Publications

BACKGROUND/OBJECTIVES: Breast cancer is the most common malignancy in women and the second leading cause of cancer-related deaths globally. It is also the second most frequent source of brain metastases (BMs), contributing to 5-20% of cases. Despite this, routine brain imaging for screening is not recommended and is only conducted when clinical symptoms or physical findings suggest metastasis. This study aims to identify clinical predictors associated with overall survival (OS) and the timing of BM development in breast cancer patients. METHODS: We performed a retrospective review of medical records for 113 patients diagnosed with BMs secondary to breast cancer at our institution between 2000 and 2020. Baseline demographic data and clinical characteristics related to BMs were collected. To identify factors associated with OS and time to BM development after breast cancer diagnosis, we conducted univariate analysis using Kaplan-Meier curves, bivariate analysis with the log-rank test, and multivariate analysis via the Cox Proportional Hazard model. RESULTS: An early diagnosis of BMs was identified as a

OBJECTIVE: Chronic subdural hematoma (cSDH) is often associated with clinical seizures, with incidence rates ranging from 2.6% to 23%. While risk factors like hematoma size and craniotomy with membranectomy are well established, the impact of middle meningeal artery embolization (MMAe) remains underexplored. This study aims to evaluate postoperative seizure rates in cSDH patients treated with MMAe and compare them with those undergoing craniotomy or burr hole evacuation. METHODS: A bi-institutional retrospective review of 580 cSDH cases treated with burr hole evacuation (with or without MMAe), craniotomy (with or without MMAe), or MMAe alone from 2017 to 2021 was conducted. Fisher exact tests, t tests, and analysis of variance were used to analyze patient, hematoma, and procedural characteristics. Logistic regression identified factors associated with postoperative seizures, complications, and recurrence requiring reoperation. Linear regression was used to assess factors influencing length of hospital stay. RESULTS: Among 580 cases, postoperative seizure rates were 4.2% for burr hole evacuation, 1.3% for burr hole evacuation with MMAe, 12.1% for craniotomy, 11.8% for craniotomy with MMAe, and 4.3% for MMAe alone. Logistic regression showed significantly higher seizure risk in craniotomy with MMAe vs. burr hole with MMAe (odds ratio [OR]

BACKGROUND: Meningiomas are typically benign, slow-growing tumors, but in rare cases, they can also cause symptomatic compression of cerebral arteries, potentially leading to stroke. Historically, management of such cases often required supplementary revascularization procedures. This report reviews cerebral artery compression secondary to meningiomas and presents a case of a left sphenoid wing meningioma causing compression of the left middle cerebral artery (MCA) with resulting acute neurological deficits, which resolved after emergency tumor resection and blood pressure optimization. OBSERVATIONS: A 28-year-old female with a history of migraines presented with acute right hemiplegia, numbness, and dysarthria (National Institutes of Health Stroke Scale score 11). Imaging revealed a 4.5-cm dura-based mass in the left middle cranial fossa, displacing and compressing the left MCA, with early signs of infarction. An angiogram revealed limited treatment options, and she underwent an urgent left frontal craniotomy for tumor resection and neurovascular decompression. Pathological examination confirmed meningioma. Following surgery, she experienced near-complete recovery of motor and language function. LESSONS: Meningiomas are a rare cause of symptomatic MCA stenosis. While revascularization strategies have been described, surgical decompression can potentially provide rapid neurological improvement. Urgent tumor resection with medical optimization should be considered as an effective treatment strategy for symptomatic meningioma-induced cerebral artery stenosis. https://thejns.org/doi/10.3171/CASE2515.

BACKGROUND: Tumor-treating fields (TTFields) are alternating electric fields approved for the treatment of glioblastoma. They must penetrate through the skull to reach the gross tumor volume (GTV) in the brain. Since the skull is an attenuator of electric fields, removal of a section of cortical bone by craniectomy may facilitate the delivery of TTFields into the GTV. METHODS: We identified a glioblastoma patient who underwent craniectomy for evacuation of a subdural empyema. The patient subsequently received standard adjuvant treatment with TTFields plus temozolomide without replacement of the skull defect. Post-acquisition magnetic resonance imaging datasets were obtained from this index patient and 2 others for virtual craniectomy analysis. After anatomic delineation, a 3-dimensional finite element mesh was generated and then solved for the distribution of applied electric fields, rate of energy deposition, and current density at the GTV. RESULTS: The geometry of craniectomy defect alone, with or without burr holes, did not alter TTFields delivery to GTV. Biomaterials filling the defect could significantly influence electric field penetration, particularly when they are highly conductive at 10 S/m or 7.76 $\times$ 10(6) S/m as in tantalum. The ratio of GTV relative to defect size also enhanced or attenuated TTFields coverage when the GTV was expanded or eroded, respectively. CONCLUSIONS: Craniectomy, biomaterials filling the defect, and the ratio of GTV relative to defect size may interact in a combinatorial fashion in modulating TTFields penetration into the brain. These findings are clinically relevant for personalized TTFields treatment.

Objective This study evaluated the potential of Chat Generative Pre-trained Transformer (ChatGPT) as an educational tool for neurosurgery residents preparing for the American Board of Neurological Surgery (ABNS) primary examination. Methods Non-imaging questions from the Congress of Neurological Surgeons (CNS) Self-Assessment in Neurological Surgery (SANS) online question bank were input into ChatGPT. Accuracy was evaluated and compared to human performance across subcategories. To quantify ChatGPT s educational potential, the concordance and insight of explanations were assessed by multiple neurosurgical faculty. Associations among these metrics as well as question length were evaluated. Results ChatGPT had an accuracy of 50.4% (1,068/2,120), with the highest and lowest accuracies in the pharmacology (81.2%, 13/16) and vascular (32.9%, 91/277) subcategories, respectively. ChatGPT performed worse than humans overall, as well as in the functional, other, peripheral, radiology, spine, trauma, tumor, and vascular subcategories. There were no subjects in which ChatGPT performed better than humans and its accuracy was below that required to pass the exam. The mean concordance was 93.4% (198/212) and the mean insight score was 2.7. Accuracy was negatively associated with question

BACKGROUND: This study aims to evaluate the length of stay (LOS) in patients who had adjunct middle meningeal artery embolization (MMAE) for chronic subdural hematoma after conventional surgery and determine the factors influencing the LOS in this population. METHODS: A retrospective review of 107 cases with MMAE after conventional surgery between September 2018 and January 2024 was performed. Factors associated with prolonged LOS were identified through univariable and multivariable analyses. RESULTS: The median LOS for MMAE after conventional surgery was 9 days

BACKGROUND AND OBJECTIVES: Postoperative seizures are a common complication after surgical drainage of nonacute chronic subdural hematomas (SDHs). The literature increasingly supports the use of prophylactic antiepileptic drugs for craniotomy, a procedure that is often associated with larger collections and worse clinical status at admission. This study aimed to compare the incidence of postoperative seizures in patients treated with burr-hole drainage and those treated with craniotomy through propensity score matching (PSM). METHODS: A retrospective cohort analysis was conducted on patients with surgical drainage of nonacute SDHs (burr-holes and craniotomies) between January 2017 to December 2021 at 2 academic institutions in the United States. PSM was performed by controlling for age, subdural thickness, subacute component, and preoperative Glasgow Coma Scale. Seizure rates and accompanying abnormalities on electroencephalographic tracing were evaluated postmatching. RESULTS: A total of 467 patients with 510 nonacute SDHs underwent 474 procedures, with 242 burr-hole evacuations (51.0%) and 232 craniotomies (49.0%). PSM resulted in 62 matched pairs. After matching, univariate analysis revealed that burr-hole evacuations exhibited lower rates of

PURPOSE: Craniotomies for tumor resection can at times result in wound complications which can be devastating in the treatment of neuro-oncological patients. A cranial stair-step technique was recently introduced as an approach to mitigate these complications, especially in this patient population who often exhibit additional risk factors including steroids, chemoradiation, and VEGF inhibitor treatments. This study evaluates our cranial stair-step approach by comparing its postoperative complications using propensity score matching with those of a standard craniotomy wound closure. METHODS: A retrospective chart review was conducted on patients with intracranial neoplasms undergoing primary craniotomy at a single institution. Patients with prior craniotomies and less than three months of follow-up were excluded. Analyses were performed using R Studio. RESULTS: 383 patients were included in the study, 139 of whom underwent the stair-step technique while the rest underwent traditional craniotomy closures. The stair-step cohort was older, had higher ASA classes, and had a higher prevalence of coronary artery disease. The stair-step patients were administered fewer steroids before (40.29% vs. 56.56%, p

BACKGROUND: Primary lymphomas arising in peripheral nerves are extremely rare, with just a few case reports documented in the literature. OBSERVATIONS: The authors present the case of a 62-year-old female with C8 radiculopathy, initially suspected to have a schwannoma based on imaging but later diagnosed with primary C8 nerve root B-cell lymphoma. Following histopathological confirmation, the patient underwent 5 courses of chemotherapy, resulting in a decrease in the size of her lesion on magnetic resonance imaging. At her clinical follow-up 3 months later, her symptoms had improved. After performing a systematic review of the literature while adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines, the authors found only 3 similar cases, each with atypical presentations and treated with various chemotherapeutic agents and one of which experienced a central nervous system recurrence. LESSONS: These cases highlight the importance of early and accurate diagnosis for optimal management and long-term vigilance of primary lymphomas in the peripheral nerve. https://thejns.org/doi/10.3171/CASE24338.