January 2013

COMING IN FEBRUARY 2013

Health-Related Quality of Life After Spontaneous SubarachnoidHemorrhage Measured in a Recent Patient Population:

Martin Tjahjadi, Christian Heinen, Ralph König,Eckhard Rickels, Christian Rainer Wirtz,

Dieter Woischneck, Thomas Kapapa

Rebleeding After Aneurysmal Subarachnoid Hemorrhage:A Literature Review:

Carl Christian Larsen and Jens Astrup

Low-Level Amplification of Oncogenes Correlates Inverselywith Age for Patients with Nontypical Meningiomas:

Marie E. Beckner, Raghuram Sampath, Ashley B. Flowers,Kristopher Katira, Dwain D’Souza, Shashikant Patil,

Raj B. Patel, Mary L. Nordberg, Anil Nanda

Pituitary Metastases: Role of Surgery:Matteo Zoli, Diego Mazzatenta, Marco Faustini-Fustini,

Ernesto Pasquini, Giorgio Frank

Pituitary Tumor Surgery: Review of 3004 Cases:Mauro Loyo-Varela, Tenoch Herrada-Pineda,

Francisco Revilla-Pacheco, Salvador Manrique-Guzman

Lessons Learned from War: A Comprehensive Review ofthe Published Experiences of the Iranian Neurosurgeons

During the Iraq-Iran Conflict and Review of theRelated Literature:

Vafa Rahimi-Movaghar, Seyed Behzad Jazayeri,Marjan Alimi, Kazem Abbassioun, Abbas Amirjamshidi

Pages 99–109

Impact of Ultra-Low-Field Intraoperative Magnetic

Resonance Imaging on Extent of Resection and

Frequency of Tumor Recurrence in 104 Surgically

Treated Nonfunctioning Pituitary Adenomas

Martin Hlavica, David Bellut, Doreen Lemm, Christoph Schmid,

Rene Ludwig Bernays

Hlavica et al. present their experience using ultra-low-fieldintraoperative MRI (iMRI) to aid in transsphenoidal resection ofnonfunctioning pituitary adenomas (NFPAs). One hundred threeconsecutive patients underwent iMRI-guided surgical resection oftheir NFPAs over a 4-year period, and were followed for anaverage of 34 months after their surgical procedure for clinicaland radiographic findings. The authors found that iMRI washelpful in identifying residual tumor in 46.2% of their cases. Thisadditional tumor resection increased their 3-month remission rateby 52.2%. The size and invasiveness of the tumor, as seen onpreoperative imaging, was associated with remission. The authorsconcluded that the outcomes for transsphenoidal resection ofNFPAs can be improved by the use of iMRI by leading to morecomplete tumor removal.

Pages 110–115

Mortality and Discharge to Home After Closed Brain

Biopsy: Analysis of 3523 Cases from the State of

California, 2003-2009

Derek R. Johnson, Brian P. O’Neill, Paul A. Decker, Matt L. Kosel,

Giuseppe Lanzino, Julie E. Hammack

Johnson et al. retrospectively evaluated the safety of closed brainbiopsy in the state of California. By querying the PatientDischarge Database for inhospital mortality and discharge tohome rates for patients undergoing closed brain biopsy, theauthors reviewed data for 3523 hospitalizations over a 7-yearperiod. They found an inhospital mortality rate of 3.5%. A total of62.7% of hospitalizations resulted in discharge directly home.Their multivariate analysis revealed that scheduled versusunscheduled admissions were predictive of mortality; these samefactors, in addition to patient race, were predictive of dischargedirectly to home. The authors conclude that the mortality rate ofclosed brain biopsy is higher than generally recognized.

Pages 130–135

Cognitive, Physical, and Psychological Status After

Intracranial Aneurysm Rupture: A Cross-Sectional

Study of a Stockholm Case Series 1996 to 1999

Ann-Christin von Vogelsang, Mikael Svensson, Yvonne Wengström,

Christina Forsberg

Von Vogelsang et al. describe the long-term psychological, physical,and cognitive function of a single-institution’s ruptured aneurysmcohort. Two hundred seventeen patients treated at a neurosurgicalclinic in Stockholm, Sweden, were followed-up with phoneinterviews and questionnaires an average of 10.1 years after theiraneurysm rupture. The authors found that aneurysm patients hadhigher levels of anxiety and depression than a normative referencegroup. These findings were particularly more prominent in thosepatients with posterior circulation aneurysms. Cognition was alsoworse in the aneurysm group compared to the general population,with 21.7% of patients displaying cognitive impairment. Only 2.8%of the respondent group reported severe physical disability. The

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authors conclude that long-term psychological and cognitive functioncan be significantly affected by aneurysm rupture, and that routinepostoperative screening may be helpful in identifying patients in needof further treatment.

Pages 136–142

Falling Temperature and Colder Weather Are

Associated with an Increased Risk of Aneurysmal

Subarachnoid Hemorrhage

Randeep S. Gill, Hali L. Hambridge, Eric B. Schneider, Thomas Hanff,

Rafael J. Tamargo, Paul Nyquist

Gill et al. characterize the relationship between specific weatherpatterns and incidence of aneurysmal subarachnoid hemorrhage(aSAH). The authors retrospectively reviewed 1175 aSAH casesover 18 years from a single tertiary medical center, then collectedhistorical data in Baltimore, Maryland, from the National WeatherService on maximum ambient temperature (MAT), averagerelative humidity, and atmospheric pressure on each day ofhemorrhage. They used a Poisson regression model to assessdaily risk of incidence of aSAH based on daily weather data and1-day changes in MAT. The authors report that an MAT drop of1°F from one day to the next was associated with a 0.6%increase in risk of aSAH. This finding was especially strong forwomen. Similarly, warmer temperatures were associated with a0.3% decrease in risk of aSAH for each degree Fahrenheitincrease from the previous day. The authors conclude that theincidence of aSAH increases in response to dramatic temperaturedrops. These findings may be helpful in predicting allocation ofresources at tertiary medical centers.

Pages 143–148

Stent-Assisted Endovascular Recanalization of Extracranial

Internal Carotid Artery Occlusion in Acute Ischemic Stroke

Richard T. Dalyai, Nohra Chalouhi, Saurabh Singhal, Pascal Jabbour,

L. Fernando Gonzalez, Aaron S. Dumont, Robert Rosenwasser,

George Ghobrial, Stavropoula I. Tjoumakaris

Dalyai et al. report on their single institution experiencetreating acute carotid occlusions using endovascularthrombolysis and stent placement. They reviewed radiographicand clinical characteristics of 17 patients treated for acuteinternal carotid artery (ICA) occlusion with stent-assistedendovascular thrombolysis. Patients included in the review hada National Institute of Health Stroke Scale (NIHSS) of at least 6and presence of significant ischemic penumbra on computedtomography perfusion. Of these patients, 16 had successfulimmediate recanalization of the ICA. The authors report amean admission NIHSS of 16.5, which improved to a mean of6.9 upon discharge. They report an overall mortality rate of17%. The authors conclude that in the setting of ischemicstroke secondary to acute ICA occlusion, emergentendovascular carotid artery thrombolysis and stenting may be apromising treatment option with favorable clinical outcomes.

Pages 154–158

Dabigatran: A Primer for Neurosurgeons

Jennifer E. Fugate, Alejandro A. Rabinstein, Robert D. McBane,

Giuseppe Lanzino

Rabinstein et al. report on the new oral anticoagulantdabigatran (Pradaxa) and the periopertave neurosurgical

implications in patients taking the drug. This new drug has anadvantage over traditional anticoagulants such as warfarin inthat it provides rapid, steady anticoagulation without the needfor laboratory monitoring. Furthermore, dabigatran is associatedwith a lower risk of intracranial hemorrhage compared towarfarin. The authors report, however, that this lack of reliablemonitoring or ability to reverse its anticoagulant effects posesa challenge to treating physicians when urgent neurosurgicalintervention is necessary. Based on review of the Englishliterature, the authors make recommendations for theperioperative management of dabigatran, including thediscontinuation of the drug 2 to 4 days before a proposedneurosurgical procedure (in patients with normal renal function)when the risk of surgical bleeding outweighs theperiprocedural risk of thrombosis. The authors also recommendconsidering temporary use of a more traditional anticoagulant,such as warfarin, in the immediate postoperative period whenthe concern for postoperative bleeding is high. The authorsalso make recommendations on the management of bleedingfrom dabigatran for emergent procedures. The authorsconclude that although it has its advantages, dabigatran usedoes pose significant limitations in neurosurgical patients.

Pages 159–161

What Can Be Learned from the DECRA Study

Stephen Honeybul, Kwok M. Ho, Christopher R.P. Lind

Honeybul et al. review the data from the DecompressiveCraniectomy in Patients with Severe Traumatic Brain Injurystudy (DECRA) published by Cooper et al. in 2011. This studyset out to evaluate the outcomes of patients suffering fromdiffuse traumatic brain injury randomized to earlydecompressive craniectomy versus standard medical therapy.The authors examine the data closely to counter thecontroversial findings that surgically managed patients hadmore unfavorable outcomes compared with their medicalcohort and that standard medical therapy should be adopted tosave the medical system millions of dollars. Honeybul et al.discuss problems with randomization, high crossover rate, andthat inclusion criteria did not reflect standard clinical practice.They offer an alternative interpretation of the data, and posefurther questions as to the role of surgical intervention inmalignant intracranial hypertension.

Pages 198–206

Florence Nightingale: Light to Illuminate the World

from the Woman with the Lantern

Gulten Dinc, Sait Naderi, Yucel Kanpolat

Naderi et al. recount the history of the modernization of thenursing profession, and how the West’s response to theOttoman-Russian war of 1853-1855 created opportunities forFlorence Nightingale and her colleagues to care for ailingpatients in a novel way. The authors discuss the personalhistory of Florence Nightingale, and how her privilegedupbringing drove her to care for the sad and suffering. Thesepersonal qualities inspired her to care for the wounded as theCrimean war escalated, during which she and 38 other nursesworked to provide nutrition, clothing, hygiene, and comfort tohospitalized soldiers. The organization of these efforts providedthe foundation for the modern practice of nursing.

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