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Brainstem cavernous malformations (BSCMs) are relatively uncommon, low-flow vascular lesions in children. check details Given the paucity of data, guidelines regarding the clinical management of BSCMs in children are lacking and the surgical indication is most commonly based on an individual surgeon's judgment and experience. The goal in this study was to evaluate the clinical behavior of BSCMs in childhood and the long-term outcome in children managed conservatively and surgically.

This was an observational, retrospective study including all children with BSCMs who were followed at 2 institutions between 2008 and 2020.

The study population consisted of 40 children (27 boys, 67.5%) with a mean age of 11.4 years. Twenty-three children (57.5%) were managed conservatively, whereas 17 children (42.5%) underwent resection of BSCMs. An aggressive clinical course was observed in 13 children (32.5%), who experienced multiple hemorrhages with a progressive pattern of neurological decline. Multiple BSCMs were observed in 8 pats on the other. Given the greater life expectancy and the known higher functional recovery in children, surgical treatment should be considered early in young patients presenting with surgically accessible lesions and an aggressive clinical course, and it should be performed in a high-volume center.

This study aimed to evaluate the efficacy of endovascular treatment (EVT) in patients with secondary coma following acute basilar artery occlusion (comatose patients) and to identify the impact of the Glasgow Coma Scale (GCS) score on medical decisions.

Patients from the Endovascular Treatment for Acute Basilar Artery Occlusion study were divided into comatose and noncomatose cohorts. The primary outcome was favorable functional independence (modified Rankin Scale [mRS] scores 0-3). The safety outcome was 90-day mortality. Subgroup analysis was performed to identify populations best suited for EVT. Multivariate logistic regression was used to identify independent predictive factors of clinical outcomes.

Comatose patients who underwent EVT had more favorable functional outcomes and lower mortality compared with those who underwent standard medical treatment (functional outcomes 15.98% vs 4.17%; mortality 62.72% vs 82.29%). Moreover, EVT was associated with better outcomes in the cohort with GCS scores ofnosis in comatose patients.

The objective of this study was to examine the relationship between the mental health domain of the refined 22-item Scoliosis Research Society Outcome Questionnaire (SRS) and various postoperative outcome measures in the adult spinal deformity (ASD) population. Given the scale and involved nature of deformity surgery, some surgeons have proposed that preoperative mental health scores (MHSs) may assist in screening out poor surgical candidates. In this study, the authors aimed to further assess the SRS MHS as a preoperative metric and its association with postoperative outcomes and to comment on its potential use in patient selection and optimization for ASD surgery.

The authors conducted a retrospective study of 100 consecutive patients who had undergone primary or revision ASD surgery at a single academic institution between 2015 and 2019. Each patient had a minimum 2-year follow-up. Patients were categorized on the basis of their baseline mental health per the SRS mental health domain, with a score < with LMH may be uniquely positioned to substantially benefit from surgical intervention and improve their HRQOL scores and thus should be considered for ASD surgery to an extent similar to patients with HMH.

5-Aminolevulinic acid (5-ALA)-enhanced fluorescence-guided resection of high-grade glioma (HGG) using microscopic blue light visualization offers the ability to improve extent of resection (EOR); however, few descriptions of HGG resection performed using endoscopic blue light visualization are currently available. In this report, the authors sought to describe their surgical experience and patient outcomes of 5-ALA-enhanced fluorescence-guided resection of HGG using primary or adjunctive endoscopic blue light visualization.

The authors performed a retrospective review of prospectively collected data from 30 consecutive patients who underwent 5-ALA-enhanced fluorescence-guided biopsy or resection of newly diagnosed HGG was performed. Patient demographic data, tumor characteristics, surgical technique, EOR, tumor fluorescence patterns, and progression-free survival were recorded.

In total, 30 newly diagnosed HGG patients were included for analysis. The endoscope was utilized for direct 5-ALA-guided port-b light endoscope is a viable primary or adjunctive visualization platform for optimization of 5-ALA-enhanced HGG fluorescence. Implementation of the blue light endoscope to guide resection of HGG glioma is feasible and ergonomically favorable, with a potential advantage of enabling increased detection of tumor fluorescence in deep surgical cavities compared to the microscope.

The blue light endoscope is a viable primary or adjunctive visualization platform for optimization of 5-ALA-enhanced HGG fluorescence. Implementation of the blue light endoscope to guide resection of HGG glioma is feasible and ergonomically favorable, with a potential advantage of enabling increased detection of tumor fluorescence in deep surgical cavities compared to the microscope.

Intraoperative language mapping under general anesthesia is imperative for brain tumor surgery because awake surgery is not always feasible. Monitoring corticocortical evoked potential (CCEP) is known to be a useful method for tracking neuronal connectivity and localizing functional areas. The authors evaluated the clinical benefit of intraoperative CCEP monitoring for language function preservation in patients undergoing glioma surgery.

Between January 2019 and June 2021, the authors performed a total of 29 consecutive glioma surgeries using CCEP monitoring under general anesthesia because of a risk of speech impairment; these were analyzed. Language area mapping was implemented by the anterior language area to posterior language area CCEP method for arcuate fasciculus mapping, and tumor resection was performed while avoiding the localized language areas. Language function before and after surgery was evaluated by the Controlled Oral Word Association Test (COWAT).

Intraoperative CCEP was successfully mge function under general anesthesia in glioma surgery in patients in whom awake surgery is not feasible.

Iliac screw fixation and anterior column support are highly recommended to prevent lumbosacral pseudarthrosis after long-level adult spinal deformity (ASD) surgery. Despite modern instrumentation techniques, a considerable number of patients still experience nonunion at the lumbosacral junction. However, most previous studies evaluating nonunion relied only on plain radiographs and only assessed when the implant failures occurred. Therefore, using CT, it is important to know the prevalence after iliac fixation and to evaluate risk factors for nonunion at L5-S1.

Seventy-seven patients who underwent ≥ 4-level fusion to the sacrum using iliac screws for ASD and completed a 2-year postoperative CT scan were included in the present study. All L5-S1 segments were treated by interbody fusion. Lumbosacral fusion status was evaluated on 2-year postoperative CT scans using Brantigan, Steffee, and Fraser criteria. Risk factors for nonunion were analyzed using patient, surgical, and radiographic factors. The metal faumbosacral nonunion during ASD surgery, 15.6% of patients still showed nonunion on 2-year postoperative CT scans. High ASA grade was a significant risk factor for nonunion. Rod fracture between L5 and S1 occurred more frequently in the nonunion group.

The authors developed a method to predict the etiology of intracranial large-vessel occlusion stroke (ILVOS) before endovascular treatment.

The authors retrospectively evaluated two etiologies of ILVOS-intracranial atherosclerotic stenosis-related occlusion (ICAS-O) and embolism-related occlusion (EMB-O)-in a cohort of patients from the National Comprehensive Stroke Center database of China. Patients were randomly divided into the derivation and validation cohorts at a ratio of 21. The authors derived the score in the derivation cohort and assessed the score in the validation cohort.

The authors identified 608 of 662 patients with ILVOS who received endovascular treatment during the study period. After adjustment for confounding factors, hypertension (OR 2.90, 95% CI 1.34-6.26), diabetes mellitus (OR 2.80, 95% CI 1.45-5.42), absence of atrial fibrillation (OR 27.29, 95% CI 13.27-56.09), National Institutes of Health Stroke Scale score < 7 (OR 2.92, 95% CI 1.22-6.99), and absence of the computed tomography hyperdense sign (OR 2.86, 95% CI 1.22-6.74) were significantly related to ICAS-O. A score was derived to help predict ICAS-O or EMB-O. The area under the curve values of the receiver operating characteristic curve for ICAS-O identification were 0.886 (95% CI 0.839-0.933) and 0.880 (95% CI 0.846-0.914) in the derivation and validation cohorts, respectively.

The atrial fibrillation-blood pressure-clinical neurological deficit-computed tomography hyperdense sign-diabetes mellitus (ABC2D) score can be used to identify atherosclerotic or embolic etiology of patients with ILVOS who require emergency endovascular treatment.

The atrial fibrillation-blood pressure-clinical neurological deficit-computed tomography hyperdense sign-diabetes mellitus (ABC2D) score can be used to identify atherosclerotic or embolic etiology of patients with ILVOS who require emergency endovascular treatment.

Although pituitary adenomas (PAs) are common intracranial tumors, literature evaluating the utility of comorbidity indices for predicting postoperative complications in patients undergoing pituitary surgery remains limited, thereby hindering the development of complex models that aim to identify high-risk patient populations. We utilized comparative modeling strategies to evaluate the predictive validity of various comorbidity indices and combinations thereof in predicting key pituitary surgery outcomes.

The Nationwide Readmissions Database was used to identify patients who underwent pituitary tumor operations (n = 19,653) in 2016-2017. Patient frailty was assessed using the Johns Hopkins Adjusted Clinical Groups (ACG) System. The Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) were calculated for each patient. Five sets of generalized linear mixed-effects models were developed, using as the primary predictors 1) frailty, 2) CCI, 3) ECI, 4) frailty + CCI, or 5) frailty + ECI. Compl= 0.10) or the frailty + CCI model (AUC 0.610; p = 0.29).

This investigation is to the authors' knowledge the first to implement mixed-effects modeling to study the utility of common comorbidity indices in a large, nationwide cohort of patients undergoing pituitary surgery. Knowledge gained from these models may help neurosurgeons identify high-risk patients who require additional clinical attention or resource utilization prior to surgical planning.

This investigation is to the authors' knowledge the first to implement mixed-effects modeling to study the utility of common comorbidity indices in a large, nationwide cohort of patients undergoing pituitary surgery. Knowledge gained from these models may help neurosurgeons identify high-risk patients who require additional clinical attention or resource utilization prior to surgical planning.