The authors' approach to implantation of DBS leads into the STN was associated with consistent lead placement in the dorsolateral STN, a low rate of morbidity, efficient use of operating room time, and robust improvement in motor function. The mean coordinates of the middle of the electrode array, measured on postoperative MR images, were 11.6 mm lateral, 2.9 mm posterior, and 4.7 mm inferior to the midcommissural point, and 6.5 mm lateral and 3.5 mm anterior to the center of the red nucleus. Voltage thresholds for several types of stimulation-induced adverse effects were predictive of lead location. Technical nuances of the surgery are described in detail.
IMPORTANCEPer the World Health Organization 2016 integrative classification, newly diagnosed glioblastomas are separated into isocitrate dehydrogenase gene 1 or 2 (IDH)-wild-type and IDH-mutant subtypes, with median patient survival of 1.2 and 3.6 years, respectively. Although maximal resection of contrast-enhanced (CE) tumor is associated with longer survival, the prognostic importance of maximal resection within molecular subgroups and the potential importance of resection of non-contrast-enhanced (NCE) disease is poorly understood.OBJECTIVE To assess the association of resection of CE and NCE tumors in conjunction with molecular and clinical information to develop a new road map for cytoreductive surgery.
To the Editor:The recent outbreak of a novel coronavirus illness (coronavirus disease 2019; COVID-19) has grown into a global pandemic. As a response, there have been several treatment recommendations published by international, federal, state, and local governing bodies. Here, we aim to help neurosurgeons synthesize these recommendations into an institutional policy that fits the unique demands of neurosurgical practice. We performed a comprehensive review of COVD-19 policies and aggregated multidisciplinary expertise at our institution to formulate recommendations for scheduling surgery, providing neurosurgical coverage, and engaging in neurosurgical research during the COVID-19 outbreak. Here, we present a neurosurgical algorithm for varying levels of COVID-19 community infection. This algorithm (with an accompanying checklist) is centered around a 3-tiered system of viral "surge" quantification, which we use to triage case scheduling, and a paired coverage model (PCM), which we use to provide inpatient services. COVID-19 represents a challenge to ongoing practice; however, with clear algorithms, checklists, and contingency planning, it is possible to provide focused neurosurgical care during this pandemic.
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