Neurosurgery (Neurosurgery)

Publications in this journal

• Article: Traumatic Intracranial Hemorrhage in Patients Taking Dabigatran: Report of Three Cases and Review of the Literature.

  Shafik N Wassef, Taylor J Abel, Andrew Grossbach, Stephanus V Viljoen, Adam W Jackson, Matthew A Howard, Jeremy D W Greenlee
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND AND IMPORTANCE:: Dabigatran is a direct thrombin inhibitor gaining popularity as a stroke prevention agent in atrial fibrillation patients. Compared to warfarin, dabigatran showed superiority in stroke prevention, but lower rates of major hemorrhage and intracerebral hemorrhage. While warfarin has a well-established reversal strategy, there is far less experience reversing dabigatran. CLINICAL PRESENTATION:: We present our experience with three patients who suffered intracranial hemorrhage either spontaneously or after low energy cranial trauma and review the available literature describing dabigatran use in traumatic brain injury patients. CONCLUSION:: Intracranial hemorrhage in patients taking anticoagulants and/or antiplatelets can have either a benign or malignant clinical course. At this time, there is little experience with dabigatran reversal; however, several strategies for rapid reversal have been proposed. All patients with intracranial hemorrhage taking dabigatran should be admitted for close neurological monitoring and serial imaging.
  Neurosurgery 05/2013;
• Article: Chronic 30 Hz Deep Cerebellar Stimulation Coupled With Training Enhances Post-Ischemia Motor Recovery and Peri-Infarct Synaptophysin Expression in Rodents.

  Andre G Machado, Jessica Cooperrider, Havan T Furmaga, Kenneth B Baker, Hyun Joo Park, Zhihong Chengabigabi, John Gale
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND:: Over 500,000 Americans suffer strokes every year, making stroke the leading cause for disability in the US and in the industrialized world. New treatments to improve post-stroke motor recovery are needed. OBJECTIVE:: To investigate a novel approach for enhancing motor recovery that involves chronic, electrical stimulation of ascending cerebellar output combined with motor training. METHODS:: Adult Sprague-Dawley rats underwent unilateral endothelin-1 (ET-1) injections in the dominant cerebral cortex and placement of a chronic stimulating electrode in the contralateral lateral cerebellar nucleus. After one week, animals were separated into two groups (STIM and STIM), matched for post-stroke motor performance in the pasta matrix task. At two weeks post-ischemia, the treatment phase was initiated, with animals in the STIM group receiving pulsed, 30 Hz stimulation for 12h/day. Motor training continued for both groups over three to five weeks. RESULTS:: A total of twenty-three animals were examined after three weeks of treatment. STIM animals showed a significant improvement in motor function compared to post-ischemia, baseline performance as well as in comparison to the STIM group. Immunohistochemistry revealed a significant increase in the perilesional expression of synaptophysin for the STIM versus the STIM animals. CONCLUSION:: These results indicate that chronic activation of ascending cerebellofugal pathways enhances motor recovery after focal cortical ischemia. The recovery was associated with an increase in perilesional cortical plasticity relative to non-treated controls.
  Neurosurgery 05/2013;
• Article: Pathology of Spinal Ependymomas: An Institutional Experience Over 25 Years in 134 Patients.

  Phiroz E Tarapore, Peter Modera, Agne Naujokas, Michael C Oh, Beejal Amin, Tarik Tihan, Andrew T Parsa, Christopher P Ames, Dean Chou, Praveen V Mummaneni, Phillip R Weinstein
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND:: Ependymomas comprise approximately 40% of primary intraspinal tumors. Current WHO grading may not correlate with observed progression-free survival (PFS). OBJECTIVE:: This retrospective study of prospectively collected data examines whether PFS is influenced by histological grade or by extent of resection. It also analyzes usage and effectiveness of postoperative adjuvant radiotherapy. METHODS:: We reviewed 134 consecutive patients with ependymomas of all grades. Pathology slides were re-reviewed and the histological grades were confirmed by a single neuropathologist. Postoperative residual or recurrence was evaluated with follow-up MRI. RESULTS:: There were 85 male and 49 female patients, ranging from 10 to 79 (median 41) years of age. Thirty were WHO grade I, 101 were grade II, and 3 were grade III tumors. Kaplan Meier analysis of PFS demonstrated a mean duration of 6 years for grade I, 14.9 years for grade II, and 3.7 years for grade III (p<.001). In grade II ependymomas, mean PFS was 11.2 years with STR and 17.8 years with GTR (p<.01). PFS of patients who underwent STR was not significantly changed by adjuvant radiotherapy (p<.36). CONCLUSION:: Patients with grade II ependymoma have significantly longer PFS than patients with grade I ependymoma. Extent of resection did not affect PFS in grade I ependymoma but it did in grade II. Contrary to their higher grade, WHO grade II ependymoma carries a better prognosis than WHO grade I ependymoma.
  Neurosurgery 05/2013;
• Article: Transvenous Retrograde Nidus Sclerotherapy under Controlled Hypotension (TRENSH): Hemodynamic Analysis and Concept Validation in a Pig Arteriovenous Malformation Model.

  Tarik F Massoud
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND:: Transvenous retrograde nidus sclerotherapy under controlled hypotension (TRENSH) is a proposed novel concept for endovascular treatment of cerebral arteriovenous malformations (AVMs). OBJECTIVE:: To assess the experimental hemodynamic feasibility of TRENSH in a pig AVM model. METHODS:: We surgically constructed carotid-jugular fistula-type AVM models in eight pigs. In five pigs (Group 1) we hemodynamically assessed the AVM through the main arterial feeder (AF) and draining vein (DV) at systemic normotension (Systnorm). We then performed retrograde nidus angiography through the DV at progressively deeper levels of hemorrhagic systemic hypotension (Systhypo), and graded and correlated these angiograms with the degree of Systhypo. In another three pigs (Group 2) we correlated the effects of temporary balloon occlusion of the main AF with the angiographic extent of retrograde nidus filling. RESULTS:: In Group 1 pigs, the drop in AF pressure correlated strongly (r=0.93-0.99) with the drop in DV pressure at progressively deeper Systhypo. Minimal retrograde nidus filling occurred at Systnorm. We observed progressively greater extents of retrograde nidus filling as the transnidal pressure gradients fell with deeper Systhypo. Near-complete retrograde permeation of the nidus was possible as the transnidal gradients approached zero mmHg. As more of the nidus filled, its concurrent emptying was documented through a greater number of DVs. Temporary AF occlusion resulted in improved retrograde nidus filling in all Group 2 pigs. CONCLUSION:: Endovascular TRENSH appears feasible in a pig AVM model. Further experimental investigations of TRENSH are necessary to assess its full potential prior to future clinical applications.
  Neurosurgery 05/2013;
• Article: Is There a Shortage of Neurosurgeons in the United States?

  Judy Rosman, Steve Slane, Beth Dery, Michael A Vogelbaum, Aaron A Cohen-Gadol, William T Couldwell
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND:: Neurosurgical workforce decision-making is typically driven by the 1 neurosurgeon per 100,000 population ratio proposed in 1977 in the Study on Surgical Services for the United States (SOSSUS) report. The actual ratio has always been higher than suggested. OBJECTIVE:: We evaluated whether the 1:100,000 ratio from the SOSSUS report is still valid, whether there are enough neurosurgeons in the U.S. to meet patient needs, and whether demand is driven by patient need. METHODS:: For our analysis, the distribution of practicing US neurosurgeons was merged with census data to yield density indices of neurosurgeons by state; a survey assessing practice characteristics was emailed to practicing neurosurgeons; and a compilation of job advertisements for U.S. neurosurgeons was evaluated. RESULTS:: Multi-variant statistical analyses yielded inconclusive results regarding patient demand because existing data sets are not designed to establish patient demand and many neurosurgeons are subspecialized. The data indicated the ratio of neurosurgeons to total U.S. population is 1:65,580. In the survey responses, neurosurgeon-to-patient ratios varied dramatically by state and were inconsistently correlated with whether neurosurgeons indicated they were overworked or underworked. The 305 job advertisements may indicate a shortage. Twenty-four percent of advertising practices indicated that they are recruiting only for emergency room coverage, and an additional 26% indicated that they might not be recruiting if not for the need for emergency coverage. CONCLUSION:: Demand ratios should be re-evaluated by region and subspecialty to consider changes in neurosurgery practice. A "shortage" in the employment market may reflect factors other than patient need.
  Neurosurgery 05/2013;
• Article: Rembrandt's 'Anatomy Lesson of Dr Deijman' of 1656 Dissected.

  Frank F A Ijpma, Norbert E Middelkoop, Thomas M van Gulik
  [show abstract] [hide abstract]
  ABSTRACT: More than 350 years ago, Rembrandt painted 'The Anatomy Lesson of Dr Deijman'. This group portrait, featuring important members of the Amsterdam Guild of Surgeons, belongs to the series of paintings of the Guild. Rembrandt's masterpiece is one of the most famous historical images of a dissection of the brain. Unfortunately, a large part of the original painting was destroyed due to a fire. Still visible, however, is how Dr. Deijman, Doctor of Medicine and reader in anatomy, performs a dissection of the cerebral membranes in the corpse of the executed criminal Joris Fonteijn. As there is no consensus about the nature, accuracy, and the 'symbolic' significance of the anatomical structures depicted in the painting, we compared the painting with a real anatomical dissection of the skull of a cadaver in order to unravel the hidden messages behind this 'anatomy lesson'.
  Neurosurgery 05/2013;
• Article: Response to Journal Club: Factors and Outcomes Associated With Early and Delayed Aneurysm Treatment in Subarachnoid Hemorrhage Patients in the United States.

  Farhan Siddiq, Malik M Adil, Adnan I Qureshi
  Neurosurgery 05/2013; 72(5):868-869.
• Article: Journal Club: Factors and Outcomes Associated With Early and Delayed Aneurysm Treatment in Subarachnoid Hemorrhage Patients in the United States.

  Gregory D Arnone, Ziad A Hage
  Neurosurgery 05/2013; 72(5):864-867.
• Article: Calendar of Events: Full contact information is available online only.

  Russell R Lonser
  Neurosurgery 05/2013; 72(5):871-872.
• Article: Patterns of Aneurysm Recurrence.

  Carl Muroi, Javier Fandino, Mohamed El Beltagy, Yasuhiro Yonekawa
  Neurosurgery 05/2013; 72(5):E874.
• Article: Instructions for Obtaining SANS Neurosurgery Continuing Medical Education (CME) Credit.

  Ganesh Rao
  Neurosurgery 05/2013; 72(5):N12.
• Article: Characterization of Chronic Subdural Hematoma Fluid Proteome.

  Anna-Leena Heula, Steffen Ohlmeier, Juha Sajanti, Kari Majamaa
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND:: Chronic subdural hematoma (CSDH) is commonly caused by head injury, but the progression of CSDH is recognized as an inflammatory process. The protein composition of the CSDH fluid has not been fully elucidated, nor the contribution of its components to the enlargement of the hematoma cavity and to its chronic manifestation. OBJECTIVE:: To characterize the protein content of CSDH fluid and study the differences between CSDH fluid and serum in order to identify proteins putatively involved in the pathogenesis of CSDH. METHODS:: CSDH fluid and serum of five patients were investigated with two-dimensional gel electrophoresis followed by glycosylation-specific fluorescence staining and mass spectrometry. RESULTS:: Two-dimensional gel electrophoresis revealed about 1100 protein spots in the CSDH fluid. We identified 213 spots representing 57 different proteins, most of which were glycosylated. The comparison with serum revealed 11 proteins with elevated levels in the CSDH fluid including carbonic anhydrase 1 (CAI), catalase, ferritin light chain, fibrinogen (α, β, γ), hemoglobin (α, β), malate dehydrogenase, peroxiredoxin 2 and TGF-β-induced protein ig-h3 (TGFBI). The levels of haptoglobin and a fragment of complement C4 were decreased. Changes in spot positions were detected for apolipoprotein A1 and a fragment of complement C3. CONCLUSION:: The hematoma fluid originates mainly from blood and the results suggest the involvement of coagulation and fibrinolysis cascades. However, proteins with a potential role in CSDH pathogenesis were detected including CAI, TGFBI and the altered components of the complement system. Inflammation and fibrosis indicate targets for further studies in the pathogenesis of CSDH.
  Neurosurgery 04/2013;
• Article: External Validation of the IMPACT Model and the Role of Markers of Coagulation.

  Raj Rbr, Siironen J, Kivisaari R, Hernesniemi J, Tanskanen P, Handolin L, Skrifvars Mb
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND:: Markers of coagulation have shown to be of important value in predicting traumatic brain injury (TBI) outcome. OBJECTIVE:: To externally validate and investigate the role of markers of coagulation for outcome prediction using the IMPACT model while adjusting for overall injury severity. METHODS:: A retrospective chart analysis of TBI patients admitted to Helsinki University Central Hospital between 2009-2010 was performed. Outcome was estimated using the criteria of the IMPACT model. Admission international normalized ratio (INR) and platelet count were used as markers of coagulation. Overall injury severity was categorized with the injury severity score (ISS). Variables were added to the calculated IMPACT risk, generating new models. Model performance was assessed by analyzing and comparing the area under the curve (AUC) of the models. RESULTS:: For 342 included patients, 6-month mortality was 32% and unfavorable neurological outcome 36%. Patients with poor outcome had lower platelets and higher INR and ISS compared to those with good outcome (p< .001). The IMPACT model had an AUC of 0.85 for predicting mortality and 0.81 for neurological outcome. Addition of INR but not ISS or platelets to the IMPACT predicted risk improved the predictive validity for mortality ([INCREMENT] AUC 0.02, p= .034) but not neurological outcome ([INCREMENT] AUC 0.00, p= .401). In multivariate analysis, INR remained significant for mortality but not for neurological outcome when adjusting for IMPACT risk and ISS (p= .012). CONCLUSION:: The IMPACT model showed excellent performance and INR was an independent predictor for mortality, independent of overall injury severity.
  Neurosurgery 04/2013;
• Article: The Efficacy of Lumbar Hybrid Stabilization Using the DIAM™ to Delay Adjacent Segment Degeneration: An Intervention Comparison Study With a Minimum Two-Year Follow-up.

  Chang-Hyun Lee, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng, Sang Hoon Yoon, Hyun-Jib Kim
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND:: Although posterior lumbar interbody fusion (PLIF) has a successful fusion rate, the long-term outcome of PLIF is occasionally below expectations because of adjacent segment degeneration (ASD). OBJECTIVE:: To evaluate the ability of hybrid stabilization using DIAM(Device for Interspinous Assisted Motion) to delay ASD. METHODS:: An intervention comparison study of 75 patients (hybrid, 25; PLIF, 50) was performed. The indications for hybrid stabilization were facet joint degeneration, Pfirrmann grade II-III, and stenosis at the rostral adjacent segment. The PLIF group consisted of patients matched for age, gender, and fusion. The hybrid stabilization procedure included traditional PLIF and DIAM installation at a superior adjacent segment. The outcomes were analyzed using linear mixed model analysis. Conditional logistic regression was performed to calculate the odds ratio for the association of surgical methods. RESULTS:: The hybrid group (24%) revealed fewer ASDs than the PLIF group (48%). Among ASDs, spondylolisthesis occurred more frequently in the PLIF group than the hybrid group. Hybrid surgery was significantly associated with ASD; the odds ratio for hybrid surgery was 0.28 when compared to PLIF. Foraminal height of the PLIF group decreased more than the hybrid group (P=.01). Segmental mobility showed a greater increase in the PLIF group than the hybrid group (P=.04). However, the clinical outcomes did not show significant differences between the groups. CONCLUSION:: Hybrid stabilization using DIAM and pedicle screws can be used for patients with facet degeneration at adjacent segments but should be further investigated.
  Neurosurgery 04/2013;
• Article: Commentary: Societal Statement on Recent Acute Stroke Intervention Trials: Results and Implications.

  Alexander A Khalessi, Kyle M Fargen, Sean Lavine, J Mocco
  Neurosurgery 04/2013;
• Article: An Evidence-Based Approach to the Efficient Use of CT-imaging in the Neurosurgical Patient.

  Matthew C Garrett, Arzu Bilgin-Freiert, Christine Bartels, Richard Everson, Nasim Afsarmanesh, Nader Pouratian
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND:: Computed tomography (CT) is the current standard for rapidly diagnosing some of the more common structural pathologies that affect the neurosurgical patient peri-operatively. With this convenience comes the potential for over-utilization.Objective: To investigate the utility of head CTs ordered for various clinical indications. METHODS:: All head CT studies ordered by the UCLA neurosurgery department from 8/15/2011-12/15/2011 were prospectively studied. Variables collected included: demographic information, diagnosis, surgical procedures, indication for CT, CT result, and whether the study led to a documentable change in management. RESULTS:: There were 801 head CT studies ordered for the 462 patients who were admitted to the neurosurgical service. The authors identified fourteen indications for ordering a head CT with the following probabilities of a positive finding: exam change (17/56, 30.3%), follow-up(4-6 hours after intracerebral hemorrhage) (16/126, 12.7%), CT-angiogram (11/30, 36.7%),routine post-operative imaging (6/126, 4.7%), post-ventriculostomy placement (4/62, 6.5%), immediately prior to (4/31, 12.9%) or after removal (2/42, 4.8%) of a ventriculostomy, surveillance (>24 hours after intracerebral hemorrhage or EVD placement) (3/66, 4.5%), headaches (2/8, 25%), ground level fall (1/8, 12.5%), intracranial pressure (ICP) spikes (2/6, 33.3%) and delayed (6-24 hours after intracerebral hemorrhage) (1/25, 4%). CONCLUSION:: The probability of discovering a clinically significant finding varies widely for each of the listed study indications. This prospective analysis of all CTs ordered at a single institution suggests that imaging studies obtained without a change in neurological status were unlikely to produce a positive finding, and even when positive, were extremely unlikely to result in any intervention.
  Neurosurgery 04/2013;
• Article: A Case of Falcine Sinus Dural ArteriovenousFistula.

  Shotaro Yoshioka, Junta Moroi, Shinya Kobayashi, Nobuharu Furuya, Tatsuya Ishikawa
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: and Importance: The falcine sinus is an embryonic vessel that connects the superior and inferior sagittal sinusesandmostly closes after birth. Although some cases of persistent falcine sinus have beenreported, duralarteriovenous fistula(dAVF) associated with the falcine sinus has not previouslybeen reported. CLINICAL PRESENTATION:: A 60-year-old man presented with asymptomatic dAVFs on digital subtraction angiography. The dAVFs were mainly fed by the cortical branch of the left anterior cerebral artery and drained into the falcine sinus. Intraoperatively, all veins drainingin a retrograde manner into cortical veins were obstructed. However, cortical venous reflux didnot disappear before removal of the falxcerebri, including the falcine sinus and inferior sagittal sinus. In this case, we consideredfalcine sinus dAVFas equivalent to olfactory groove dAVF, sincethe medial olfactory artery,in its role as a common feeding artery in olfactory groove dAVF, is a rudiment of the anterior cerebral artery as the main feeding artery in this case.Intraoperative findings and the surgical specimen revealed a small vessel network in the falxcerebri communicating with the falcine and inferior sagittal sinuses, which was considered to represent a falcine venous plexus not as a vessel anomaly. CONCLUSION:: Extensive removal of the falxcerebri including the falcine sinus or complete endovascular obliteration of the whole falcine sinus as early as possible represents an important strategy in the surgical treatment of falcine sinus dAVF.
  Neurosurgery 04/2013;
• Article: Evolution of TransoralSurgery: Three Decades of Change in Patients, Pathologies and Indications.

  David Choi, Hugh Alan Crockard
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND:: Transoral surgery may be used to approachpathologies at the craniocervical junction.However, the requirement for this approach has decreased over the past few decades. OBJECTIVE:: To assess the outcome and complications of transoral surgery and extended transoral approaches at a single UK center between 1980 and 2011. METHODS:: Retrospective review of 495 ventral midline operations (between 1980-2004) and prospective review of 38 operations (2004-2011) in a total of 479 patients. Trends in surgery and factors associated with good or bad outcome were assessed over this 30-year period. RESULTS:: Of 533 operations, the most frequently performed surgeries were simple transoral surgery (320 operations), transoral surgery with splitting of the palate (107), "Open-door" maxillotomy (58), and mandibulotomy (9). Since the 1990s there has been a steady decline in the number of operations performed, mainly due to the decrease in the number of patients with rheumatoid arthritis presenting for surgery. The incidence of craniocervical junction tumors remained constant.The number of complications was significantly associated with the pre-operative neurological status, and more complications were seen in myelopathic rheumatoid patients, and a higher trend in congenital basilar invagination.The rates of pharyngeal infection (0.6%) and CSF leak (0.3%) for standard transoral surgery were extremely low. CONCLUSION:: The number of transoral and associated operations has decreased over time. Transoral surgery is now mainly indicated for ventral midline tumors such as chordomas. Transnasal endoscopic techniques show promise, but a major advantage of standard transoral surgery is the low CSF leak and infection rates.
  Neurosurgery 04/2013;
• Article: Simultaneous Recording of Single-neuron Activities and Broad-area Intracranial Electroencephalography: Electrode Design and Implantation Procedure.

  Takeshi Matsuo, Kensuke Kawai, Takeshi Uno, Naoto Kunii, Naohisa Miyakawa, Kenichi Usami, Keisuke Kawasaki, Isao Hasegawa, Nobuhito Saito
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND:: There has been a growing interest in clinical single-neuron recording, to better understand epileptogenicity and brain function. It is crucial to compare this new information, single-neuronal activity, with that obtained from conventional intracranial electroencephalographyduring simultaneous recording. However, it is difficult to implant microwires and subdural electrodes during a single surgical operation, since the stereotactic frame hampers flexible craniotomy. OBJECTIVE:: We describenewly designed electrodes as well as surgical techniques to implant these with subdural electrodes that enable simultaneous recording from hippocampal neurons and broad areas of the cortical surface. METHODS:: We designed a depth electrode that does not protrude into the dura and pulsates naturally with the brain. The length and the tract of the depth electrode were determined preoperatively between the lateral subiculum and the lateral surface of the temporal lobe. A frameless navigation system was used to insert the depth electrode. Surface grids and ventral strips were placed before and after the insertion of the depth electrodes, respectively. Finally, a microwire bundle was inserted into the lumen of the depth electrode. We evaluated the precision of implantation, the recording stability, and therecording rate with microwire electrodes. RESULTS:: Depth-microwire electrodes were placed with a precision of 3.6mm. The mean successful recording rate of single- or multiple-unit activity was 14.8%, which was maintained throughout the entire recording period. CONCLUSION:: We achieved simultaneous implantation of microwires, depth electrodes and broad-area subdural electrodes. Our method enabled simultaneous and stable recording of hippocampal single-neuron activities and multi-channel intracranial electroencephalography.
  Neurosurgery 04/2013;
• Article: Biopsy of the Superficial Cortex: Predictors of Effectiveness and Outcomes.

  Ammar H Hawasli, Robert T Buckley, Feng Gao, David D Limbrick, Matthew D Smyth, Jeffrey R Leonard, Paul Santiago, Todd J Stewart, Tae S Park, Robert L Grubb, Joshua L Dowling, Eric C Leuthardt, Keith M Rich, Gregory J Zipfel, Ralph G Dacey, Michael R Chicoine
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND:: Brain biopsies of superficial cortex are performed for diagnosis of neurological diseases, but preoperative predictors of successful diagnosis and risks are lacking. OBJECTIVE:: We evaluated effectiveness and outcomes of superficial cortical biopsies and determined preoperative predictors of diagnosis, outcomes, morbidities and mortality. METHODS:: Single-institution retrospective analysis of 170 patients that underwent open brain biopsies of superficial cortex was performed. Clinical predictors of effectiveness and outcomes were determined using univariate/multivariate analyses and a system for risk-benefit stratification was created and tested. RESULTS:: Brain biopsies led to successful diagnosis in 122/170 (71.8%), and affected management in 97/170 (57.1%) cases. Factors increasing odds of diagnostic pathology included age >45 years (odds ratio [OR] 2.67, 95% confidence-interval [CI] 1.34-5.27, p<0.01), prior cancer diagnosis (OR 3.64, CI 1.69-7.85, p<0.001), focal (OR 3.90, CI 1.91-8.00, p<0.001) and enhancing (OR 5.03, CI 2.41-10.52, p<0.001) lesions on MRI, biopsy of specific MRI lesion (OR 9.34, CI 4.29-20.33, p<0.001), and use of intraoperative navigation (OR 6.59, CI 3.04-14.28, p<0.001). Brain biopsies led to symptomatic intracranial hemorrhage (ICH), seizures, other significant morbidities or perioperative mortality in 12.4%, 16.2%, 37.1%, and 8% of cases, respectively. Risk of postoperative ICH was increased by aspirin history (OR 2.51, CI 1.23-5.28, p<0.05) and age >60 years (OR 2.66, CI 1.36-5.18, p<0.01). CONCLUSION:: Effectiveness and risk of morbidity/mortality can be estimated preoperatively for patients undergoing open brain biopsies of the superficial cortex. Increased age and specific imaging characteristics increases odds of diagnostic biopsy. Conversely, increased age and aspirin elevates risk of postoperative complication.
  Neurosurgery 04/2013;