Julian Gendreau

Johns Hopkins University | JHU · Department of Neurosurgery

A method using a computerized system to provide accurate medical patient prognoses and patient outcomes utilizing machine learning algorithms that are able be viewed through a mobile device application. This includes using previously derived data from a large number of patients to build machine learning models to predicting several measures through...

Purpose: Skull base chordoma is a rare and locally destructive malignancy which presents unique therapeutic challenges. While achieving gross total resection (GTR) confers the greatest survival advantage, the role of adjuvant radiotherapy (RT) for patients who receive GTR remains unclear in the absence of prospective trials. Here, we aim to assess...

Background: Current treatment guidelines for clival chordomas recommend surgical resection followed by high dose radiotherapy (RT). However, in patients where gross total resection (GTR) is achieved, the benefits of additional RT remain unclear. Objective: To investigate whether RT offers any benefit to progression free survival (PFS) in patient...

Introduction Meningiomas—the most common extra-axial tumors—are benign, slow-growing dural-based lesions that can involve multiple cranial fossae and can progress insidiously for years until coming to clinical attention secondary to compression of adjacent neurovascular structures. For complex, multicompartmental lesions, multistaged surgeries have...

In the pages that follow, we will outline several dreams which we believe humanity will bring to reality within the next decades. While we as a civilization have made unparalleled advances in technology, we have accomplished these so rapidly that we have yet to truly understand how we can apply these capabilities to medicine in order to improve the...

Introduction Pituitary apoplexy has historically been considered an emergent condition that necessitates surgical intervention when there is acute symptomatic onset. This potentially serious condition often occurs in the setting of an underlying adenoma, cystic lesion, or other sellar mass. When these mass lesions hemorrhage within the confined spa...

Background Endovascular treatment with the woven endobridge (WEB) device has been widely utilized for managing intracranial aneurysms. However, predicting the probability of achieving adequate occlusion (Raymond–Roy classification 1 or 2) remains challenging. Objective Our study sought to develop and validate a predictive calculator for adequate o...

Objective Axel Perneczky is responsible for conceptualizing the “keyhole” philosophy as a new paradigm of minimal invasiveness within cranial neurosurgery. Keyhole neurosurgery aims to limit approach-related traumatization and minimize brain retraction while still enabling the neurosurgeon to achieve operative goals. The supraorbital keyhole cranio...

Introduction Pituitary apoplexy has historically been considered an emergent condition that necessitates surgical intervention when there is acute symptomatic onset. This potentially serious condition often occurs in the setting of an underlying adenoma, cystic lesion, or other sellar mass. When these mass lesions hemorrhage within the confined spa...

The authors regret that the middle initial for Mark A. Pacult was not included in the author list. The author name has now been updated. The authors would like to apologize for any inconvenience caused.

BACKGROUND AND OBJECTIVES Surgery for the very elderly is a progressively important paradigm as life expectancy continues to rise. Patients with glioblastoma multiforme often undergo surgery, radiotherapy (RT), and chemotherapy (CT) to prolong overall survival (OS). However, the efficacy of these treatment modalities in patients aged 80 years and o...

OBJECTIVE Spinal chordoma treatment guidelines recommend resection. However, in patients in whom gross-total resection (GTR) is achieved, the benefits of radiation therapy (RT) are unclear. Therefore, the authors performed a systematic review to determine if RT is associated with postoperative progression-free survival (PFS) or overall survival (OS...

Introduction Here we systematically review the extant literature to highlight the advantages of bilateral versus unilateral approaches and endoscopic endonasal (midline) approaches versus transcranial approaches for olfactory groove meningiomas, focusing on complications, extent of resection, and local recurrence rates. Methods Three databases were...

OBJECTIVE Factors that may drive recommendations for operative intervention for patients with intramedullary spinal cord tumors (ISCTs) have yet to be extensively studied. The authors investigated racial and socioeconomic disparities in the management of patients with primary spinal cord ependymomas and nonependymal gliomas, with the aim of determi...

Published 03/06/2024 Copyright © Copyright 2024 Brown et al. This is an open access abstract distributed under the terms of the Creative Commons Attribution License CC Objectives: CyberKnife radiotherapy (CKRS) is a rapidly emerging technique for treatment of vestibular schwannoma (VS). In the present study, we systematically review the literature...

OBJECTIVE While single-position surgery (SPS) eliminates the need for patient repositioning, the placement of screws in the unconventional lateral position poses unique challenges related to asymmetry relative to the surgical table. Use of robotic guidance or intraoperative navigation can help to overcome this. The aim of this study was to compare...

Introduction: Optic pathway gliomas (OPG) are generally low-grade lesions arising from the astrocytes of the visual pathway, most commonly of the optic tract and hypothalamus. While OPGs can be locally aggressive, most are slow growing and detected in one of two ways: (1) during serial screening in NF1 patients and (2) when patients who do not have...

Introduction: The American Association of Neurological Surgeons (AANS), North American Skull Base Society (NASBS), American Rhinologic Society (ARS), and American Neurotology Society (ANS. fellowship directories are important information repositories for skull base surgical fellowship programs. However, there is limited research on the amount and d...

Introduction: Olfactory groove meningiomas (OGM) represent roughly 8–13% of intracranial meningiomas and comprise those lesions arising from the anterior fossa in the region of the cribriform plate. Multiple approaches for the resection of these lesions have been described, with the goals of surgery being to grossly resect the lesion, maximally pre...

Introduction: While transcranial approaches (TCA) have historically been the standard for olfactory groove meningioma (OGM) resection, endoscopic endonasal approaches (EEA) have become increasingly popular. Here we systematically review the extant literature to highlight the advantages of bilateral versus unilateral approaches and EEA versus TCA fo...

Introduction: Petroclival meningiomas are among the most formidable and technically challenging tumors in skull base surgery owing to their deep-seated location and proximity to critical neurovascular structures. Selection of surgical approach should be tailored to each individual patient and dependent upon the location and extension of the tumor a...

Introduction: Decompressive hemicraniectomy (DHC) is a critical procedure used to alleviate elevated intracranial pressure (ICP) in emergent situations. It is typically performed to create space for the swollen brain and to prevent dangerous and potentially fatal increases in ICP. DHC is indicated for pathologies ranging from MCA stroke to traumati...

Background: Tranexamic acid (TXA) has been shown to decrease intraoperative blood loss across multiple surgical disciplines. However, there is a theoretical risk of thromboembolic events secondary to induced hypercoagulability. The safety and efficacy of TXA administration for the resection of intracranial meningioma is unknown especially since a d...

Introduction: There is a growing body of evidence demonstrating improved survival outcomes for patients with CNS neoplasms who are treated at high volume facilities (HVFs) as compared to low volume facilities (LVFs). In the present study, we use population level data to investigate the relationship between center volume (HVF and LVF), survival outc...

Objective: Axel Perneczky is responsible for the conceptualization of the “keyhole” philosophy as a new paradigm of minimal invasiveness within cranial neurosurgery. The aim of keyhole neurosurgery is to limit approach-related traumatization and to minimize brain retraction while still enabling the neurosurgeon to achieve operative goals. The supra...

Introduction: There is a growing body of evidence demonstrating improved outcomes for patients with CNS neoplasms treated at academic centers (ACs) versus nonacademic centers (non-ACs). This represents a potential healthcare disparity within neurosurgery. Herein, we investigate the relationship between facility type and surgical outcomes in meningi...

Introduction: Meningiomas are predominantly slow growing extra-axial tumors that typically reach clinical attention when they grow large enough to cause mass effect or seizures. However, some are discovered incidentally, and the frequency of asymptomatic meningioma detection has increased due to the advent of more advanced and available imaging mod...

Decompressive hemicraniectomy (DHC) is a critical procedure used to alleviate elevated intracranial pressure (ICP) in emergent situations. It is typically performed to create space for the swelling brain and to prevent dangerous and potentially fatal increases in ICP. DHC is indicated for pathologies ranging from MCA stroke to traumatic subarachnoi...

Introduction: Staphylococcus aureus (S aureus) is the foremost bacterial cause of surgical-site infection (SSI) and is a common source of neuromodulation SSI. Endogenous colonization is an independent risk factor for SSI; however, this risk has been shown to diminish with screening and decolonization. Methods: A systematic review was performed a...

Introduction: Increasingly, applicants to various residencies and fellowships have utilized program websites for information. This trend has increased during the COVID-19 health crisis. Neurosurgical residents' interest in applying for functional neurosurgery fellowships are oftentimes reliant on online resources to identify programs of interest,...

Background and Objectives: Clinical management of falcotentorial (FT) meningiomas (~1% of all meningiomas) can be challenging due to intimate involvement with the Galenic venous system. Our objective is to identify the key surgical strategies for FT meningiomas. Methods: Three databases were queried. Thirty studies reporting surgical resection of F...

Laparoscopic ALIF (L-ALIF), which employs laparoscopic cameras to facilitate a less invasive approach, originally gained attention during the ‘90s but has subsequently fallen out of favor. As the envelope for endoscopic approaches continues to be pushed, it is possible that there will be a recurrence of interest in laparoscopic and/or endoscopic an...

Introduction The cautionary stance normally taken towards TXA is rooted in concerns regarding its complication profile, namely its purported risk for venous thromboembolic events (VTEs). In the present review, we intend to bring increased attention to TXA as a remarkably valuable tool that does not appear to increase the risk for VTE when used as i...

Objectives: We perform a systematic review and meta-analysis in order to profile surgical and survival outcomes for clival chordoma. Background: Despite their precarious behavioral classification (histopathologically benign (low-grade), behaviorally malignant), great strides have been taken to improve prognostication and treatment paradigms for pat...

Objectives: In the present study, we systematically review the extant literature describing CyberKnife radiosurgery (CKRS) as treatment for vestibular schwannoma (VS). We then perform pooled meta-analysis of long-term tumor control and hearing preservation rates reported across all retrospective observational series describing the efficacy of CKRS....

Objectives: To understand why skull base surgeons plan multi-stage resection of petroclival meningiomas. Background: Petroclival meningiomas are among the most formidable and technically challenging tumors in skull base surgery owing to their deep-seated location and proximity to critical neurovascular structures. Selection of surgical approach sho...

Objectives: Our study examines the current literature on AR-assisted MISS, synthesizes findings, and creates a narrative highlighting the history and future of AR in spine surgery. Background: Spine surgery has undergone significant changes in approach and technique. With the adoption of intraoperative navigation, minimally invasive spinal surgery...

OBJECTIVE The American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) Joint Cerebrovascular (CV) Section serves as a centralized entity for the dissemination of information related to CV neurosurgery. The quality of scientific conferences, such as the CV Section’s Society of NeuroInterventional Surgery Annua...

Staged surgery for skull base lesions has been utilized to facilitate maximal safe resection and optimize outcomes while minimizing morbidity and complications. Conversely, staged surgery for primary intraparenchymal neoplasms is less commonly performed and has not been reported as extensively within the literature. As such, we performed a systemat...

Numerous minimally invasive approaches to hypothalamic hamartomas (HHs) have been developed though their efficacy in treating seizures has not been closely analyzed. A systematic review was performed using three databases per PRISMA in order to identify all studies comparing seizure outcomes for HHs treated via endoscopic disconnection (ED), resect...

INTRODUCTION Though it remains a rare and devastating tumor, great strides have been taken to improve prognostication and treatment paradigms for patients with skull base chordoma. With respect to surgical techniques, lateral transcranial (TC) approaches have traditionally been used, however endoscopic endonasal approaches (EEA) have been advocated...

INTRODUCTION Clival chordomas that involve the craniovertebral junction (CVJ) are particularly challenging to remove due to risk for postoperative atlantoaxial instability. Preoperative instability can also be present due to mass effect from the clival lesion. Surgery involves a delicate balance of acknowledging existing preoperative instability, w...

Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor in the United States, accounting for approximately 56.6% of all gliomas and 47.7% of all primary malignant CNS tumors. The prognosis of GBM is notably grim, with a 1-year relative survival rate of 41.4% and a 5-year survival rate of 5.8% following diagnosis. Recent effor...

Machine learning is a burgeoning field in data science that has many applications in medicine, and it is especially useful in neurosurgery due to the often-complex and potentially emergent nature of day-to-day cases. Machine learning models have the potential to deliver accurate patient prognostication while offering the benefit of providing real-t...

Medulloblastoma is the most common malignant intracranial tumor affecting the pediatric population. Despite advancements in multimodal treatment over the past 2 decades yielding a >75% 5-year survival rate, children who survive often have substantial neurological and cognitive sequelae. We aimed to identify risk factors and develop a clinically fri...

OBJECTIVE Staged surgery for skull base lesions has been utilized to facilitate maximal safe resection and optimize outcomes in pediatric patients. Despite its extensive applications, there is a paucity of information regarding open multi-stage resection of intrinsic, intra-axial neoplasms. We reviewed the literature in order to shed light on relev...

INTRODUCTION Meningiomas at the falcotentorial (FT) junction are rare, as they account for only 0.3%-1.1% of all intracranial meningiomas. Clinical management of FT meningiomas can be challenging. METHODS The authors queried three databases per PRISMA guidelines to identify all studies reporting indications for surgical resection of FT meningioma....