerebral hemorrhage (PICH) to determine riskfactors associated with 30-day mortality and 90-day functionalrecovery. The authors report that recurrent PICH occurred in9.5% of patients, and that mortality at 30-days was 13.6% forthe initial hemorrhagic event and 14.1% for the secondhemorrhagic event. Good functional recovery (ModifiedRankin’s Scale �2) was achieved in 52.2% of initial PICHpatients but only 31.0% of recurrent PICH patients (P �0.003). The authors performed a multivariate analysis to showthat unconsciousness, surgical intervention, and underlyingdisease were all associated with high mortality. Conservativetreatment, small hemorrhagic volume, and peripheral locationwere associated with good functional recovery. RecurrentPICH patients who did not have a previous disability secondaryto their first hemorrhagic event had similar functionaloutcomes to the initial PICH group. The authors conclude thatgiven optimal treatment, patients with recurrent PICH canachieve the same clinical outcomes as those with just an initialhemorrhagic event.

Pages 515-524

Seizure Control for Patients Undergoing Meningioma

Surgery

Kaisorn L. Chaichana, Courtney Pendleton, Hasan Zaidi,

Alessandro Olivi, Jon D. Weingart, Gary L. Gallia, Michael Lim,

Henry Brem, Alfredo Quinones-Hinojosa

Chaichana et al. performed a retrospective review of patientswith supratentorial meningiomas to identify risk factors forpresentation with and control of seizures. In their series of 626patients, 13% presented with seizures. Factors significantlyassociated with seizures included absence of headaches andvasogenic edema. The authors also reviewed seizure controlfor these patients at 48 months postoperatively and report that90% of these patients did not have any further seizures. Theassociation between seizure recurrence and tumor recurrencedid not achieve statistical significance. The authors proposethat identifying risk factors for seizures in patients withmeningiomas may help guide specific treatment for thosepatients with particular risk.

Pages 568-575

Neurotrauma Outside the High-Income Setting: A

Review of Audit and Data-Collection Strategies

Holly A. Sitsapesan, Timothy P. Lawrence, Clare Sweasey, Knut Wester

Sitsapesan et al. attempt to identify issues in data collectionstrategies for neurotrauma in the developing world. Theauthors reviewed publications on neurotrauma in thedeveloping world from 1980 to 2010 and compared the quality

of their findings to their internal head injury database. Theauthors found that head injury in underdeveloped countries isunderreported relative to the scale of the problem. They reportthat heterogeneous data collection and categorizationtechniques play a significant role in the lack of data available,and they propose that standardizing scoring systems andoutcome measures may improve comparability of data.

Pages 576-584

Intramedullary Spinal Cord Metastases: A 20-Year

Institutional Experience with a Comprehensive

Literature Review

Wen-Shan Sung, Mei-Jo Sung, Jon Ho Chan, Benjamin Manion,

Jeeuk Song, Arvind Dubey, Albert Erasmus, Andrew Hunn

Sung et al. review their institutional experience as well as theEnglish literature experience on metastatic tumors to theintramedullary spinal cord. In a 20-year period, this singleinstitution diagnosed 8 patients with intramedullary spinal cordmetastases (ISCM). The authors also reviewed 293 reportedcases in the literature, and characterized types of primarytumor, presenting symptom, and treatment efficacy. Themajority of primary tumors were breast and lung cancers thatwere evenly distributed throughout the cervical, thoracic, andlumbar spine. Patients most commonly presented with motorweakness. Survival of these lesions tended to be poor (4-month median survival) and only improved by 1 month withsurgical versus conservative treatment. The authors do report,however, that surgical treatment was more likely to result inneurologic improvement compared with conservativemeasures.

Pages 585-592

A Survey-Based Study of Wrong-Level Lumbar Spine

Surgery: The Scope of the Problem and Current

Practices in Place to Help Avoid These Errors

Michael W. Groff, Joshua E. Heller, Eric A. Potts, Praveen V. Mummaneni,

Christopher I. Shaffrey, Justin S. Smith

Groff et al. survey the members of the Joint Section onDisorders of the Spine and Peripheral Nerves (Spine Section)to determine practices used by surgeons to avoid wrong-levellumbar spine surgery. Fifty-four percent of surgeons respondedto 1045 requests to complete the anonymous survey onlumbar decompression surgery. The authors report that mostsurgeons routinely (74%) or sometimes (11%) obtainpreoperative imaging prior to making an incision; a similar sizedcohort routinely (73%) obtains further imaging prior to boneremoval. Despite these practices, nearly half of the surgeonssurveyed reported having performed wrong-level lumbar spinesurgery at least once, and nearly 20% have been involved witha malpractice case related to one of these errors. Furthermore,less than half of responding surgeons (40%) feel that the jointcommission’s “time-out” protocol has led to a reduction ofthese errors. Groff et al. conclude that, despite regulatoryprotocols, the substantial heterogeneity involved in localizingspine levels does not effectively mitigate wrong-level surgery.

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