【期刊速览】Journal of Neurosurgery | Online 2024年10月速览（三）

1. Extended transcavernous posterior clinoidectomy in endoscopic endonasal surgery

内镜经鼻手术中扩大的经海绵窦后位切除术

Researchers developed a novel technical variant for endoscopic endonasal posterior clinoidectomy, termed extended transcavernous posterior clinoidectomy, which provides maximal exposure of the posterior clinoid process compared to the extradural and transcavernous techniques. The study emphasized the importance of customizing the posterior clinoidectomy technique based on tumor type, configuration, and anatomical variations of the posterior clinoid process to ensure successful surgical outcomes.

The researchers developed a novel analysis method in which a 3D model of the trigeminal nerve was used to quantitatively and objectively evaluate the morphological changes of the trigeminal nerve and to elucidate the cause of trigeminal neuralgia. In the preoperative trigeminal nerve on the affected side, the centerline was long and curved, and the cross-sectional area was small and flat. Further analyses may help clarify the pathophysiology, aid in diagnoses, and predict the efficacy of treatment.

REF: Ishiwada T, Tanaka Y, Onogi S, et al. Morphological analysis of the trigeminal nerve in trigeminal neuralgia using the nerve's centerline and multiple cross-sections of a 3D model. J Neurosurg. Published online October 11, 2024. doi:10.3171/2024.6.JNS24626 PMID: 39393092

The authors investigated whether use of a rapid response system (RRS) affects clinical outcomes in these patients. This population-based cohort study revealed that implementing RRS was associated with enhanced short- and long-term survival outcomes in patients who underwent cranial neurosurgery. The authors' findings indicate that the introduction of RRS can enhance patient survival rates after cranial neurosurgery.

REF: Oh TK, Song IA. Rapid response system and outcomes in patients who underwent cranial neurosurgery: a nationwide cohort study. J Neurosurg. Published online October 11, 2024. doi:10.3171/2024.6.JNS24984 PMID: 39393098

This study investigated the recovery of visual acuity and its impact on patient-reported outcomes in patients treated surgically for medial sphenoid wing meningioma. Patients with a shorter duration of preoperative visual symptoms (≤ 4 months) experienced significantly better postoperative visual outcomes and improved quality of life measures. These findings offer valuable guidance for preoperative consultations and enhance clinical decision-making.

REF: Gessler F, Hajdari S, Potthoff AL, et al. Visual deterioration secondary to medial sphenoid wing meningioma: systematic assessment of patient-reported outcomes and factors contributing to recovery after surgical treatment. J Neurosurg. Published online October 11, 2024. doi:10.3171/2024.5.JNS232349 PMID: 39393103

The authors compared the surgical anatomy of the minipterional (MPT) and supraorbital eyebrow (SE) approaches to the interpeduncular region. Key findings revealed that the SE approach provided adequate access to the interpeduncular fossa, whereas the MPT approach offered direct access to the upper prepontine cistern and anterior mesencephalic safe entry zone. These insights enhance understanding of the pros and cons of each route to plan the most suited surgical exposure and, thereby, optimize patient outcomes.

REF: Torregrossa F, De Bonis A, Nizzola M, et al. Anatomoradiological comparison between the minipterional and supraorbital eyebrow approaches to the interpeduncular region. J Neurosurg. Published online October 4, 2024. doi:10.3171/2024.6.JNS24561 PMID: 39366021

Optimal management of the pituitary stalk during craniopharyngioma resection remains a controversial subject. This meta-analysis aimed to evaluate the effect of pituitary stalk preservation on postoperative diabetes insipidus (DI), anterior pituitary function (PF), extent of resection, and recurrence. Pituitary stalk preservation was demonstrated to confer protective benefit on PF, although the benefit persisted on long-term follow-up for posterior PF only. Stalk preservation in pediatric patients should be given careful consideration, as it is associated with higher rates of incomplete resection. These results should be interpreted with caution due to inclusion of small studies and inadequate reporting of outcomes in the literature.

This study evaluated the safety and efficacy of medical management versus endovascular and surgical interventions for extracranial pseudoaneurysms. The authors found that medical management is safe and effective, particularly for patients < 50 years of age with pseudoaneurysms < 6 mm in diameter, and results in fewer complications than endovascular treatments. A management flowchart was proposed to guide treatment decisions, highlighting the potential for conservative management in most cases.

Researchers evaluated whether frailer patients had worse outcomes or more complications after MR-guided focused ultrasound (MRgFUS) thalamotomy for tremor. Frailty was not associated with worse clinical outcomes, suggesting that MRgFUS may even be appropriate for frailer patients. Additionally, MRgFUS patients with essential tremor were frailer than those patients with tremor-dominant Parkinson disease, which may reflect referral patterns.