【期刊速览】Journal of Neurosurgery | Online 2024年10月速览（一）

1. Association between accumulation of 2-hydroxyglutarate detected by MR spectroscopy and preoperative seizure in IDH-mutant glioma

IDH突变型神经胶质瘤中MR光谱检测到的2-羟基戊二酸的积累与术前癫痫发作之间的关联

Researchers used 3T magnetic resonance spectroscopy (MRS) to determine whether accumulation of 2-hydroxyglutaric acid (2HG) is indicative of preoperative seizures in glioma. This study showed that elevated 2HG levels on MRS may be associated with preoperative seizures, suggesting that 2HG accumulation increases the risk of preoperative seizures in IDH-mutant gliomas. Thus, this study provides a strong preclinical rationale for predicting preoperative epilepsy using clinical setting 2HG-MRS in patients with IDH-mutant gliomas.

The purpose of the study was to determine whether oral administration of paroxetine, an inhibitor of P2X4, by which vascular endothelial cells sense blood flow, prevents cerebral aneurysm growth and recanalization after coil embolization. In a historical cohort study, paroxetine significantly prevented both cerebral aneurysm growth and recanalization in the year after coiling. P2X4 inhibitors, including paroxetine, may be clinically applicable as prophylaxis against both aneurysm rupture and recurrence after coil embolization.

REF: Fukuda S, Niwa Y, Ren N, et al. Effects of paroxetine, a P2X4 inhibitor, on cerebral aneurysm growth and recanalization after coil embolization: the NHO Drug for Aneurysm Study. J Neurosurg. Published online October 25, 2024. doi:10.3171/2024.6.JNS24714 PMID: 39454214

This study evaluated the feasibility of an optic radiation (OR)-sparing surgical strategy using the endoscopic transorbital approach for treating lesions involving the mediobasal temporal region, with the application of OR tractography to ensure preservation of the visual pathway during and after surgery. The approach enabled gross-total resection in most patients without surgical complications, and postoperative neuro-ophthalmological examinations showed intact or stable visual function in all patients. Follow-up diffusion tensor imaging tractography confirmed the preservation of the optic tracts, indicating that the approach minimizes the risk of visual dysfunction.

REF: Jeon C, Hong CK, Chong K, et al. Endoscopic transorbital approach for resection of mediobasal temporal lesions using an optic radiation-sparing strategy. J Neurosurg. Published online October 25, 2024. doi:10.3171/2024.6.JNS232810 PMID: 39454213

Researchers investigated whether multiple infusions of mesenchymal stem cells (MSCs) improved functional outcomes in acute cerebral ischemia in rats. They found that multiple MSC infusions significantly improved motor recovery, reduced ischemic volume, increased corpus callosum thickness, and increased the number of neural tracts compared with single standard or high-dose infusions. These findings suggest that multiple MSC infusions may be more effective for the treatment of acute cerebral ischemia via enhanced neuroprotection and induced neural plasticity.

REF: Yokoyama T, Sasaki M, Nagahama H, et al. Multiple intravenous infusions versus a single infusion of mesenchymal stem cells in a rat model of cerebral ischemia. J Neurosurg. Published online October 25, 2024. doi:10.3171/2024.6.JNS241111 PMID: 39454218

The authors aimed to study regional differences in reimbursement rates across neurosurgical procedures and to compare Medicare, Medicaid, and usual, customary, and reasonable rates (UCRs) via FAIR Health rate estimates. This study found consistently lower reimbursement rates in Medicare and Medicaid when compared with the in-network and out-of-network FAIR Health estimates; while FAIR Health rates showed high variability across locales, Medicare and Medicaid did not significantly vary, despite being price-indexed for geography. This work reinforces concerns regarding Medicare and Medicaid reimbursement rates in neurosurgery.

REF: McGuire LS, Huntoon K, Gerald BM, et al. Regional differences in reimbursement rates from Medicare, Medicaid, and FAIR Health across common procedures for neurological surgeons. J Neurosurg. Published online October 25, 2024. doi:10.3171/2024.6.JNS24515 PMID: 39454216

This population-based study quantified trends in the incidence, treatment, and survival of patients with chordoma in Ontario over a recent 17-year period. The average annual incidence was 12 cases per 10 million, with no significant change across the study period. The authors found evidence of increased treatment with radiotherapy or chemotherapy each year, with no significant changes in survival. Findings suggest an increased adoption of multidisciplinary cancer care for patients living with chordoma in Ontario.

Using the 5-year interim data of the first large-scale prospective multicenter study (AMORE), researchers aimed to clarify the 5-year risk of disease progression, transient ischemic attack (TIA), and de novo parenchymal lesions in asymptomatic moyamoya disease (MMD), and to identify risk predictors. Predictors of disease progression were younger age and hypercholesterolemia. Disease progression prior to TIA was a significant predictor for TIA. Microbleeds at enrollment were a significant predictor for de novo microbleeds. The authors report how asymptomatic MMD progresses prior to onset of cerebrovascular events and propose a strategy to manage asymptomatic MMD.

The authors evaluated electrocorticography and navigated transcranial magnetic stimulation-tailored supratotal resection (ETT-SpTR) for low-grade gliomas (LGGs) in controlling seizures and preserving neurological function. Their key finding was that ETT-SpTR significantly improved seizure outcomes, with 85.7% of patients in the ETT-SpTR group achieving Engel class IA outcomes. This study adds value by demonstrating the effectiveness of ETT-SpTR in improving epileptic outcomes while preserving neurological functions in LGG patients.