【期刊速览】Journal of Neurosurgery | Online 2024年9月速览（一）

1. Enhancing surgical precision: a novel electromyography finding for confident identification of the root exit zone during microvascular decompression surgery

提高手术精度: 一项新颖的肌电图发现，可在微血管减压手术中自信地识别根出口区

The Sang-Ku sign (SKS) could aid in identifying the offending vessel on the root exit zone (REZ), even in the absence of lateral spread response (LSR). The SKS could be an excellent navigator for facial nerve REZ. Along with LSR, SKS might be the key EMG finding we need for successful decompression in HFS.

This study investigated characteristic patterns and predictors for switching to interventional treatment when an initial conservative strategy was established in patients with unruptured intracranial aneurysms (UIAs). The likelihood of switching to interventional treatment was low (6.9%), occurring most often due to an increase in size and rarely in aneurysms < 3 mm. Conservatively managed UIAs should be closely monitored with regular radiological follow-ups, particularly if the initial size was > 3 mm at diagnosis.

REF: Bandhauer B, Gruber P, Andereggen L, et al. From conservative to interventional management in unruptured intracranial aneurysms. J Neurosurg. Published online September 27, 2024. doi:10.3171/2024.6.JNS24568 PMID: 39332040

Glioma margins are often poorly defined by 5-aminolevulinic acid imaging because of variable accumulation of protoporphyrin IX (PpIX) in tumor cells, fluorescence decay, and subjective interpretation of the fluorescence appearance by the surgeon. Fluorescein sodium-based, intraoperative, cellular-resolution confocal laser endomicroscopy (CLE) imaging showed higher accuracy than PpIX fluorescence for detecting regions with infiltrating tumor. Real-time CLE intraoperative imaging may significantly improve discrimination and augment management of glioma margins, leading to improvement in the resection of such tumors.

REF: Abramov I, Mathis AM, Xu Y, et al. Intraoperative confocal laser endomicroscopy during 5-aminolevulinic acid-guided glioma surgery: significant considerations for resection at the tumor margin. J Neurosurg. Published online September 27, 2024. doi:10.3171/2024.5.JNS24140 PMID: 39332037

Authors of this study assessed an algorithm for the diagnosis and management of idiopathic intracranial hypertension (IIH) in patients undergoing surgical repair of cerebrospinal fluid (CSF) leaks in the setting of skull base meningoencephaloceles. The data helped to characterize the CSF dynamics of this population, showing that pre- and postoperative opening pressures were not significantly different, with a mean variability that was likely not clinically significant. This study encourages further work to determine the optimal IIH management strategy for these patients.

REF: Thapliyal M, Murayi R, Nowacki AS, et al. A management algorithm for idiopathic intracranial hypertension in skull base meningoencephaloceles. J Neurosurg. Published online September 27, 2024. doi:10.3171/2024.6.JNS232723 PMID: 39332027

Pituitary neuroendocrine tumors (PitNETs) with oculomotor cistern (OMC) involvement are often underrecognized. The proposed clinicoradiological grading distinguishes three different pathways of tumor spread in the posterosuperior compartment of the cavernous sinus: noncompression, compression, and invasion. Progressive OMC involvement was correlated with tumor dimensions, invasiveness, higher percentages of Ki-67, and major risk for recurrence or progression of residual tumor. Endoscopic transsphenoidal surgery was found to be an effective surgical strategy in treating this subgroup of PitNETs.

REF: Serioli S, Buffoli B, Vezzoli M, et al. The oculomotor cistern and pituitary adenomas: anatomical and clinical study. J Neurosurg. Published online September 27, 2024. doi:10.3171/2024.5.JNS232626 PMID: 39332026

This is the first study to systematically evaluate length of stay (LOS) in the endoscopic skull base surgery population, especially when an intraoperative CSF leak was repaired. The study reported variability in LOS based on CSF leak flow rate and lesion site, and identified several drivers (extent of surgery, postoperative complications) for prolonged LOS. Setting benchmarks for LOS may help inform quality improvement and improve healthcare efficiency, especially with growing scrutiny in this area.