Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Management of Low-Grade Gliomas and Radiation Necrosis: A Single-Institution Case Series

Background: Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive treatment modality for ablation of low-grade glioma (LGG) and radiation necrosis (RN). Objective: To evaluate the efficacy, safety, and survival outcomes of patients with radiographically presumed recurrent or newly diagnosed LGG and RN treated with LITT. Methods: The neuro-oncological database of a quaternary center was reviewed for all patients who underwent LITT for management of LGG between 1 January 2013 and 31 December 2020. Clinical data including demographics, lesion characteristics, and clinical and radiographic outcomes were collected. Kaplan-Meier analyses comprised overall survival (OS) and progression-free survival (PFS). Results: Nine patients (7 men, 2 women; mean [SD] age 50 [16] years) were included. Patients underwent LITT at a mean (SD) of 11.6 (8.5) years after diagnosis. Two (22%) patients had new lesions on radiographic imaging without prior treatment. In the other 7 patients, all (78%) had surgical resection, 6 (67%) had intensity-modulated radiation therapy and chemotherapy, respectively, and 4 (44%) had stereotactic radiosurgery. Two (22%) patients had lesions that were wild-type IDH1 status. Volumetric assessment of preoperative T1-weighted contrast-enhancing and T2-weighted fluid-attenuated inversion recovery (FLAIR) sequences yielded mean (SD) lesion volumes of 4.1 (6.5) cm(3) and 26.7 (27.9) cm(3), respectively. Three (33%) patients had evidence of radiographic progression after LITT. The pooled median (IQR) PFS for the cohort was 52 (56) months, median (IQR) OS after diagnosis was 183 (72) months, and median (IQR) OS after LITT was 52 (60) months. At the time of the study, 2 (22%) patients were deceased. Conclusions: LITT is a safe and effective treatment option for management of LGG and RN, however, there may be increased risk of permanent complications with treatment of deep-seated subcortical lesions

Analyzing international medical graduate research productivity for application to US neurosurgery residency and beyond: A survey of applicants, program directors, and institutional experience

BackgroundThe authors investigated perceived discrepancies between the neurosurgical research productivity of international medical graduates (IMGs) and US medical graduates (USMGs) through the perspective of program directors (PDs) and successfully matched IMGs.MethodsResponses to 2 separate surveys on neurosurgical applicant research productivity in 115 neurosurgical programs and their PDs were analyzed. Neurosurgical research participation was analyzed using an IMG survey of residents who matched into neurosurgical residency within the previous 8 years. Productivity of IMGs conducting dedicated research at the study institution was also analyzed.ResultsThirty-two of 115 (28%) PDs responded to the first research productivity survey and 43 (37%) to the second IMG research survey. PDs expected neurosurgery residency applicants to spend a median of 12–24 months on research (Q1-Q3: 0–12 to 12–24; minimum time: 0–24; maximum time: 0–48) and publish a median of 5 articles (Q1-Q3: 2–5 to 5–10; minimum number: 0–10; maximum number: 4–20). Among 43 PDs, 34 (79%) ranked “research institution or associated personnel” as the most important factor when evaluating IMGs' research. Forty-two of 79 (53%) IMGs responding to the IMG-directed survey reported a median of 30 months (Q1-Q3: 18–48; range: 4–72) of neurosurgical research and 12 published articles (Q1-Q3: 6–24; range: 1–80) before beginning neurosurgical residency. Twenty-two PDs (69%) believed IMGs complete more research than USMGs before residency. Of 20 IMGs conducting dedicated neuroscience/neurosurgery research at the study institution, 16 of 18 who applied matched or entered a US neurosurgical training program; 2 applied and entered a US neurosurgical clinical fellowship.ConclusionThe research work of IMGs compared to USMGs who apply to neurosurgery residency exceeds PDs' expectations regarding scientific output and research time. Many PDs perceive IMG research productivity before residency application as superior to USMGs. Although IMGs comprise a small percentage of trainees, they are responsible for a significant amount of US-published neurosurgical literature. Preresidency IMG research periods may be improved with dedicated mentoring and advising beginning before the research period, during the period, and within a neurosurgery research department, providing a formal structure such as a research fellowship or graduate program for IMGs aspiring to train in the US

Cavernous Malformations and Artificial Intelligence: Machine Learning Applications

Significant progress has been made in the use of artificial intelligence (AI) in clinical medicine over the past decade, but the clinical development of AI faces challenges. Although the spectrum of AI applications is growing within clinical medicine, including in subspecialty neurosurgery, applications focused on cerebral cavernous malformations (CCMs) are relatively scarce. The recently introduced brainstem cavernous malformation (BSCM) grading scale, approach triangles, and safe entry zone systems provide a discrete framework to explore future machine learning (ML) applications of AI systems. Given the immense scalability of these models, significant resources will likely be allocated to pursuing these future efforts

Eponyms in Vascular Neurosurgery: Comprehensive Review of 18 Veins

This review is the first comprehensive anatomic report of all venous eponyms used in vascular neurosurgery and provides the historical context of their authors as well as the surgical relevance of every structure. A PubMed literature review identified 13 individuals for whom 18 eponymous venous structures of the brain were named. These structures are the Batson plexus, veins of Breschet, Breschet sinus, vein of Dandy, vein of Galen, prosencephalic vein of Markowski, torcular Herophili, vein of Labbé, venous plexus of Rektorzik, vein of Rolando, basal vein of Rosenthal, sylvian veins, lateral lakes of Trolard, vein of Trolard, hypoglossal plexus of Trolard, petro-occipital vein of Trolard, venous circle of Trolard, and the vein of Vesalius. Eponyms provide a valuable shorthand that encompasses anatomic nuances, variabilities, and surgical relevance. In addition, they elucidate the historical context in which these structures were described and are an academic honor to our predecessors

Eponyms in Vascular Neurosurgery: Comprehensive Review of 11 Arteries

OBJECTIVE: Anatomic knowledge and insight depend on the cumulative contributions of anatomists over time, and eponyms pay homage to some of these individuals. METHODS: A PubMed literature review identified 11 eponymous arteries of the brain and spinal cord. RESULTS: The 11 eponyms include the artery of Adamkiewicz, the artery of Bernasconi and Cassinari, the artery of Davidoff and Schechter, the recurrent artery of Heubner, McConnell\u27s capsular arteries, the artery of Percheron, the artery of Salmon, the Vidian artery, the arteria termatica of Wilder, the circle of Willis, and the artery of Wollschlaeger and Wollschlaeger. CONCLUSIONS: Eponyms remind us of an artery\u27s importance and can improve our clinical acumen or technique. They have become an integral part of our day-to-day vocabulary, often without our historical knowledge of these anatomists. This report reviews these histories and the anatomy to deepen our appreciation of arterial eponyms in vascular neurosurgery