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Journal of Neurosurgery: Pediatrics Noviembre

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Avoiding early complications and reoperation during occipitocervical fusion in pediatric patients

Occipitocervical fusion for pediatric occipitocervical  instability has a high rate of success in a wide variety of challenging circumstances; however, identifying potential risk factors can help to target variables that should be the focus of improvement.

Pediatric patients in the cohort of Mazur et al., with postoperative wound infections requiring surgical debridement had higher surgical failure rates after occipitocervical fusion. Those with skeletal dysplasia and congenital spinal anomaly were more likely to require reoperation for hardware failure. Better understanding of the mode of surgical failure may enable surgeons to develop strategies to decrease the need for reoperation in pediatric patients with OC instability 1).

1) Mazur MD, Sivakumar W, Riva-Cambrin J, Jones J, Brockmeyer DL. Avoiding early complications and reoperation during occipitocervical fusion in pediatric patients. J Neurosurg Pediatr. 2014 Aug 29:1-11. [Epub ahead of print] PubMed PMID: 25171720.


Journal of Neurosurgery: Spine November 2014


Adverse events in emergency oncological spine surgery: a prospective analysis

Cover ImageEmergency oncological spine surgery are generally palliative to reduce pain and improve patients neurology and health-related quality of life. In individuals with limited life expectancy, adverse events (AEs) can have catastrophic implications; therefore, an accurate AE incidence must be considered in the surgical decision-making process.

Dea et al., carried out a Prospective cohort study in a quaternary care referral center that included consecutive patients admitted between January 1, 2009, and December 31, 2012. Inclusion criteria were all patients undergoing emergency surgery for metastatic spine disease. AE data were reported and collected with the Spine AdVerse Events Severity System, version 2 [SAVES V2] forms) at weekly dedicated morbidity and mortality rounds attended by attending surgeons, residents, fellows, and nursing staff.

A total of 101 patients (50 males, 51 females) met the inclusion criteria and had complete data. Seventysix patients (76.2%) had at least 1 AE, and 11 patients (10.9%) died during their admission. Intraoperative surgical AEs were observed in 32% of patients (9.9% incidental durotomy, 16.8% blood loss > 2 L). Transient neurological deterioration occurred in 6 patients (5.9%). Infectious complications in this patient population were significant (surgical site 6%, other 50.5%). Delirium complicated the postoperative period in 20.8% of cases.

When evaluated in a rigorous prospective manner, metastatic spine surgery is associated with a higher morbidity rate than previously reported. This AE incidence must be considered by the patient, oncologist, and surgeon to determine appropriate management and preventative strategies to reduce AEs in this fragile patient population.

Dea N, Versteeg A, Fisher C, Kelly A, Hartig D, Boyd M, Paquette S, Kwon BK, Dvorak M, Street J. Adverse events in emergency oncological spine surgery: a prospective analysis. J Neurosurg Spine. 2014 Aug 22:1-6. [Epub ahead of print] PubMed PMID: 25147976.

Journal of Neurosurgery November 2014


Gamma Knife surgery for incidental cerebral arteriovenous malformations

Thirty-one patients, each with an incidentally diagnosed unruptured cerebral arteriovenous malformation, underwent Gamma Knife radiosurgery (GKS) between 1989 and 2009. The nidus volumes ranged from 0.3 to 11.1 cm(3) (median 3.2 cm(3)). A margin dose between 15 and 26 gray (Gy) (median 20 Gy) was used to treat the AVMs. Four patients underwent repeat GKS for still-patent AVM residuals after the initial GKS procedure. Clinical follow-up ranged from 24 to 196 months, with a mean of 78 months (median 51 months) after the initial GKS.

19 patients (61.3%) had a total AVM obliteration on angiography. In 7 patients (22.6%), no flow voids were observed on MRI but angiographic confirmation was not available. In 5 patients (16.1%), the AVMs remained patent. A small nidus volume was significantly associated with increased AVM obliteration rate. Thirteen patients (41.9%) developed radiation-induced imaging changes: 11 were asymptomatic (35.5%), 1 had only headache (3.2%), and 1 developed seizure and neurological deficits (3.2%). Two patients each had 1 hemorrhage during the latency period (116.5 risk years), yielding an annual hemorrhage rate of 1.7% before AVM obliteration.

The decision to treat asymptomatic AVMs, and if so, which treatment approach to use, remain the subject of debate. GKS as a minimally invasive procedure appears to achieve a reasonable outcome with low procedure-related morbidity. In those patients with incidental AVMs, the benefits as well as the risks of radiosurgical intervention will only be fully defined with long-term follow-up 1).

1) Yen CP, Ding D, Cheng CH, Starke RM, Shaffrey M, Sheehan J. Gamma Knife surgery for incidental cerebral arteriovenous malformations. J Neurosurg. 2014 Aug 22:1-7. [Epub ahead of print] PubMed PMID: 25148009.

Journal of Neurosurgery: Octubre 2014

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The history of neurosurgery at the University of Rochester

Autograft-derived spinal cord mass following olfactory mucosal cell transplantation in a spinal cord injury patient

What is the risk of infecting a cerebrospinal fluid–diverting shunt with percutaneous tapping ?

Immediate complications associated with high-flow cerebrospinal fluid egress during endoscopic endonasal skull base surgery

Bradford’s law in pediatric neurosurgery

Bradford’s law describes the number of core journals in a given field or subject and has recently been applied to neurosurgery.

The objective of the Venable et al., study was to use currently accepted formulations of Bradford’s law to identify core journals of pediatric neurosurgery. An additional analysis was completed to compare regional dependence on citation density among North American and European neurosurgeons.

All original research publications from 2009 to 2013 were analyzed for the 25 top publishing pediatric neurosurgeons in North America and Europe, which were sampled to construct regional citation databases of all journal references. Regional differences were compared with each database. Egghe’s formulation and the verbal formulation of Bradford’s law were applied to create specific citation density zones and identify the core journals.

Regional comparison demonstrated a preference for the Journal of Neurosurgery and Child’s Nervous System, respectively, but four of the top five journals were common to both groups. Applying the verbal formulation of Bradford’s law to the North American citation database, a pattern of citation density was identified across the first three zones. Journals residing in the most highly cited first zone are presented as the core journals.

Bradford’s law can be applied to identify the core journals of neurosurgical subspecialties. While regional differences exist between the most highly cited and most frequently published in journals among North American and European pediatric neurosurgeons, there is commonality between the top five core journals in both groups 1).

1) Venable GT, Shepherd BA, Roberts ML, Taylor DR, Khan NR, Klimo P Jr. An application of Bradford’s law: identification of the core journals of pediatric neurosurgery and a regional comparison of citation density. Childs Nerv Syst.2014 Aug 7. [Epub ahead of print] PubMed PMID: 25098356.

Neurosurgery Junio 2014

Editors Choice

Stereotactic laser amygdalohippocampotomy

The report of Willie, Jon T et al., demonstrates the technical feasibility and encouraging early results of stereotactic laser amygdalohippocampotomy (SLAH), a novel approach to eliminating seizures while minimizing collateral injury in patients with mesial temporal lobe epilepsy (MTLE). Efficacy appears to approach that of open resection, especially in patients with mesial temporal sclerosis (MTS). Such minimally invasive techniques may be more desirable to patients and result in increased use of epilepsy surgery among the large number of medically intractable epilepsy patients. A larger, longer term multicenter study of seizure and cognitive outcomes after SLAH is currently under way 1).