bluuebunny/crossref_metadata_2025 huggingface dataset:
Peripheral nerve field stimulation in medically refractory trigeminal neuralgia attributed to multiple sclerosis
Authors: Klein Johann , Siepmann Timo , Schackert Gabriele , Ziemssen Tjalf , Juratli Tareq A.
Published: March 2020

OBJECTIVE

Case reports and small patient series have suggested peripheral nerve field stimulation (PNFS) as a treatment for refractory trigeminal neuralgia attributed to multiple sclerosis (MS). Here, the authors aimed to assess the effects of this technique on long-term pain severity.

METHODS

Data were prospectively collected on patients with refractory trigeminal neuralgia attributed to MS who underwent PNFS between July 2013 and August 2017 at the authors’ neurosurgical department. Patients were evaluated before and after the first treatment as well as at follow-up at least twice a year. Patients underwent assessment of their pain severity using the Barrow Neurological Institute (BNI) Scale before treatment and at follow-up and were questioned about adverse events following cranial MRI performed after implantation of a permanent PNFS system.

RESULTS

Eight patients (3 women) underwent PNFS trials and their median age was 61 years (IQR 73.75 − 46.5 years). Seven patients proceeded to permanent implantation of the stimulation system. At a median follow-up of 33 months (IQR 42 − 24 months), pain severity decreased from baseline to the last follow-up (BNI score decrease from V [IQR V − V] to III [IQR V − III], p = 0.054). Four patients experienced long-lasting benefit (at 48, 33, 24, and 15 months’ follow-up, respectively), while in 3 patients the treatment eventually failed after an initially successful period. One patient had an infection, requiring system removal and subsequent reimplantation. No other complications occurred. No adverse events were noted in the patients undergoing MRI postimplantation.

CONCLUSIONS

This analysis indicates a possibly beneficial long-term effect of PNFS on refractory trigeminal neuralgia attributed to MS in some patients.
The endoscopic endonasal eustachian tube anterolateral mobilization strategy: minimizing the cost of the extreme-medial approach
Authors: Labib Mohamed A. , Belykh Evgenii , Cavallo Claudio , Zhao Xiaochun , Prevedello Daniel M. , Carrau Ricardo L. , Little Andrew S. , Ferreira Mauro A. T. , Preul Mark C. , Youssef A. Samy , Nakaji Peter
Published: March 2020

OBJECTIVE

The ventral jugular foramen and the infrapetrous region are difficult to access through conventional lateral and posterolateral approaches. Endoscopic endonasal approaches to this region are obstructed by the eustachian tube (ET). This study presents a novel strategy for mobilizing the ET while preserving its integrity. Qualitative and quantitative comparisons with previous ET management paradigms are also presented.

METHODS

Ten dry skulls were analyzed. Four ET management strategies were sequentially performed on a total of 6 sides of cadaveric head specimens. Four measurement groups were generated: in group A, the ET was intact and not mobilized; in group B, the ET was mobilized inferolaterally; in group C, the ET underwent anterolateral mobilization; and in group D, the ET was resected. ET range of mobilization, surgical exposure area, and surgical freedom were measured and compared among the groups.

RESULTS

Wide exposure of the infrapetrous region and jugular foramen was achieved by removing the pterygoid process, unroofing the cartilaginous ET up to the level of the posterior aspect of the foramen ovale, and detaching the ET from the skull base and soft palate. Anterolateral mobilization of the ET facilitated significantly more retraction (a 126% increase) of the ET than inferolateral mobilization (mean ± SD: 20.8 ± 11.2 mm vs 9.2 ± 3.6 mm [p = 0.02]). Compared with group A, groups C and D had enhanced surgical exposure (142.5% [1176.9 ± 935.7 mm2] and 155.9% [1242.0 ± 1096.2 mm2], respectively, vs 485.4 ± 377.6 mm2 for group A [both p = 0.02]). Furthermore, group C had a significantly larger surgical exposure area than group B (p = 0.02). No statistically significant difference was found between the area of exposure obtained by ET removal and anterolateral mobilization. Anterolateral mobilization of the ET resulted in a 39.5% increase in surgical freedom toward the exocranial jugular foramen compared with that obtained through inferolateral mobilization of the ET (67.2° ± 20.5° vs 48.1° ± 6.7° [p = 0.047]) and a 65.4% increase compared with that afforded by an intact ET position (67.2° ± 20.5° vs 40.6° ± 14.3° [p = 0.03]).

CONCLUSIONS

Anterolateral mobilization of the ET provides excellent access to the ventral jugular foramen and infrapetrous region. The surgical exposure obtained is superior to that achieved with other ET management strategies and is comparable to that obtained by ET resection.
Riluzole enhances the antitumor effects of temozolomide via suppression of MGMT expression in glioblastoma
Authors: Yamada Tetsuya , Tsuji Shohei , Nakamura Shinsuke , Egashira Yusuke , Shimazawa Masamitsu , Nakayama Noriyuki , Yano Hirohito , Iwama Toru , Hara Hideaki
Published: March 2020

OBJECTIVE

Glutamatergic signaling significantly promotes proliferation, migration, and invasion in glioblastoma (GBM). Riluzole, a metabotropic glutamate receptor 1 inhibitor, reportedly suppresses GBM growth. However, the effects of combining riluzole with the primary GBM chemotherapeutic agent, temozolomide (TMZ), are unknown. This study aimed to investigate the efficacy of combinatorial therapy with TMZ/riluzole for GBM in vitro and in vivo.

METHODS

Three GBM cell lines, T98G (human; O6-methylguanine DNA methyltransferase [MGMT] positive), U87MG (human; MGMT negative), and GL261 (murine; MGMT positive), were treated with TMZ, riluzole, or a combination of both. The authors performed cell viability assays, followed by isobologram analysis, to evaluate the effects of combinatorial treatment for each GBM cell line. They tested the effect of riluzole on MGMT, a DNA repair enzyme causing chemoresistance to TMZ, through quantitative real-time reverse transcription polymerase chain reaction in T98G cells. Furthermore, they evaluated the efficacy of combinatorial TMZ/riluzole treatment in an orthotopic mouse allograft model of MGMT-positive GBM using C57BL/6 J mice and GL261 cells.

RESULTS

Riluzole displayed significant time- and dose-dependent growth-inhibitory effects on all GBM cell lines assessed independently. Riluzole enhanced the antitumor effect of TMZ synergistically in MGMT-positive but not in MGMT-negative GBM cell lines. Riluzole singularly suppressed MGMT expression, and it significantly suppressed TMZ-induced MGMT upregulation (p < 0.01). Furthermore, combinatorial TMZ/riluzole treatment significantly suppressed tumor growth in the intracranial MGMT-positive GBM model (p < 0.05).

CONCLUSIONS

Riluzole attenuates TMZ-induced MGMT upregulation and enhances the antitumor effect of TMZ in MGMT-positive GBMs. Therefore, combinatorial TMZ/riluzole treatment is a potentially promising novel therapeutic regimen for MGMT-positive GBMs.
Age dependency and modification of the Subarachnoid Hemorrhage Early Brain Edema Score
Authors: Eibach Michael , Won Sae-Yeon , Bruder Markus , Keil Fee , Herrmann Eva , Berkefeld Joachim , Seifert Volker , Konczalla Juergen
Published: March 2020

OBJECTIVE

The Subarachnoid Hemorrhage Early Brain Edema Score (SEBES) system measures cerebral edema on CT and can be used to predict outcome after subarachnoid hemorrhage (SAH). The authors developed a modified SEBES (SEBES 6c) and assessed whether it could predict outcome after SAH better than the SEBES. Furthermore, they verified the age dependency of these scores.

METHODS

In this retrospective study, all patients with aneurysmal SAH in the period from January 2011 to February 2017 at a single institution were analyzed. The SEBES, which is based on the absence of visible sulci at two defined CT levels (0–4 points), and the SEBES 6c were determined from the initial CT. The SEBES 6c system includes the two levels from the original SEBES and one level located 2 cm below the vertex (0–6 points). The authors investigated whether the various SEBESs are age dependent and if they can predict delayed infarction (DI) and outcome.

RESULTS

Two hundred sixty-one patients met the study inclusion criteria. The SEBES was an independent predictor for DI (OR 1.6 per 1-point increase) and unfavorable outcome (OR 1.36 per 1-point increase), in accordance with findings in the first publication on SEBES. However, here the authors found that the SEBES was age dependent. In the age group younger than 60 years, the patients with high-grade SEBESs (3–4 points) had DIs and unfavorable outcomes significantly more often than the patients with low-grade scores (0–2 points). In the age groups 60–69 years and ≥ 70 years, no significant differences in DI and outcome were identified between high-grade and low-grade scores, although trends toward DI and unfavorable outcomes among the 60–69 age group were noted in patients with high-grade SEBESs.

Receiver operating characteristic curve analysis showed that SEBES 6c had a higher prognostic value in predicting outcome than SEBES (p < 0.001). Furthermore, SEBES 6c predicted an unfavorable outcome (OR 1.31 per 1-point increase) and DI (OR 1.36 per 1-point increase) independent of vasospasms. SEBES 6c showed an age dependency similar to that of SEBES.

CONCLUSIONS

SEBES 6c is more suitable for predicting outcome after SAH than SEBES. Furthermore, it predicts outcome and DI independently of vasospasm, so it can be used to differentiate between early brain injury– and vasospasm-dependent infarctions and outcome. However, SEBES and SEBES 6c are both age dependent and can be used for patients aged < 60 years and may have limited suitability for patients aged 60–69 years and no suitability for patients aged ≥ 70 years.
Late (5–20 years) outcomes after STA-MCA anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis in patients with moyamoya disease
Authors: Kuroda Satoshi , Nakayama Naoki , Yamamoto Shusuke , Kashiwazaki Daina , Uchino Haruto , Saito Hisayasu , Hori Emiko , Akioka Naoki , Kuwayama Naoya , Houkin Kiyohiro
Published: March 2020

OBJECTIVE

Surgical revascularization is known to reduce the incidence of further ischemic and hemorrhagic events in patients with moyamoya disease, but the majority of previous studies report only short-term (< 5 years) outcomes. Therefore, in this study the authors aimed to evaluate late (5–20 years) outcomes of moyamoya patients after superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and indirect bypass (encephalo-duro-myo-arterio-pericranial synangiosis [EDMAPS]).

METHODS

Cumulative incidences of late morbidity/mortality and disease progression were evaluated among 93 patients who underwent STA-MCA anastomosis and EDMAPS. All of the patients were prospectively followed up for longer than 5 years postsurgery (10.5 ± 4.4 years). There were 35 pediatric and 58 adult patients. Initial presentation included transient ischemic attack/ischemic stroke in 80 patients and hemorrhagic stroke in 10 patients, and 3 patients were asymptomatic. Surgery was performed in a total of 141 hemispheres. Follow-up MRI/MRA was performed within a 6- or 12-month interval during the follow-up periods.

RESULTS

During the follow-up periods, 92/93 patients were free from any stroke or death, but 1 patient had a recurrence of hemorrhagic stroke (0.10% per patient-year). Disease progression occurred in the territory of the contralateral carotid or posterior cerebral artery (PCA) in 19 hemispheres of 15 patients (1.5% per patient-year). The interval between initial surgery and disease progression varied widely, from 0.5 to 15 years. Repeat bypass surgery for the anterior and posterior circulation resolved ischemic attacks in all 10 patients.

CONCLUSIONS

The study results indicate that STA-MCA anastomosis and EDMAPS would be the best choice to prevent further ischemic and hemorrhagic stroke for longer than 10 years on the basis of the demonstrated widespread improvement in cerebral hemodynamics in both the MCA and ACA territories in the study patients. However, after 10 years postsurgery regular follow-up is essential to detect disease progression in the territory of the contralateral carotid artery and PCA and prevent late cerebrovascular events.
Comparative anatomical analysis between the minipterional and supraorbital approaches
Authors: Martínez-Pérez Rafael , Albonette-Felicio Thiago , Hardesty Douglas A. , Prevedello Daniel M.
Published: March 2020

OBJECTIVE

Keyhole approaches, namely the minipterional approach (MPTa) and the supraorbital approach (SOa), are alternatives to the standard pterional approach to treat lesions located in the anterior and middle cranial fossae. Despite their increasing popularity and acceptance, the indications and limitations of these approaches require further assessment. The purpose of the present study was to determine the differences in the area of surgical exposure and surgical maneuverability provided by the MPTa and SOa.

METHODS

The areas of surgical exposure afforded by the MPTa and SOa were analyzed in 12 sides of cadaver heads by using a microscope and a neuronavigation system. The area of exposure of the region of interest and surgical freedom (maneuverability) of each approach were calculated.

RESULTS

The area of exposure was significantly larger in the MPTa than in the SOa (1250 ± 223 mm2 vs 939 ± 139 mm2, p = 0.002). The MPTa provided larger areas of exposure in the ipsilateral and midline compartments, whereas there was no significant difference in the area of exposure in the contralateral compartment. All targets in the anterior circulation had significantly larger areas of surgical freedom when treated via the MPTa versus the SOa.

CONCLUSIONS

The MPTa provides greater surgical exposure and better maneuverability than that offered by the SOa. The SOa may be advantageous as a direct corridor for treating lesions located in the contralateral side or in the anterior cranial fossa, but the surgical exposure provided in the midline region is inferior to that exposed by the MPTa.
Hospital volume-outcome relationship in severe traumatic brain injury: stratified analysis by level of trauma center
Authors: Tsai Sung Huang Laurent , Goyal Anshit , Alvi Mohammed Ali , Kerezoudis Panagiotis , Yolcu Yagiz Ugur , Wahood Waseem , Habermann Elizabeth B. , Burns Terry C. , Bydon Mohamad
Published: March 2020

OBJECTIVE

The nature of the volume-outcome relationship in cases with severe traumatic brain injury (TBI) remains unclear, with considerable interhospital variation in patient outcomes. The objective of this study was to understand the state of the volume-outcome relationship at different levels of trauma centers in the United States.

METHODS

The authors queried the National Trauma Data Bank for the years 2007–2014 for patients with severe TBI. Case volumes for each level of trauma center organized into quintiles (Q1–Q5) served as the primary predictor. Analyzed outcomes included in-hospital mortality, total hospital length of stay (LOS), and intensive care unit (ICU) stay. Multivariable regression models were performed for in-hospital mortality, overall complications, and total hospital and ICU LOSs to adjust for possible confounders. The analysis was stratified by level designation of the trauma center. Statistical significance was established at p < 0.001 to avoid a type I error due to a large sample size.

RESULTS

A total of 122,445 patients were included. Adjusted analysis did not demonstrate a significant relationship between increasing hospital volume of severe TBI cases and in-hospital mortality, complications, and nonhome hospital discharge disposition among level I–IV trauma centers. However, among level II trauma centers, hospital LOS was longer for the highest volume quintile (adjusted mean difference [MD] for Q5: 2.83 days, 95% CI 1.40–4.26 days, p < 0.001, reference = Q1). For level III and IV trauma centers, both hospital LOS and ICU LOS were longer for the highest volume quintile (adjusted MD for Q5: LOS 4.6 days, 95% CI 2.3–7.0 days, p < 0.001; ICU LOS 3.2 days, 95% CI 1.6–4.8 days, p < 0.001).

CONCLUSIONS

Higher volumes of severe TBI cases at a lower level of trauma center may be associated with a longer LOS. These results may assist policymakers with target interventions for resource allocation and point to the need for careful prehospital decision-making in patients with severe TBI.
Impact of cortical hemodynamic failure on both subsequent hemorrhagic stroke and effect of bypass surgery in hemorrhagic moyamoya disease: a supplementary analysis of the Japan Adult Moyamoya Trial
Authors: Takahashi Jun C. , Funaki Takeshi , Houkin Kiyohiro , Kuroda Satoshi , Fujimura Miki , Tomata Yasutake , Miyamoto Susumu
Published: March 2020

OBJECTIVE

Here, the authors aimed to determine whether the presence of cerebral hemodynamic failure predicts subsequent bleeding attacks and how it correlates with the effect of direct bypass surgery in hemorrhagic moyamoya disease.

METHODS

Data from the Japanese Adult Moyamoya (JAM) Trial were used in this study: 158 hemispheres in 79 patients. A newly formed expert panel evaluated the SPECT results submitted at trial enrollment and classified the cortical hemodynamic state of the middle cerebral artery territory of each hemisphere into one of the following three groups: SPECT stage (SS) 0 as normal, SS1 as decreased cerebrovascular reserve (CVR), and SS2 as decreased CVR with decreased baseline blood flow. In the nonsurgical cohort of the JAM Trial, the subsequent hemorrhage rate during the 5-year follow-up was compared between the SS0 (hemodynamic failure negative) and SS1+2 (hemodynamic failure positive) groups. The effect of direct or combined direct/indirect bypass surgery on hemorrhage prevention was examined in each subgroup.

RESULTS

The hemodynamic grade was SS0 in 59 (37.3%) hemispheres, SS1 in 87 (55.1%), and SS2 in 12 (7.6%). In the nonsurgical cohort, subsequent hemorrhage rates in the SS0 and SS1+2 groups were 12 cases per 1000 person-years and 67 cases per 1000 person-years, respectively. Kaplan-Meier analysis revealed that hemorrhagic events were significantly more common in the SS1+2 group (p = 0.019, log-rank test). Cox regression analysis showed that hemodynamic failure was an independent risk factor for subsequent hemorrhage (HR 5.37, 95% CI 1.07–27.02). In the SS1+2 subgroup, bypass surgery significantly suppressed hemorrhagic events during 5 years (p = 0.001, HR 0.16, 95% CI 0.04–0.57), with no significant effect in the SS0 group (p = 0.655, HR 1.56, 95% CI 0.22–11.10). Examination of effect modification revealed that the effect of surgery tended to differ nonsignificantly between these two subgroups (p = 0.056).

CONCLUSIONS

Hemodynamic failure is an independent risk factor for subsequent hemorrhage in hemorrhagic moyamoya disease. Direct bypass surgery showed a significant preventive effect in the hemodynamically impaired hemispheres. Thus, hemodynamic failure, as well as previously proposed factors such as choroidal anastomosis, should be considered for the surgical indication in hemorrhagic moyamoya disease.

Clinical trial registration no.: C000000166 (umin.ac.jp)
Subsecond EEG-fMRI analysis for presurgical evaluation in focal epilepsy
Authors: Ito Yuji , Maesawa Satoshi , Bagarinao Epifanio , Okai Yu , Nakatsubo Daisuke , Yamamoto Hiroyuki , Kidokoro Hiroyuki , Usui Naotaka , Natsume Jun , Hoshiyama Minoru , Wakabayashi Toshihiko , Sobue Gen , Ozaki Norio
Published: March 2020

OBJECTIVE

The authors recently reported a novel subsecond analysis method of analyzing EEG–functional MRI (fMRI) to improve the detection rate of epileptic focus. This study aims to validate the utility of this method for presurgical evaluation in pharmacoresistant focal epilepsy.

METHODS

Among 13 patients with focal epilepsy undergoing presurgical examinations including simultaneous EEG-fMRI at 3T, 11 patients had interictal epileptiform discharges (IEDs) during fMRI. The authors used the sequence of topographic maps during the IEDs as a reference to obtain subsecond fMRI activation maps with the same temporal resolution as the EEG data, and constructed “spike-and-slow-wave-activation-summary” (SSWAS) maps that showed the activation frequency of voxels during IEDs. Clusters were defined by thresholding the SSWAS maps (voxel value > 10), and those containing voxels with the top 3 highest activation frequencies were considered significant. Significant hemodynamic responses using conventional event-related (ER) analysis and SSWAS maps were compared with the resection areas and surgical outcomes at 1 year after surgery.

RESULTS

Using ER analysis, 4 (36%) of 11 patients had significant hemodynamic responses. One of 4 patients had significant hemodynamic responses in the resection area and good surgical outcome. Using SSWAS maps, 10 (91%) of 11 patients had significant hemodynamic responses. Six of 10 patients had significant hemodynamic responses in the resection area, and 5 of the 6 patients achieved good surgical outcomes. The remaining 4 patients had significant hemodynamic responses distant from the resection area, and only 1 of the 4 patients achieved good surgical outcomes. The sensitivity, specificity, positive predictive value, and negative predictive value of SSWAS maps were 83.3%, 75.0%, 83.3%, and 75.0%, respectively.

CONCLUSIONS

This study demonstrated the clinical utility of SSWAS maps for presurgical evaluation of pharmacoresistant focal epilepsy. The findings indicated that subsecond EEG-fMRI analysis may help surgeons choose the resection areas that could lead to good surgical outcomes.
Impact of Medicaid insurance on outcomes following endoscopic transsphenoidal pituitary surgery
Authors: Younus Iyan , Gerges Mina , Schwartz Theodore H. , Ramakrishna Rohan
Published: March 2020

OBJECTIVE

Despite the rise of studies in the neurosurgical literature suggesting that patients with Medicaid insurance have inferior outcomes, there remains a paucity of data on the impact of insurance on outcomes after endonasal endoscopic transsphenoidal surgery (EETS). Given the increasing importance of complications in quality-based healthcare metrics, the objective of this study was to assess whether Medicaid insurance type influences outcomes in EETS for pituitary adenoma.

METHODS

The authors analyzed a prospectively acquired database of EETS for pituitary adenoma from 2005 to 2018 at NewYork-Presbyterian Hospital, Weill Cornell Medicine. All patients with Medicaid insurance were identified. As a control group, the clinical, socioeconomic, and radiographic data of all other patients in the series with non-Medicaid insurance were reviewed. Statistical significance was determined with an alpha < 0.05 using Pearson chi-square and Fisher’s exact tests for categorical variables and the independent-samples t-test for continuous variables.

RESULTS

Of 584 patients undergoing EETS for pituitary adenoma, 57 (10%) had Medicaid insurance. The maximum tumor diameter was significantly larger for Medicaid patients (26.1 ± 12 vs 23.1 ± 11 mm for controls, p < 0.05). Baseline comorbidities including diabetes mellitus, hypertension, smoking history, and BMI were not significantly different between Medicaid patients and controls. Patients with Medicaid insurance had a significantly higher rate of any complication (14% vs 7% for controls, p < 0.05) and long-term cranial neuropathy (5% vs 1% for controls, p < 0.05). There were no statistically significant differences in endocrine outcome or vision outcome. The mean postoperative length of stay was significantly longer for Medicaid patients compared to the controls (9.4 ± 31 vs 3.6 ± 3 days, p < 0.05). This difference remained significant even when accounting for outliers (5.6 ± 2.5 vs 3.0 ± 2.7 days for controls, p < 0.05). The most common causes of extended length of stay greater than 1 standard deviation for Medicaid patients were management of perioperative complications and disposition challenges. The rate of 30-day readmission was 7% for Medicaid patients and 4.4% for controls, which was not a statistically significant difference.

CONCLUSIONS

The authors found that larger tumor diameter, longer postoperative length of stay, higher rate of complications, and long-term cranial neuropathy were significantly associated with Medicaid insurance. There were no statistically significant differences in baseline comorbidities, apoplexy, endocrine outcome, vision outcome, or 30-day readmission.
Predictors of early postoperative epileptic seizures after awake surgery in supratentorial diffuse gliomas
Authors: Zanello Marc , Roux Alexandre , Zah-Bi Gilles , Trancart Bénédicte , Parraga Eduardo , Edjlali Myriam , Tauziede-Espariat Arnault , Sauvageon Xavier , Sharshar Tarek , Oppenheim Catherine , Varlet Pascale , Dezamis Edouard , Pallud Johan
Published: March 2020

OBJECTIVE

Functional-based resection under awake conditions had been associated with a nonnegligible rate of intraoperative and postoperative epileptic seizures. The authors assessed the incidence of intraoperative and early postoperative epileptic seizures after functional-based resection under awake conditions.

METHODS

The authors prospectively assessed intraoperative and postoperative seizures (within 1 month) together with clinical, imaging, surgical, histopathological, and follow-up data for 202 consecutive diffuse glioma adult patients who underwent a functional-based resection under awake conditions.

RESULTS

Intraoperative seizures occurred in 3.5% of patients during cortical stimulation; all resolved without any procedure being discontinued. No predictor of intraoperative seizures was identified. Early postoperative seizures occurred in 7.9% of patients at a mean of 5.1 ± 2.9 days. They increased the duration of hospital stay (p = 0.018), did not impact the 6-month (median 95 vs 100, p = 0.740) or the 2-year (median 100 vs 100, p = 0.243) postoperative Karnofsky Performance Status score and did not impact the 6-month (100% vs 91.4%, p = 0.252) or the 2-year (91.7 vs 89.4%, p = 0.857) postoperative seizure control. The time to treatment of at least 3 months (adjusted OR [aOR] 4.76 [95% CI 1.38–16.36], p = 0.013), frontal lobe involvement (aOR 4.88 [95% CI 1.25–19.03], p = 0.023), current intensity for intraoperative mapping of at least 3 mA (aOR 4.11 [95% CI 1.17–14.49], p = 0.028), and supratotal resection (aOR 6.24 [95% CI 1.43–27.29], p = 0.015) were independently associated with early postoperative seizures.

CONCLUSIONS

Functional-based resection under awake conditions can be safely performed with a very low rate of intraoperative and early postoperative seizures and good 6-month and 2-year postoperative seizure outcomes. Intraoperatively, the use of the lowest current threshold producing reproducible responses is mandatory to reduce seizure occurrence intraoperatively and in the early postoperative period.
Immediate postoperative measurement of thyroid-stimulating hormone as an early predictor of remission in thyroid-stimulating hormone–secreting pituitary adenomas
Authors: Kim Soo Heon , Ku Cheol Ryong , Na Minkyun , Yoo Jihwan , Kim Woohyun , Jung In-Ho , Kim Kyung Won , Moon Ju Hyung , Kim Daham , Lee Eun Jig , Kim Sun Ho , Kim Eui Hyun
Published: March 2020

OBJECTIVE

Thyroid-stimulating hormone (TSH)–secreting pituitary adenoma (TSHoma) is a rare type of pituitary adenoma; thus, little is known about TSHomas. The purpose of this study was to analyze clinical characteristics and therapeutic outcomes of TSHomas based on a single-center experience. The authors also searched for reliable preoperative and early postoperative factors that could predict long-term endocrinological remission.

METHODS

The clinical, radiological, and pathological characteristics and surgical and endocrinological outcomes of 31 consecutive cases of TSHomas that were surgically treated between 2005 and 2017 were reviewed retrospectively. Preoperative factors were evaluated for their ability to predict long-term remission by comparing remission and nonremission groups. TSH and free thyroxine levels were measured at 2, 6, 12, 18, and 24 hours after surgery to determine whether they could predict long-term remission.

RESULTS

Gross-total removal of tumor was achieved in 28 patients (90.3%), and 26 patients (83.9%) achieved endocrinological remission by surgery alone based on long-term endocrinological follow-up (median 50 months, range 32–81 months). The majority of the tumors were solid (21/31, 67.7%), and en bloc resection was possible in 16 patients (51.6%). Larger tumor size and tumor invasion into cavernous sinus and sphenoid sinus were strong predictors of lower rates of endocrinological remission. Immediate postoperative TSH level at 12 hours after surgery was the strongest predictor, with a 0.62 μIU/mL cutoff. Postoperative complications included CSF rhinorrhea in one patient and epistaxis in another patient, who underwent additional surgical treatment for the complications.

CONCLUSIONS

Tumor size and extent are major prognostic factors for both extent of resection and endocrinological remission. The consistency of TSHomas was more likely to be solid, which makes extracapsular dissection more feasible. Long-term remission of TSHomas could be predicted even during the early postoperative period.
Sphenoparietal sinus transposition technique: optimization of the surgical corridor with preservation of prominent bridging veins between the brain and the cranial base during aneurysm clipping via the pterional approach
Authors: Niibo Takeya , Takizawa Katsumi , Sakurai Jurou , Takebayashi Seizi , Koizumi Hiroyasu , Kobayashi Toru , Kobayashi Rina , Kuris Kouta , Gotou Syusuke , Tsuchiya Ryousuke , Kamiyama Hiroyasu
Published: March 2020

OBJECTIVE

The sylvian bridging veins between the brain and the dura on the inner surface of the sphenoid wing can restrict brain retraction for widening of the lateral retrocarotid space during clipping surgery for internal carotid artery (ICA)–posterior communicating artery (PCoA) and basilar apex (BX) aneurysms. In such cases, the authors perform extradural anterior clinoidectomy with peeling of the temporal dura propria from the periosteal dura and inner cavernous membrane around the superior orbital fissure, with the incision of the dura mater stretching from the base of the temporal side to just before the distal dural ring of the ICA (termed by the authors as the sphenoparietal sinus transposition [SPST] technique). This technique displaces the bridging segment of the sylvian vein posteriorly and enables widening of the surgical space without venous injury. In this study, the authors observed the operative nuances and investigated the usefulness of this technique.

METHODS

The authors retrospectively reviewed the medical charts of 66 consecutive patients with ICA-PCoA and BX aneurysms between January 2016 and July 2018. This technique was performed in 8 patients (5 patients with PCoA aneurysms and 3 with BX aneurysms) in whom the bridging segments of the sylvian veins between the brain and the skull base restricted brain retraction for widening of the surgical space. The surface areas of the lateral retrocarotid space and the aneurysm were measured at the most visible working angle before and after the SPST technique was performed.

RESULTS

With the use of the SPST technique, an adequate surgical space for aneurysm clipping was obtained with preservation of the bridging veins in all patients. The mean surface areas of the lateral retrocarotid space (p = 0.002) and aneurysm (p = 0.001) were significantly increased from 18.3 ± 18.8 and 2.8 ± 2.5 cm2 before to 64.2 ± 21.1 and 20.9 ± 20.6 cm2, respectively, after the SPST technique was performed.

CONCLUSIONS

The SPST technique enables displacement of the bridging segments of the sylvian veins without venous injury and enables widening of the surgical space around the lateral retrocarotid area.
Development and validation of prediction scores for nosocomial infections, reoperations, and adverse events in the daily clinical setting of neurosurgical patients with cerebral and spinal tumors
Authors: Lohmann Sebastian , Brix Tobias , Varghese Julian , Warneke Nils , Schwake Michael , Suero Molina Eric , Holling Markus , Stummer Walter , Schipmann Stephanie
Published: March 2020

OBJECTIVE

Various quality indicators are currently under investigation, aiming at measuring the quality of care in neurosurgery; however, the discipline currently lacks practical scoring systems for accurately assessing risk. The aim of this study was to develop three accurate, easy-to-use risk scoring systems for nosocomial infections, reoperations, and adverse events for patients with cerebral and spinal tumors.

METHODS

The authors developed a semiautomatic registry with administrative and clinical data and included all patients with spinal or cerebral tumors treated between September 2017 and May 2019. Patients were further divided into development and validation cohorts. Multivariable logistic regression models were used to develop risk scores by assigning points based on β coefficients, and internal validation of the scores was performed.

RESULTS

In total, 1000 patients were included. An unplanned 30-day reoperation was observed in 6.8% of patients. Nosocomial infections were documented in 7.4% of cases and any adverse event in 14.5%. The risk scores comprise variables such as emergency admission, nursing care level, ECOG performance status, and inflammatory markers on admission. Three scoring systems, NoInfECT for predicting the incidence of nosocomial infections (low risk, 1.8%; intermediate risk, 8.1%; and high risk, 26.0% [p < 0.001]), LEUCut for 30-day unplanned reoperations (low risk, 2.2%; intermediate risk, 6.8%; and high risk, 13.5% [p < 0.001]), and LINC for any adverse events (low risk, 7.6%; intermediate risk, 15.7%; and high risk, 49.5% [p < 0.001]), showed satisfactory discrimination between the different outcome groups in receiver operating characteristic curve analysis (AUC ≥ 0.7).

CONCLUSIONS

The proposed risk scores allow efficient prediction of the likelihood of adverse events, to compare quality of care between different providers, and further provide guidance to surgeons on how to allocate preoperative care.
Experience of Teaching a Linguopragmatic Interpretation of Foreign-Languge Text
Authors: Kvaskova L.V.
Published: March 2020

The article outlines the results of didactic activities aimed at exploring the foundations of text linguistics and discourse analysis of the authentic English text, as well as employing research skills in their lingua-pragmatic interpretation by masters’ program students specializing in “Linguistics” and “Teaching Education” at the Institute of Foreign Languages, Moscow Pedagogical State University, within the period of 2017–2018 academic studies. The article dwells upon methods of teaching and successful results of applying functional approaches to text and discourse grammar analysis in the final individual creative research projects, being fulfilled within the whole period of studying.
Models of Perceiving Social Reality in the Middle Ages
Authors: Arnautova Ju.Eu.
Published: March 2020

The article considers the views of contemporaries about the social structure of the Western European Middle Ages. Social knowledge has represented these ideas in interpretative schemes (models), operating with the ancient concept of ordo. Medieval authors understood ordo metaphysically — as the „order“ of the world order and as an „estate“, i.e. the part of the world created by God, which has its place and purpose. In public consciousness, there were two parallel models of perception of the social order, which can be arbitrarily described as “hierarchical” and “functional”. The earliest interpretation scheme was based on the New Testament (2 Tim. 2:4 and 1 Cor. 9:14; 1 Tim. 5: 1) and divided society into “two estates of the Church” (duo ordines ecclesiae), i.e. to „clerics“ (clerici) and „laity“ (laici), which vary in their way of life and occupation. In the year 400 monasticism appeared, also having a specific “life form”. Therefore concept of social order formulated by Augustine and then by Gregory the Great, had noted the existence of “the three estates of the Church” (tres ordines ecclesiae) — clerics, monks and laity. Both models were hierarchical, because they justified the priority nature of service to God. At the turn of the X–XI centuries in the process of differentiation of new professional groups (knights, peasants), the model of the “three estates of the Church” has been rethought. “Estates” are defined in it in accordance with their functions: “oratores (praying)”, “bellatores (fighting)” and “laboratores (working)”, each of them working as a part of the whole for the rest, which meant the equivalence of their functions. The scheme of the tres ordines ecclesiae existed until the beginning of the New Time, constantly adding new social realities. The highest point of its socio-historical impact is the consolidation of peasants and townspeople into one “estate”, later called in France the “third estate” (tiers état, tiers membre), whose social and economic existence was predetermined by work and lack of privileges.
Axiological Aspects of the Implementation of Russian Language Policy in Professional and Methodological Training of Foreign Language Teachers
Authors: Malev A.V. , Chernyshov S.V.
Published: March 2020

The article considers the language as the value of human existence and ethno-cultural society, which determines the importance and significance of language policy of states. The article reflects the main directions of the language policy in Russia with reference to the fundamental normative documents in this area, describes the conditions for the successful language policy in the field of foreign language education. The article presents the survey results among the students of Moscow Pedagogical State University, studying in the direction of training 44.03.01 “Pedagogical education”, which allowed to identify the degree of readiness of the students to implement the Russian language policy in their future professional activities. In conclusion, the authors propose to highlight the basic linguistic and cultural concepts in professional and methodological training of foreign language teachers and the main axiological guidelines at each level of higher education, ensuring the full implementation of language policy in foreign language education in Russia.
Ethnic Mentality in the Context of a Folklore Culture
Authors: George T.K.
Published: March 2020

The study of a foreign language is inseparable from the understanding of the culture of its speakers, and the study of culture will inevitably touch on the national features of ethnicity. The character of ethnos is due to and at the same time is the guiding vector at the moment of interpretation of the life of the people, the history and culture. The paper analyses in a comparative view the French and the Russian folk songs and the Spanish romance with a similar initial situation and different options of development/stagnation of intrigue, which is due to the exclusivity of national worldview and is a bright example of its implementation. The local diversity of dynamic stereotypes is determined both by the specifics of the performance of folklore, formed historically during the process of oral translation in conditions of continuity and variability, and often by extramusical factors. The long lyrical reflections from the first person (Russian, Spanish versions) contrast the cheerful novelist message from the third person (French version). A certain convergence between Spanish and Russian variants (opposed to the French one) of the interpretation of the topic under consideration is explained by the thesis on the proximity of Russian and Spanish souls, which, in turn, is due to the border specificity of the linguistic and cultural space of Russian-speaking and Spanish-speaking civilization models.
Professional Training of a Foreign Language Teacher for Pre-School and Primary Education: Axiological Dimension
Authors: Nikitenko Z.N.
Published: March 2020

The article provides an analysis of many years of theoretical and practical research in the field of foreign language teachers’ professional training. Special attention is drawn to the importance of not only the foreign language teacher methodological training but also to his value orientations that are necessary in the professional sphere. The issue of the axiological component of education is covered up from the point of view of primary foreign language education goals which should be reflected not only in the foreign language acquisition process by preschool and primary school age children but also in the qualitative training of teachers who are able to form a child’s moral values, personal qualities and ability to communicate in a foreign language as a phenomenon of culture and as a knowledge tool of his surroundings.
Metaphoric Nature of Views on Digital Transformation of Education
Authors: Alyabysheva Yu.A. , Veryaev A.A. , Ermakov B.B.
Published: March 2020

The article considers one of the current directions in the development of pedagogical knowledge that affects pedagogical practice and is based on the use of metaphors. Metaphors in pedagogy are quite widespread. This statement is illustrated by several examples. Often metaphors are hidden and are clearly not recognized. The article attempts to detect and describe some patterns of the process of pedagogical signifying and comprehension of metaphorical concepts. In the text of the article, the authors focused primarily on the metaphors of numbers, digital transformation and the route or individual trajectory in education. It is shown that the most contradictory definitions of metaphorical views are associated with the complex and multidimensional nature of pedagogical concepts, in particular, the larger the time/duration scales implicitly inherent in a pedagogical concept, the more diverse the content attributed to a metaphorical concept can be, the more values are generated, the more discrepancies are present in definitions given by pedagogical researchers to metaphorical concepts. It is concluded that it is necessary to take into account the definitions of the multivalent nature of concepts and ideas used in pedagogy.
Efficiency of Small Groups Method in Teaching Philosophy
Authors: Sukhanova N.P.
Published: March 2020

The processes of globalization and universal digitalization have a transforming effect on the education system. To succeed in the profession, a modern specialist needs to have not only special skills, but also be able to navigate in a situation of uncertainty, be prepared to change his occupation, and constantly improve his educational level. The importance of philosophy as an academic discipline in the system of university education is considered. The relevance and argumentativeness of the question of the methodology of teaching philosophy are shown, taking into account the special tasks of the discipline, the focus on the formation of the philosophical and methodological culture of man. The focus is on teaching the student philosophizing, the development of critical thinking skills. It substantiates the refusal to teach in the form of translation of historical and philosophical knowledge and the productivity of the “Socratic dialogue”, which requires the student to search intellectually and creatively. The method of small groups is analyzed as an interactive teaching method, which involves changing the nature of the interaction between the student and the teacher, shifting the emphasis towards student activity and turning the learning task into a search-oriented, research-oriented one. The process of organizing a seminar on philosophy in accordance with the methodology of small groups on the example of the topic «Consciousness» is presented. The results obtained during the implementation of this method in seminars are studied. The conclusion is drawn, as a result of which the small group method seems productive and effective in organizing philosophical work, since not only is the student assimilating other people’s philosophical constructions (connecting to the philosophy of teachings and systems, according to M.K. Mamardashvili), but also building a version of his personal philosophy taking into account their attitudes, programs and values (real philosophy).
Infrastructure And Development
Authors: Sampelalong Erwin , Sukartini Ni Made
Published: March 2020

The existence of infrastructure disparity between regions is considered as one of the factors that drive economic inequality between regions. This happened in areas that had been divided into several districts. Regional expansion is the formation of new administrative regions at the provincial level as well as cities and regencies from their parents. The most prominent reason in the discourse of regional expansion is that some regions are considered to have too large an area so that efforts are needed to facilitate administrative services and bureaucratic pruning by division /pemekaran (Koswara, 2001). Efforts to accelerate regional development can be implemented by increasing economic growth. One of them is to encourage infrastructure development in areas (districts) that are far from the provincial capital, due to the topography of the region, there are hills, valleys, swamps, and forests, thus encouraging an increase in the potential of an area / region on an ongoing basis. Infrastructure is a driver of economic progress. From the allocation of public and private financing, infrastructure is seen as a locomotive of national and regional development. Infrastructure also has an important influence on improving the quality of life and human well-being. This study aims to see whether the infrastructure of sanitation, water, electricity has a significant influence and contribution to economic growth in the regencies / cities of Papua province. This research method uses panel data regression with Random Effect Model (REM).
Determinant of Unemployment Duration with Survival Analysis
Authors: Safitri Hendri Cahyo Dwi , Afiatno Bambang Eko
Published: March 2020

This study aims to analyze the duration of unemployment in Gorontalo Province. The data used in the form of secondary data came from the National Labor Force Survey (Sakernas) in August 2018. The data source was obtained from the Statistics Indonesia (BPS). The total observation units used in this study were 707 individuals consisting of 122 censored data and 585 uncensored data. The technical analysis used in this study is survival analysis. The results showed that on average, the duration of unemployment in Gorontalo Province was 3.8 months. From the results of testing the variables that are significant to the duration of unemployment in Gorontalo Province, namely: sex, education level, and classification of residential areas.