Neurosurgery – Noviembre 2014

To date, there is no standard treatment for recurrent glioblastoma.

Optimal management of recurrent high grade glioma continues to be a controversial topic. Current indications for reoperation include new focal neurological deficits, tumor mass effect resulting in signs and symptoms of increased intracranial pressure, increased seizure frequency, and radiographic evidence of tumor progression with or without accompanying changes in clinical status. Existing evidence indicates that age should not be an absolute contraindication to reoperation. A time interval of at least 6 months between operations and favorable performance status (KPS score >70) are predictors of improved survival after reoperation. Extent of resection (EOR) at reoperation appears to be an important determinant of improved survival, even in patients with subtotal resection (STR) at the time of initial operation. Although fraught with patient selection bias, mounting evidence suggests a survival benefit in patients receiving gross total resection (GTR) at recurrence compared with a lesser degree of resection. Additional reoperations beyond the first reoperation may add to overall survival and should be considered in patients with a favorable KPS score at the time of recurrence, regardless of symptomatology

Hervey-Jumper SL, Berger MS. Reoperation for recurrent high-grade glioma: a current perspective of the literature. Neurosurgery. 2014 Nov;75(5):491-9. doi: 10.1227/NEU.0000000000000486. PubMed PMID: 24991712.


Hospital case volume may be associated with improved outcomes after subarachnoid hemorrhage (SAH)

Using the Get With The Guidelines Stroke registry, Prabhakaran et al., analyzed patients with a discharge diagnosis of SAH between April 2003 and March 2012 and assessed the association of annual SAH case volume with in-hospital mortality by using multivariable logistic regressionadjusting for relevant patient, hospital, and geographic characteristics.

Among 31,973 patients with SAH from 685 hospitals, the median annual case volume per hospital was 8.5 (25th-75th percentile, 6.7-12.9) patients. Mean in-hospital mortality was 25.7%, but was lower with increasing annual SAH volume: 29.5% in quartile 1 (range, 4-6.6), 27.0% in quartile 2 (range, 6.7-8.5), 24.1% in quartile 3 (range, 8.5-12.7), and 22.1% in quartile 4 (range, 12.9-94.5). Adjusting for patient and hospital characteristics, hospital SAH volume was independently associated with in-hospital mortality (adjusted odds ratio 0.79 for quartile 4 vs 1, 95% confidence interval, 0.67-0.92). The quartile of SAH volume also was associated with length of stay but not with discharge home or independent ambulatory status.

In a large nationwide registry, they observed that patients treated at hospitals with higher volumes of SAH patients have lower in-hospital mortality, independent of patient and hospital characteristics suggesting that experienced centers may provide more optimized care for SAH patients. 5)

Prabhakaran S, Fonarow GC, Smith EE, Liang L, Xian Y, Neely M, Peterson ED, Schwamm LH. Hospital case volume is associated with mortality in patients hospitalized with subarachnoid hemorrhage. Neurosurgery. 2014 Nov;75(5):500-8.
doi: 10.1227/NEU.0000000000000475. PubMed PMID: 24979097.


https://www.cns.org/education/browse-type/sans

Self-Assessment in Neurological Surgery (SANS) is a completely on-line educational tool. The teaching materials used in SANS consist of text, pictures, video clips and links to relevant Internet sites. Physicians participate in the learning process by answering questions in specific topic areas, reviewing their answers, and reading question critiques. The material is designed to be a self-instructional and self-assessment tool.

To apply for Continuing medical education (CME), users will need to complete SANS and fill out the CME survey. Partial CME credit will not be made available for incomplete participation in SANS.

 Asthagiri A. Instructions for Obtaining SANS Neurosurgery Continuing Medical Education (CME) Credit. Neurosurgery. 2014 Nov;75(5):N9. doi: 10.1227/01.neu.0000455970.98723.b9. PubMed PMID: 25328984.


Alperin N, Loftus JR, Oliu CJ, Bagci AM, Lee SH, Ertl-Wagner B, Green B,
Sekula R. Magnetic resonance imaging measures of posterior cranial fossa
morphology and cerebrospinal fluid physiology in Chiari malformation type I.
Neurosurgery. 2014 Nov;75(5):515-22. doi: 10.1227/NEU.0000000000000507. PubMed
PMID: 25328981.

Kuhn EN, Taksler GB, Dayton O, Loganathan A, Bourland D, Tatter SB, Laxton AW,
Chan MD. Is there a tumor volume threshold for postradiosurgical symptoms? A
single-institution analysis. Neurosurgery. 2014 Nov;75(5):536-45. doi:
10.1227/NEU.0000000000000519. PubMed PMID: 25171304.

McClendon J Jr. Response to journal club: the impact of body mass index on
hospital stay and complications after spinal fusion. Neurosurgery. 2014
Nov;75(5):602. doi: 10.1227/NEU.0000000000000520. PubMed PMID: 25121795.

Payne R, Bogason E, Anderson B, Brandmeir N, Church E, Cooke J, Davies G,
Hussain N, Patel A, Rohatgi P, Sieg E, Zalatimo O, Ziu E, Davanzo J. Journal
club: the impact of body mass index on hospital stay and complications after
spinal fusion. Neurosurgery. 2014 Nov;75(5):599-601. doi:
10.1227/NEU.0000000000000521. PubMed PMID: 25121794.

Binning MJ, Adel JG, Maxwell CR, Liebman K, Hakma Z, Diaz C, Silva R,
Veznedaroglu E. Early Postmarket Experience After US Food and Drug Administration
Approval With the Trevo Device for Thrombectomy for Acute Ischemic Stroke.
Neurosurgery. 2014 Nov;75(5):584-9. doi: 10.1227/NEU.0000000000000523. PubMed
PMID: 25121793.

Koutsarnakis C, Liakos F, Stranjalis G. Letter: the “over the wire” technique
for ventricular catheter revision and a proposed access kit for this purpose.
Neurosurgery. 2014 Nov;75(5):E605-6. doi: 10.1227/NEU.0000000000000516. PubMed
PMID: 25072114.

Gonzalez NR, Connolly M, Dusick JR, Bhakta H, Vespa P. Phase I clinical trial
for the feasibility and safety of remote ischemic conditioning for aneurysmal
subarachnoid hemorrhage. Neurosurgery. 2014 Nov;75(5):590-8. doi:
10.1227/NEU.0000000000000514. PubMed PMID: 25072112; PubMed Central PMCID:
PMC4205274.

Ellis JA, McDowell MM, Mayer SA, Lavine SD, Meyers PM, Connolly ES Jr. The
role of antiplatelet medications in angiogram-negative subarachnoid hemorrhage.
Neurosurgery. 2014 Nov;75(5):530-5. doi: 10.1227/NEU.0000000000000490. PubMed
PMID: 25072111.

Freidberg SR, Cosgrove R, David CA, Tarlov EC. Correspondence: obituary,
charles a. Fager, MD. Neurosurgery. 2014 Nov;75(5):603-4. doi:
10.1227/NEU.0000000000000511. PubMed PMID: 25050584.

Tarantino R, Donnarumma P, Nigro L, Rullo M, Santoro A, Delfini R. Surgery of
intradural extramedullary tumors: retrospective analysis of 107 cases.
Neurosurgery. 2014 Nov;75(5):509-14. doi: 10.1227/NEU.0000000000000513. PubMed
PMID: 25050582.

Phillips JL, Chalouhi N, Jabbour P, Starke RM, Bovenzi CD, Rosenwasser RH,
Wilent WB, Romo VM, Tjoumakaris SI. Somatosensory evoked potential changes in
neuroendovascular procedures: incidence and association with clinical outcome in
873 patients. Neurosurgery. 2014 Nov;75(5):560-7. doi:
10.1227/NEU.0000000000000510. PubMed PMID: 25050580.

Nelson KS, Brearley AM, Haines SJ. Evidence-based assessment of
well-established interventions: the parachute and the epidural hematoma.
Neurosurgery. 2014 Nov;75(5):552-9. doi: 10.1227/NEU.0000000000000504. PubMed
PMID: 25050576.

Paúl L, Casasco A, Kusak ME, Martínez N, Rey G, Martínez R. Results for a
series of 697 arteriovenous malformations treated by gamma knife: influence of
angiographic features on the obliteration rate. Neurosurgery. 2014
Nov;75(5):568-83. doi: 10.1227/NEU.0000000000000506. PubMed PMID: 25050575.

Iwata T, Mori T, Miyazaki Y, Tanno Y, Kasakura S, Aoyagi Y. Global oxygen
extraction fraction by blood sampling to anticipate cerebral hyperperfusion
phenomenon after carotid artery stenting. Neurosurgery. 2014 Nov;75(5):546-51.
doi: 10.1227/NEU.0000000000000485. PubMed PMID: 24991711.

 

Rosenthal G, Ng I, Moscovici S, Lee KK, Lay T, Martin C, Manley GT.
Polyetheretherketone implants for the repair of large cranial defects: a 3-center
experience. Neurosurgery. 2014 Nov;75(5):523-9. doi:
10.1227/NEU.0000000000000477. PubMed PMID: 24979096.

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