inJournal of Neurosurgery: Pediatrics
In Brief
This study investigated the long-term outcome of cervical saccular limited dorsal myeloschisis. The findings indicate favorable ambulation and sphincter control, regardless of the lesion level or type. Myelocystocele-type lesions displayed higher rates of hydrocephalus, Chiari type II malformation, and neurological deficits in comparison with stalk-type lesions. Older age at surgery and spinal anomalies were associated with neurologic deficits. Overall, cervical saccular limited dorsal myeloschisis has a better outcome compared with true myelomeningocele in more distal areas.
inJournal of Neurosurgery
In Brief
The study investigated the use of the Woven EndoBridge (WEB) device with and without concomitant stent for intracranial aneurysms. Aneurysm occlusion rates were similar in both groups (with and without stent), but stent-assisted cases had higher thromboembolic complications. This research contributes to the current understanding of the novel treatment device and indicates that employing a stent concurrently might increase the likelihood of thromboembolic complications.
inJournal of Neurosurgery: Spine
OBJECTIVE
Malignant melanotic nerve sheath tumors are rare tumors characterized by neoplastic melanin-producing Schwann cells. In this study, the authors report their institution’s experience in treating spinal and peripheral malignant melanotic nerve sheath tumors and compare their results with the literature.
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Data were collected from 8 patients who underwent surgical treatment for malignant melanotic nerve sheath tumors between 1996 and 2023 at Mayo Clinic and 63 patients from the literature. Time-to-event analyses were performed for the combined group of 71 cases to evaluate the risk of recurrence, metastasis, and death based on tumor location and type of treatment received. Unpaired 2-sample t-tests and Fisher’s exact tests were used to determine statistical significance between groups.
RESULTS
在1996年至2023年之间,恶性患者8米elanotic nerve sheath tumors underwent surgery at the authors’ institution, while 63 patients were identified in the literature. The authors’ patients and those in the literature had the same mean age at diagnosis (43 years). At the authors’ institution, 5 patients (63%) experienced metastasis, 6 patients (75%) experienced long-term recurrence, and 5 patients (62.5%) died. In the literature, most patients (60.3%) were males, with a peak incidence between the 4th and 5th decades of life. Nineteen patients (31.1%) were diagnosed with Carney complex. Nerve root tumors accounted for most presentations (n = 39, 61.9%). Moreover, 24 patients (38.1%) had intradural lesions, with 54.2% (n = 13) being intramedullary and 45.8% (n = 11) extramedullary. Most patients underwent gross-total resection (GTR) (n = 41, 66.1%), followed by subtotal resection (STR) (n = 12, 19.4%), STR with radiation therapy (9.7%), and GTR with radiation therapy (4.8%). Sixteen patients (27.6%) experienced metastasis, 23 (39.7%) experienced recurrence, and 13 (22%) died. Kaplan-Meier analyses showed no significant differences among treatment approaches in terms of recurrence-free, metastasis-free, and overall survival (p > 0.05). Similar results were obtained when looking at the differences with respect to intradural versus nerve root location of the tumor (p > 0.05).
CONCLUSIONS
Malignant melanotic nerve sheath tumors are rare tumors with a high potential for malignancy. They carry a dismal prognosis, with a pooled local recurrence rate of 42%, distant metastasis rate of 27%, and mortality rate of 26%. The findings from this study suggest a trend favoring the use of GTR alone or STR with radiation therapy over STR alone. Mortality was similar regardless, which highlights the need for the development of effective treatment options to improve survival in patients with melanotic schwannomas.
inJournal of Neurosurgery
In Brief
The aim of this study was to evaluate the long-term outcomes of elbow and shoulder function in patients with brachial plexus injuries (BPIs) receiving nerve reconstruction in the delayed setting (6-12 months after injury). In the delayed setting, nerve reconstruction was found to effectively restore functional elbow flexion and acceptable shoulder abduction in non-pan-plexus patients with BPI, but not in pan-plexus BPI. Judicious use of the donor nerves in pan-plexus injuries is required in addition to preserving a donor nerve for a backup plan such as free-functioning muscle transplantation or tendon transfers.
inJournal of Neurosurgery: Spine
In Brief
In this study, researchers investigated how the choice of superior endplate, L5 or S1, impacts the measurement of spinopelvic parameters in adult spinal deformity patients with lumbosacral transitional vertebrae. Findings revealed that using the L5 vertebra underestimates deformity and diminishes the correlation with health-related quality of life scores. This insight underscores the importance of standardized measurement techniques for accurate surgical planning and emphasizes the superior suitability of the S1 endplate for such assessments.
inJournal of Neurosurgery: Pediatrics
In Brief
This study aimed to evaluate the effects of thin-split encephalomyosynangiosis (EMS) in combined revascularization surgery on postoperative outcomes in pediatric patients with moyamoya disease (MMD). The authors found that thin-split EMS can reduce transient neurological events that do not accompany crying or hemodynamic changes. Furthermore, the procedure has sufficient prevention effects against stroke events during the chronic postoperative period. The thin-split EMS method could be valuable for revascularization in pediatric patients with MMD.
Article Spotlight
Resection of corticotroph microadenomas invading the medial wall of the cavernous sinus in two cases of a primary and recurrent case of Cushing’s disease
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JNSPG Journal Club
September 2023 -Cervical spondylotic myelopathy
Featuring presentations on selected articles published in this issue byDr. Jay Turner,Dr. Michael D. White,Dr. David Levi,Dr. Michael Y. Wang, andDr. Ken Porche. Moderated byDr. Praveen V. Mummaneniwith Drs. William Couldwell (Editor-in-Chief) and Aaron Cohen-Gadol (Associate Editor).
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