Publications by authors named "James K Liu"

321 Publications

The Impact of Diabetes Mellitus on Adverse Outcomes Following Meningioma Surgery.

World Neurosurg 2021 May 29. Epub 2021 May 29.

Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center - RWJBarnabas Health, Livingston, New Jersey, USA. Electronic address:

Objective: To investigate the association between diabetes mellitus and incidence of adverse outcomes in patients who underwent meningioma surgery.

Methods: The 2012-2014 National Inpatient Sample (NIS) database was used. Prolonged length of stay (LOS) was indicated by values greater than the 90 percentile of the sample. Fisher's Exact test and ANOVA were used to compare demographics, hospital characteristics, comorbidity, and complications amongst race cohorts. Logistic regression was used to analyze the independent effect of diabetes on adverse outcomes.

Results: After selecting for patients with primary diagnosis of meningioma who underwent a resection procedure, 7,745 individuals were identified and divided into diabetic (n=1,518) and non-diabetic (n=6,227) cohorts. Demographics, hospital characteristics, and comorbidities were significantly different among the two cohorts. Average LOS was longer in diabetic patients (8.15 vs 6.04 days, p<0.001), and total charges were higher in diabetic patients ($139,462.66 vs $123,250.71, p<0.001). Multivariate regression indicated diabetic patients have higher odds of experiencing a complication (OR 1.442, 95%CI 1.255-1.656, p<0.001) and in-hospital mortality (OR 1.672, 95%CI 1.034-2.705, p=0.036) after meningioma surgery. Analysis of individual postoperative complications revealed diabetic patients experienced increased odds of pulmonary (OR 1.501, 95%CI 1.209-1.864, p<0.001), neurological (OR 1.690, 95%CI 1.383-2.065, p<0.001), and urinary/renal complications (OR 2.618, 95%CI 1.933-3.545, p<0.001). Additionally, diabetic patients were more likely to have a prolonged LOS (OR 1.694, 95%CI 1.389-2.065, p<0.001).

Conclusions: Diabetes is an important factor associated with complications after meningioma surgery. Preventative measures must be taken to optimize postoperative outcomes in these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2021.05.101DOI Listing
May 2021

Capecitabine and stereotactic radiation in the management of breast cancer brain metastases.

BMC Cancer 2021 May 15;21(1):552. Epub 2021 May 15.

Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA.

Background: Little is known about the safety and efficacy of concurrent capecitabine and stereotactic radiotherapy in the setting of breast cancer brain metastases (BCBM).

Methods: Twenty-three patients with BCBM underwent 31 stereotactic sessions to 90 lesions from 2005 to 2019 with receipt of capecitabine. The Kaplan-Meier method was used to calculate overall survival (OS), local control (LC), and distant intracranial control (DIC) from the date of stereotactic radiation. Imaging was independently reviewed by a neuro-radiologist.

Results: Median follow-up from stereotactic radiation was 9.2 months. Receptor types of patients treated included triple negative (n = 7), hormone receptor (HR)+/HER2- (n = 7), HR+/HER2+ (n = 6), and HR-/HER2+ (n = 3). Fourteen patients had stage IV disease prior to BCBM diagnosis. The median number of brain metastases treated per patient was 3 (1 to 12). The median dose of stereotactic radiosurgery (SRS) was 21 Gy (range: 15-24 Gy) treated in a single fraction and for lesions treated with fractionated stereotactic radiation therapy (FSRT) 25 Gy (24-30 Gy) in a median of 5 fractions (range: 3-5). Of the 31 stereotactic sessions, 71% occurred within 1 month of capecitabine. No increased toxicity was noted in our series with no cases of radionecrosis. The 1-year OS, LC, and DIC were 46, 88, and 30%, respectively.

Conclusions: In our single institution experience, we demonstrate stereotactic radiation and capecitabine to be a safe treatment for patients with BCBM with adequate LC. Further study is needed to determine the potential synergy between stereotactic radiation and capecitabine in the management of BCBM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12885-021-08302-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126143PMC
May 2021

Interhemispheric Precuneus Retrosplenial Transfalcine Approach for Falcotentorial Meningiomas: Anatomic Study and Clinical Series.

Oper Neurosurg (Hagerstown) 2021 Apr 30. Epub 2021 Apr 30.

Department of Neurological Surgery, Stanford University, Stanford, California, USA.

Background: Falcotentorial meningiomas are surgically challenging. Currently accepted approaches include occipital interhemispheric and supracerebellar infratentorial approaches, which have documented drawbacks.

Objective: To propose an alternative approach to the posterior tentorial incisural space, the interhemispheric precuneus retrosplenial transfalcine approach (IPRTA).

Methods: A total of 6 colored-silicone-injected adult cadaveric heads were dissected. We measured the interval between bridging veins and studied computed tomography venography scans of 20 subjects to confirm the feasibility of the IPRTA. Bony landmarks, the region's bridging veins, and the anterior and posterior borders of the approach were identified. The surgical corridor widths (veins' interval) and lengths were compared between alternative midline approaches. We also reviewed 4 consecutive clinical cases using this approach.

Results: The IPRTA provides the shortest distance to the anterior and posterior limits of the posterior tentorial incisura. Moreover, it is the only approach that provides direct visualization of the anterior and posterior limits of falcotentorial junction meningiomas. In all specimens and patients, a minimum 30-mm interval between the anterior and posterior parietal veins was found in at least one of the hemispheres. Tumor removal was successful in all 4 patients but resulted in mild paresthesia in the lower extremities of 2 patients and temporary foot drop in 1 patient.

Conclusion: The IPRTA offers the shortest and most direct corridor for falcotentorial meningiomas and provides excellent visualization of most of the critical structures in the region. Detailed preoperative evaluation of the deep and superficial venous structures is recommended.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ons/opab095DOI Listing
April 2021

Subacute vision loss after microvascular decompression for trigeminal neuralgia.

Acta Neurochir (Wien) 2021 06 3;163(6):1635-1638. Epub 2021 Apr 3.

Department of Neurological Surgery, New Jersey Medical School, Rutgers University, 90 Bergen Street, Suite 8100, Newark, NJ, 07103, USA.

Microvascular decompression is the surgery of choice for typical trigeminal neuralgia (TN) that fails conservative medical management. Visual loss after MVD is a rare complication that has not been reported. In this article, we present a patient who developed delayed visual loss and papilledema from transverse sinus stenosis resulting from bone wax compression after MVD for TN. While waxing the edges of a retrosigmoid craniotomy may seem mundane, meticulous care should be taken to ensure that there is no compression of the venous sinuses, as this could lead to intracranial hypertension.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00701-021-04819-xDOI Listing
June 2021

Craniovertebral Junction Lesions (Part 2).

Authors:
James K Liu

J Neurol Surg B Skull Base 2021 Feb 17;82(Suppl 1):S1. Epub 2021 Mar 17.

Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, United States.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0040-1721667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969133PMC
February 2021

Breast cancer subtype predicts clinical outcomes after stereotactic radiation for brain metastases.

J Neurooncol 2021 May 19;152(3):591-601. Epub 2021 Mar 19.

Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA.

Purpose: We investigated the prognostic ability of tumor subtype for patients with breast cancer brain metastases (BCBM) treated with stereotactic radiation (SRT).

Methods: This is a retrospective review of 181 patients who underwent SRT to 664 BCBM from 2004 to 2019. Patients were stratified by subtype: hormone receptor (HR)-positive, HER2-negative (HR+/HER2-), HR-positive, HER2-positive (HR+/HER2+), HR-negative, HER2-positive (HR-/HER2+), and triple negative (TN). The Kaplan-Meier method was used to calculate overall survival (OS), local control (LC), and distant intracranial control (DIC) from the date of SRT. Multivariate analysis (MVA) was conducted using the Cox proportional hazards model.

Results: Median follow up from SRT was 11.4 months. Of the 181 patients, 47 (26%) were HR+/HER2+, 30 (17%) were HR-/HER2+, 60 (33%) were HR+/HER2-, and 44 (24%) were TN. Of the 664 BCBMs, 534 (80%) received single fraction stereotactic radiosurgery (SRS) with a median dose of 21 Gy (range 12-24 Gy), and 130 (20%) received fractionated stereotactic radiation therapy (FSRT), with a median dose of 25 Gy (range 12.5-35 Gy) delivered in 3 to 5 fractions. One-year LC was 90%. Two-year DIC was 35%, 23%, 27%, and 16% (log rank, p = 0.0003) and 2-year OS was 54%, 47%, 24%, and 12% (log rank, p < 0.0001) for HR+/HER2+, HR-/HER2+, HR+/HER2-, and TN subtypes, respectively. On MVA, the TN subtype predicted for inferior DIC (HR 1.62, 95% CI 1.00-2.60, p = 0.049). The modified breast-Graded Prognostic Assessment (GPA) significantly predicted DIC and OS (both p < 0.001).

Conclusions: Subtype is prognostic for OS and DIC for patients with BCBM treated with SRT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11060-021-03735-5DOI Listing
May 2021

Far Lateral Transcondylar Transtubercular Approach for Microsurgical Resection of Foramen Magnum Meningioma: Operative Video and Technical Nuances.

J Neurol Surg B Skull Base 2021 Feb 2;82(Suppl 1):S19-S21. Epub 2020 Dec 2.

Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Saint Barnabas Medical Center, RWJ Barnabas Health, Newark and Livingston, New Jersey, United States.

Surgical access to the ventral foramen magnum remains a technical challenge. With large lesions in this region compressing the brainstem and distorting the regional neurovascular relationships, formulating a surgical plan and its appropriate execution have crucial importance in achieving favorable outcomes. While the endoscopic endonasal approaches have gained increasing attention to access the clivus and the ventral brainstem, foramen magnum meningiomas are still preferred to be removed via an approach that obviates a trajectory through the nasopharyngeal mucosa. Therefore, the far lateral approach remains one of the most practical approaches for these challenging lesions. This operative video demonstrates the use of the far lateral transcondylar transtubercular approach to remove a large meningioma in the ventral foramen magnum in a 63-year-old male with progressive cervical myelopathy, presenting as spastic quadriparesis without any cranial nerve abnormality. Using a right-sided far lateral transcondylar transtubercular approach, the meningioma was exposed within the cerebellomedullary gutter engulfing the vertebral artery and distorting the course of the adjacent cranial nerves. Using the different corridors identified between the vertebral artery, spinal accessory, vagus, and hypoglossal nerves, multiple angles of attacks to the tumor were established and utilized to resect the lesion. A gross total resection was achieved and the patient was neurologically intact without any neurological deficits. This video demonstrates the importance of understanding the intricacies of neurovascular anatomy of the cervicomedullary region (i.e., the various triangles formed between these structures), and the effective use of these corridors to safely and efficiently remove a challenging ventral foramen magnum meningioma with neurovascular involvement, while preserving cranial nerve function. The surgical technique and nuances are described in a step-by-step fashion in this illustrative operative video. The link to the video can be found at: https://youtu.be/s1dFhuaRSt8 .
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0040-1716533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935721PMC
February 2021

Endoscopic Endonasal Transclival Odontoidectomy for Basilar Invagination: Operative Video and Technical Nuances.

J Neurol Surg B Skull Base 2021 Feb 2;82(Suppl 1):S16-S18. Epub 2020 Dec 2.

Department of Neurological Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Saint Barnabas Medical Center, Robert Wood Johnson Barnabas Health, Newark, New Jersey, United States.

Basilar invagination is a congenital or acquired craniovertebral junction abnormality where the tip of the odontoid process projects through the foramen magnum which can cause severe symptomatic compression of the brainstem and spinal cord. If left untreated, patients can develop progressive quadriparesis. Traditionally, basilar invagination can be treated with cervical traction and posterior stabilization. However, in irreducible cases, anterior decompression via a transoral or endonasal approach may be necessary. In this operative video, we demonstrate an endoscopic endonasal transclival approach for odontoidectomy to successfully treat a 37-year-old female with severe basilar invagination causing symptomatic compression on the cervicomedullary junction resulting in unsteady gait and motor weakness. The patient had Klippel-Feil syndrome where the C1 arch was assimilated to the foramen magnum and transclival drilling was needed to adequately access the odontoid process for removal. A second-stage posterior occipitocervical stabilization and fusion was performed the following day. Immediate postoperative imaging showed excellent decompression of the cervicomedullary junction. Postoperatively, the patient had significant improvement in gait and motor strength in all extremities, and was ambulating independently without assistance at 1 year after surgery. The endoscopic endonasal transclival odontoidectomy is a useful strategy to treat severe irreducible basilar invagination causing symptomatic neural compression. The surgical technique and nuances are described in a step-by-step fashion in this illustrative operative video. The link to the video can be found at: https://youtu.be/HL4K7KqJEJM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0040-1715522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935726PMC
February 2021

Extended Anterolateral Infralabyrinthine Transjugular Approach for Microsurgical Resection of Giant Glomus Vagale Tumor: Operative Video and Technical Nuances.

J Neurol Surg B Skull Base 2021 Feb 26;82(Suppl 1):S59-S60. Epub 2020 Nov 26.

Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Saint Barnabas Medical Center, RWJ Barnabas Health, Newark, New Jersey, United States.

Glomus vagale tumor is a paraganglioma of the vagus nerve. It is a rare type of benign tumor that occupies the head and neck and skull base regions. Patients often present with lower cranial nerve dysfunctions such as difficulty swallowing, tongue weakness, and hoarseness. Surgical treatment can be complex and difficult due to its high vascularity, frequent involvement of lower cranial nerves, and surrounding critical vascular structures. In this operative video, we demonstrate an extended anterolateral infralabyrinthine transjugular approach for microsurgical resection of a giant glomus vagale tumor in a 53-year-old male who presented with an enlarging neck mass, difficulty swallowing, right tongue weakness, and hoarseness. Imaging revealed a giant glomus vagale tumor in the right parapharyngeal space extending into the jugular foramen with occlusion of the internal jugular vein. After preoperative embolization, the patient underwent a near-total resection of the tumor with a small microscopic residual at the pars nervosa. In summary, the extended anterolateral infralabyrinthine transjugular approach is a useful strategy for removal of giant glomus vagale tumors extending into the skull base. The surgical technique and nuances are described in a step-by-step fashion in this illustrative operative video. The link to the video can be found at: https://youtu.be/L0EosQK95LE .
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0040-1716532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936041PMC
February 2021

Phage display targeting identifies EYA1 as a regulator of glioblastoma stem cell maintenance and proliferation.

Stem Cells 2021 Feb 16. Epub 2021 Feb 16.

Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.

Glioblastoma (GBM) ranks among the most lethal of human malignancies with GBM stem cells (GSCs) that contribute to tumor growth and therapeutic resistance. Identification and isolation of GSCs continues to be a challenge, as definitive methods to purify these cells for study or targeting are lacking. Here, we leveraged orthogonal in vitro and in vivo phage display biopanning strategies to isolate a single peptide with GSC-specific binding properties. In silico analysis of this peptide led to the isolation of EYA1 (Eyes Absent 1), a tyrosine phosphatase and transcriptional coactivator. Validating the phage discovery methods, EYA1 was preferentially expressed in GSCs compared to differentiated tumor progeny. MYC is a central mediator of GSC maintenance but has been resistant to direct targeting strategies. Based on correlation and colocalization of EYA1 and MYC, we interrogated a possible interaction, revealing binding of EYA1 to MYC and loss of MYC expression upon targeting EYA1. Supporting a functional role for EYA1, targeting EYA1 expression decreased GSC proliferation, migration, and self-renewal in vitro and tumor growth in vivo. Collectively, our results suggest that phage display can identify novel therapeutic targets in stem-like tumor cells and that an EYA1-MYC axis represents a potential therapeutic paradigm for GBM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/stem.3355DOI Listing
February 2021

Combined Petrosal Approach for Resection of a Large Trigeminal Schwannoma With Meckel's Cave Involvement-Part II: Microsurgical Approach and Tumor Resection: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 Feb;20(3):E226

Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey; Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey.

This video is the second part of a 2-part video presentation demonstrating the microsurgical technique of a combined petrosal approach for resection of a large trigeminal schwannoma in a 54-yr-old woman involving multiple cranial fossae extending anteriorly into Meckel's cave. The patient presented with long-standing worsening headache and facial tingling and numbness. After discussing the benefits and risks of the surgery as well as the alternative management strategies, the patient decided to proceed with surgery and informed consent was obtained. The surgery was performed in a single stage. The technical nuances of anterior and posterior (retrolabyrinthine) petrosectomy are demonstrated and discussed. Microsurgical resection of the tumor is also demonstrated emphasizing the important steps of dural opening, arachnoid dissection, identification and preservation of cranial nerves, and exploration of Meckel's cave. Use of endoscopic-assistance for visualization of the cerebellopontine angle and neurovascular structures is also demonstrated.  Table in video reprinted by permission from Copyright Clearance Center: Springer Nature, Acta Neurochirurgica, Frontotemporal epidural approach to trigeminal neurinomas, Dolenc VV, Copyright 1994.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ons/opaa364DOI Listing
February 2021

Combined Petrosal Approach for Resection of a Large Trigeminal Schwannoma With Meckel's Cave Involvement-Part I: Anatomic Rationale and Analysis: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2021 Feb;20(3):E225

Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.

Resection of large trigeminal schwannomas involving both posterior and middle cranial fossae is challenging. The depth of the surgical target in the superomedial corner of the cerebellopontine angle and the petrous apex makes for a difficult lesion to favorably access, expose, and safely resect. Judicious planning of a skull base approach is therefore the most crucial step in successful management of these formidable tumors. When properly chosen, planned, and executed, the combined petrosal approach sets the stage for an optimal exposure of such tumors that involve both posterior and middle cranial fossae. The present video is the first of a 2-part video presentation that explains the anatomic rationale of selecting a combined petrosal approach (anterior petrosectomy and retrolabyrinthine petrosectomy) for the resection of a large trigeminal schwannoma involving the posterior and middle cranial fossae with an extension into Meckel's cave in a 54-yr-old female presenting with 5-yr history of increasing headaches, left-sided face numbness, and disequilibrium. The benefits, risks, and alternatives of the surgical procedure were discussed in detail with the patient and she consented to proceed with surgery. Part I also discusses the important nuances of positioning the patient, as well as planning and execution of the skin incision, including pericranial flap harvesting.  Of note, the patient consented to the publication of images obtained from her.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ons/opaa363DOI Listing
February 2021

Gender differences in NIH grant funding in neurological surgery.

J Clin Neurosci 2020 Oct 17;80:43-49. Epub 2020 Aug 17.

Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, NJ, USA; Department of Otolaryngology- Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey; Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center - RWJBarnabas Health, Livingston, New Jersey, USA. Electronic address:

Research productivity is a vital component to an academic neurosurgeon's career. We sought to evaluate gender differences in NIH funding among faculty in neurological surgery departments. NIH funding awarded to PIs of neurological surgery departments from 2014 to 2019 were obtained and analyzed for gender differences in funding trends, with attention to terminal degree and academic rank, as well as publication range in length of years and h-index. 79.4% of all NIH grants were awarded to male PIs, with the remaining 20.5% given to their female counterparts. Mean of the total NIH grants awarded to men was significantly higher at $1,796,684 (± Standard Error of Mean (SEM) $155,849, IQR: $1,759,250) compared to women at $1,151,968 (± SEM $137,914, IQR: $1,388,538) (P = 0.022). Mean NIH funding per grant for men was $365,760 (± SEM: $39,592, IQR: $189,692) and for women was $292,912 (± SEM: 28,239, IQR: $283,177). Differences in mean NIH funding per grant approached but did not reach statistical significance between men and women (P = 0.122). When stratified for academic rank, there was a significant difference in mean NIH funding per grant between men and women on the associate professor level (p < 0.005), with women exceeding men in funding at this academic level, with other academic ranks remaining non-significant. Overall, male neurosurgeons receive significantly more total NIH grant funding than their female counterparts, except at the level of associate professor where women were found to surpass men.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2020.07.052DOI Listing
October 2020

Initial Approach to Patients with a Newly Diagnosed Solitary Brain Metastasis.

Authors:
James K C Liu

Neurosurg Clin N Am 2020 Oct;31(4):489-503

Department of Neuro-Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, CSB 6141, Tampa, FL 33612, USA. Electronic address:

Solitary brain metastasis is defined by a single metastatic brain lesion as the only site of metastasis. The initial approach to this condition consists of radiographical evaluation to establish diagnosis, followed by assessment of functional and prognostic status. Neurologic symptom management consists of using dexamethasone and antiepileptic medications. Treatment consists of a combination of surgical and radiation therapy. Surgical treatment is indicated where there is a need for tissue diagnosis or immediate alleviation of neurologic symptoms and mass effect. Stereotactic radiosurgery has become an effective treatment modality. Whole-brain radiation therapy may have a role as an adjunctive therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.nec.2020.05.001DOI Listing
October 2020

Adult Intracranial Myxoid Mesenchymal Tumor with EWSR1-ATF1 Gene Fusion.

World Neurosurg 2020 11 17;143:91-96. Epub 2020 Jul 17.

Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA. Electronic address:

Background: Intracranial myxoid mesenchymal tumors (IMMTs) carrying an EWSR1-CREB gene family fusion are extremely rare and have only been identified in 10 previous reports. All but one has been found in children or young adults. Although there appear to be similarities to a myxoid variant of angiomatoid fibrous histiocytoma (AFH), clear histologic differences exist that appear to distinguish IMMTs as a distinct and novel entity. Previous reports have lacked detailed long-term follow-up and recommendations regarding treatment approach.

Case Description: This case describes a 48-year-old woman who presented with a left intraventricular mass that was identified on histology as an IMMT with an EWSR1-ATF1 gene fusion. After initial resection, the tumor demonstrated local recurrence. Repeat resection was performed followed by immediate demonstration of local and distant tumor recurrence. Histologic analysis of the tumor demonstrated a myxoid mesenchymal tumor distinct from AFH. Fractionated stereotactic radiation therapy was administered after the second resection, and tumor control was achieved at 1 year.

Conclusions: Intracranial myxoid mesenchymal tumor is a novel and rare entity that has been previously identified in only 10 cases. This case is particularly remarkable because it is only the second IMMT case to occur in a middle-aged adult and shares striking similarities in clinical presentation to the previously reported case. Given the aggressive recurrence seen with the presented case, we recommend the treatment plan to be surgical resection followed by adjuvant radiation therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2020.07.057DOI Listing
November 2020

Letter to the Editor Regarding "Investigating the Gender Pay Gap in Industry Contributions to Academic Neurosurgeons".

World Neurosurg 2020 06;138:574-575

Department of Neurological Surgery, Rutgers University, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2020.02.012DOI Listing
June 2020

The historical evolution of microvascular decompression for trigeminal neuralgia: from Dandy's discovery to Jannetta's legacy.

Acta Neurochir (Wien) 2020 11 9;162(11):2773-2782. Epub 2020 Jun 9.

Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ, 07103, USA.

Although the symptoms of trigeminal neuralgia (TN) have been well described throughout the history of medicine, its etiology was initially not well understood by most surgeons. The standard procedure used to treat TN today, microvascular decompression (MVD), evolved due to the efforts of numerous neurosurgeons throughout the twentieth century. Walter Dandy was the first to utilize the cerebellar (suboccipital) approach to expose the trigeminal nerve for partial sectioning. He made unique observations about the compression of the trigeminal nerve by nearby structures, such as vasculature and tumors, in TN patients. In the 1920s, Dandy unintentionally performed the first MVD of the trigeminal nerve root. In the 1950s, Palle Taarnhøj treated a TN patient by performing the first intentional decompressive procedure on the trigeminal nerve root solely through the removal of a compressive tumor. By the 1960s, W. James Gardner was demonstrating that the removal of offending lesion(s) or decompression of nearby vasculature alleviated pressure on the trigeminal nerve and the pain associated with TN. By the 1990s, Peter Jannetta proved Dandy's original hypothesis; he visualized the compression of the trigeminal nerve at the root entry zone in TN patients using an intraoperative microscope. In this paper, we recount the historical evolution of MVD for the treatment of TN.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00701-020-04405-7DOI Listing
November 2020

Nasoseptal Flap Necrosis After Endoscopic Skull Base Surgery in the Setting of COVID-19 Pandemic.

World Neurosurg 2020 08 29;140:374-377. Epub 2020 May 29.

Department of Otolaryngology - Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA.

Background: A novel viral strain known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created a worldwide pandemic known as coronavirus 2019 (COVID-19). Early reports from China have highlighted the risks associated with performing endoscopic endonasal skull base surgery in patients with SARS-CoV-2. We present a rare complication of nasoseptal flap (NSF) necrosis associated with COVID-19, further emphasizing the challenges of performing these procedures in this era.

Case Description: A 78-year-old man underwent an extended endoscopic endonasal transplanum resection of a pituitary macroadenoma for decompression of the optic chiasm. The resulting skull base defect was repaired using a pedicled NSF. The patient developed meningitis and cerebrospinal fluid (CSF) leak on postoperative day 13, requiring revision repair of the defect. Twelve days later, he developed persistent fever and rhinorrhea. The patient was reexplored endoscopically, and the NSF was noted to be necrotic and devitalized with evident CSF leakage. At that time, the patient tested positive for SARS-CoV-2. Postoperatively, he developed acute respiratory distress syndrome complicated by hypoxic respiratory failure and death.

Conclusions: To our knowledge, this is the first reported case of NSF necrosis in a patient with COVID-19. We postulate that the thrombotic complications of COVID-19 may have contributed to vascular pedicle thrombosis and NSF necrosis. Although the pathophysiology of SARS-CoV-2 and its effect on the nasal tissues is still being elucidated, this case highlights some challenges of performing endoscopic skull base surgery in the era of COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2020.05.237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256530PMC
August 2020

Delayed Development of Spinal Subdural Hematoma Following Cranial Trauma: A Case Report and Review of the Literature.

World Neurosurg 2020 09 22;141:44-51. Epub 2020 May 22.

Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; Morsani College of Medicine, University of South Florida, Tampa, Florida, USA. Electronic address:

Background: Spinal subdural hematomas (SDHs) have been reported secondary to direct trauma or iatrogenic causes associated with coagulopathies. Spinal SDHs found after the development of acute intracranial SDHs, without any evidence of trauma to the spine, are extremely rare. In addition to this rare presentation, there is a lack of consensus regarding whether surgical decompression is the ideal treatment strategy. Depending on the extent of SDH within the spinal canal, surgical decompression may be difficult where diffuse hematoma within the intradural space requires multilevel decompression for treatment.

Case Description: A 46-year-old man initially presented with an acute cranial SDH following isolated head trauma. After a period of full recovery, he developed delayed lower extremity paraparesis secondary to the formation of a thoracolumbar SDH. This hematoma coincided with resolution of the cranial SDH and likely was due to redistribution of blood from the cranial subdural space into the spinal canal. Given the diffuse multilevel nature of the spread of hematoma and lack of a focal area of compression, he was managed conservatively. He demonstrated small signs of neurologic improvement over several days and regained considerable strength over the following several weeks.

Conclusions: This report demonstrates a very rare occurrence of a traumatic intracranial SDH migrating into the thoracic and lumbar spine. This case also highlights that despite acute neurologic deficits, conservative management may be a feasible strategy that can result in recovery of neurologic function.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2020.05.158DOI Listing
September 2020

Rapid Recovery of Cranial Nerve Deficits After Anterior Petrosal (Kawase) Approach for Medically Refractory Petrous Apicitis.

World Neurosurg 2020 08 17;140:122-127. Epub 2020 May 17.

Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA. Electronic address:

Background: The mainstay treatment for petrous apicitis (Gradenigo's syndrome) is medical management with antibiotics, steroids, and placement of pressure equalization tubes. The role for surgery is limited as second-line treatment if conservative methods have failed.

Case Description: We report 2 cases of medically refractory petrous apicitis presenting with progressive cranial neuropathies who underwent petrous apex resection and debridement via an anterior petrosal (Kawase) approach. Both patients had improvement of their preoperative cranial nerve deficits within 24-48 hours of surgery, that previously did not improve after 2 weeks of medical management.

Conclusions: To our knowledge, the use of the Kawase approach for petrous apicitis has not been previously reported. In addition, we postulate that surgical intervention can potentially result in quicker recovery of preexisting cranial nerve deficits in medically refractory petrous apicitis. This raises the potential role of earlier surgical intervention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2020.05.070DOI Listing
August 2020

Letter to the Editor Regarding "Pituitary Apoplexy: Large Surgical Series with Grading System".

World Neurosurg 2020 03;135:405

Department of Neurological Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2019.11.174DOI Listing
March 2020

First case series of the transradial approach for neurointerventional procedures in pediatric patients.

J Neurosurg Pediatr 2020 Jan 31:1-5. Epub 2020 Jan 31.

Departments of1Neurological Surgery and.

Objective: The transradial approach (TRA) has been widely adopted by interventional cardiologists but is only now being accepted by neurointerventionalists. The benefits of the TRA over the traditional transfemoral approach (TFA) include reduced risk of adverse clinical events and faster recovery. The authors assessed the safety and feasibility of the TRA for neurointerventional cases in the pediatric population.

Methods: Pediatric patients undergoing cerebrovascular interventions since implementation of the TRA at the authors' institution were retrospectively reviewed. Pertinent patient information, procedure indications, vessels catheterized, fluoroscopy time, and complications were reviewed.

Results: There were 4 patients in this case series, and their ages ranged from 13 to 15 years. Each patient tolerated the procedure performed using the TRA without any postprocedural issues, and only 1 patient experienced radial artery spasm, which resolved with the administration of intraarterial verapamil. None of the patients required conversion to the TFA.

Conclusions: The TRA can be considered a safe alternative to the TFA for neurointerventional procedures in the pediatric population and provides potential advantages. However, as pediatric patients require special consideration due to their smaller-caliber arteries, routine use of ultrasound guidance is advised when attempting the TRA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2019.12.PEDS19448DOI Listing
January 2020

Leptomeningeal disease in melanoma patients: An update to treatment, challenges, and future directions.

Pigment Cell Melanoma Res 2020 07 19;33(4):527-541. Epub 2020 Jan 19.

Department of Neuro-Oncology & Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.

In February 2018, the Melanoma Research Foundation and the Moffitt Cancer Center hosted the Second Summit on Melanoma Central Nervous System Metastases in Tampa, Florida. The meeting included investigators from multiple academic centers and disciplines. A consensus summary of the progress and challenges in melanoma parenchymal brain metastases was published (Eroglu et al., Pigment Cell & Melanoma Research, 2019, 32, 458). Here, we will describe the current state of basic, translational, clinical research, and therapeutic management, for melanoma patients with leptomeningeal disease. We also outline key challenges and barriers to be overcome to make progress in this deadly disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/pcmr.12861DOI Listing
July 2020

Efficacy of simultaneous pericranial and nasoseptal "double flap" reconstruction of anterior skull base defects after combined transbasal and endoscopic endonasal approaches.

Acta Neurochir (Wien) 2020 03 7;162(3):641-647. Epub 2019 Dec 7.

Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen St, Suite 8100, Newark, NJ, 07101, USA.

Background: The "double flap" reconstruction technique, comprised of a simultaneous vascularized pedicled pericranial flap (PCF) and pedicled nasoseptal flap (NSF), can be used to repair anterior skull base defects after a combined cranionasal or transbasal-endoscopic endonasal approach (EEA) has been performed to remove malignant anterior skull base tumors. The use of two vascularized flaps may potentially decrease the incidence of post-radiation flap necrosis and postoperative cerebrospinal fluid (CSF) leaks after radiation therapy.

Methods: We conducted a retrospective review of a prospective skull base database on patients who underwent the double flap reconstruction technique after a combined transbasal-EEA approach. Data collected for each patient included demographics, method of tumor resection and repair, complications, tumor recurrence, and follow-up.

Results: Nine patients who underwent a combined transbasal-EEA approach for resection of anterior skull base tumors with significant intracranial extension followed by reconstruction of the cranial base using the double flap technique. Four were men and five were women, with a mean age of 49 years (range, 15-68 years). There was no postoperative CSF leakage detected or complications of infection, meningitis, mucocele, or tension pneumocephalus after a mean follow-up of 35.7 months (range, 4.5-98 months). Seven of the nine patients underwent adjuvant radiation without flap necrosis. Local tumor recurrence was not observed in any of the patients at last follow-up; however, one patient developed distant brain metastasis.

Conclusion: The simultaneous PCF and NSF double flap reconstruction is an effective technique in preventing postoperative CSF leakage and post-radiation necrosis when repairing anterior skull base defects after combined transbasal-EEA approaches. This technique may be useful in patients anticipated to undergo postoperative radiation therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00701-019-04155-1DOI Listing
March 2020

Craniovertebral Junction Lesions (Part 1).

Authors:
James K Liu

J Neurol Surg B Skull Base 2019 Dec 19;80(Suppl 4):S339-S340. Epub 2019 Nov 19.

Department of Neurological Surgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, United States.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0039-3400246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6863934PMC
December 2019

Feasibility and Challenges of Microsurgical Resection of Colloid Cysts in Patients with Preexisting Ventriculoperitoneal Shunts.

World Neurosurg 2020 Jan 19;133:e492-e497. Epub 2019 Sep 19.

Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA. Electronic address:

Background: Colloid cysts are the most common third ventricular tumor and may present with symptoms related to obstructive hydrocephalus. Although definitive endoscopic or microsurgical resection is the standard of care, patients may receive temporizing ventriculoperitoneal shunts when definitive management is deferred. Subsequent definitive treatment can be challenging because of the ventricular collapse and narrowing of the operative corridor. There is currently no literature evaluating the feasibility of definitive colloid cyst resection in patients with preexisting ventriculoperitoneal shunts.

Methods: We retrospectively reviewed records for patients undergoing colloid cyst resection between 2009 and 2019 to identify patients with preexisting shunts prior to surgery.

Results: Three patients had preexisting ventriculoperitoneal shunts. Two patients had been shunted at outside institutions where microsurgical or endoscopic resection was not available. One patient received a shunt from an outside surgeon when she was deemed a poor surgical candidate because of cardiac instability. All 3 patients underwent successful gross total colloid cyst resection via the transcallosal approach without recurrences during a mean follow-up of 4.2 years. All patients had intact cognitive and memory function and returned to work.

Conclusions: Surgical resection of colloid cysts is possible despite a preexisting ventriculoperitoneal shunt. Because the ventricular space may be collapsed postoperatively because of cerebrospinal fluid diversion, a transcortical route (either endoscopic or microscopic) can be complicated by a small operative corridor with reduced visibility. The transcallosal approach was safe and feasible in these cases for providing midline access with adequate visualization for complete resection despite ventricular collapse.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2019.09.064DOI Listing
January 2020

Endoscopic Resection of Pediatric Skull Base Tumors: An Evidence-Based Review.

J Neurol Surg B Skull Base 2019 Oct 11;80(5):527-539. Epub 2018 Dec 11.

Department of Otolaryngology - Head and Neck Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, United States.

 To perform a systematic review examining experiences with endoscopic resection of skull base lesions in the pediatric population, with a focus on outcomes, recurrence, and surgical morbidities.  PubMed/MEDLINE, Cochrane Library, Embase, and Web of Science databases were evaluated. Studies were assessed for level of evidence. Bias risk was evaluated using the Cochrane Bias tool, Grades of Recommendation, Assessment, Development and Evaluation (GRADE), and Methodological Index for Non-Randomized Studies (MINORS) criteria. Patient characteristics, pathology, site of primary disease, presenting symptoms, stage, procedure specific details, and complications were evaluated. Results were reported using the Preferred Reporting Systems for Systematic Reviews and Meta-Analysis guidelines.  Ninety-three studies met criteria for inclusion, encompassing 574 patients with skull base tumors. The GRADE and MINORS criteria determined the overall evidence to be moderate quality. The most common benign and malignant pathologies included juvenile nasopharyngeal angiofibromas (  = 239) and chondrosarcomas (  = 11) at 41.6 and 1.9%, respectively. Of all juvenile nasopharyngeal angiofibroma tumors, most presented at stage IIIa and IIIb (25.8 and 27.3%, respectively). Nasal obstruction (16.5%) and headache (16.0%) were common symptoms at initial presentation. Surgical approaches included endoscopic endonasal (  = 193, 41.2%) and endoscopic extended transsphenoidal (  = 155, 33.1%). Early (< 6 weeks) and late (>6 weeks) complications included cerebrospinal fluid leak (  = 36, 17.3%) and endocrinopathy (  = 43, 20.7%). Mean follow-up time was 37 months (0.5-180 months), with 86.5% showing no evidence of disease and 2.1% having died from disease at last follow-up.  Endoscopic skull base surgery has been shown to be a safe and effective method of treating a variety of pediatric skull base tumors. If appropriately employed, the minimally invasive approach can provide optimal results in the pediatric population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0038-1676305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6748853PMC
October 2019

CDK 4/6 inhibitors and stereotactic radiation in the management of hormone receptor positive breast cancer brain metastases.

J Neurooncol 2019 Sep 9;144(3):583-589. Epub 2019 Aug 9.

Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA.

Purpose: Cyclin-dependent kinase (CDK) 4/6 inhibitors are becoming increasingly utilized in the setting of advanced, hormone receptor (HR+) positive breast cancer. Pre-clinical data suggests a potential synergy between radiation therapy (RT) and CDK4/6 inhibitors. We assessed clinical outcomes of patients treated at our institution with the use of CDK4/6 inhibitors and stereotactic radiation in the management of HR+ breast brain metastases.

Methods: A retrospective analysis of patients who received stereotactic radiotherapy for HR+ brain metastases within 6 months of CDK4/6 inhibitor administration was performed. The primary endpoint was neurotoxicity during or after stereotactic radiation. Secondary endpoints were local brain control, distant brain control, and overall survival (OS).

Results: A total of 42 lesions treated with stereotactic radiation in 15 patients were identified. Patients received either palbociclib (n = 10; 67%) or abemaciclib (n = 5; 33%). RT was delivered concurrently, before, or after CDK4/6 inhibitors in 18 (43%), 9 (21%), and 15 (36%) lesions, respectively. Median follow-up following stereotactic radiation was 9 months. Two lesions (5%) developed radionecrosis, both of which received four prior RT courses to the affected lesion prior to onset of radionecrosis and subsequently managed with steroids and bevacizumab. Six- and 12-month local control of treated lesions was 88% and 88%, while 6- and 12-month distant brain control was 61% and 39%, respectively. Median OS was 36.7 months from the date of brain metastases diagnosis.

Conclusions: Stereotactic radiation to breast brain metastases was well tolerated alongside CDK4/6 inhibitors. Compared to historical data, brain metastases control rates are similar whereas survival appears prolonged.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11060-019-03260-6DOI Listing
September 2019

ICAR: endoscopic skull-base surgery.

Int Forum Allergy Rhinol 2019 07;9(S3):S145-S365

University of Pennsylvania, Philadelphia, PA.

Background: Endoscopic skull-base surgery (ESBS) is employed in the management of diverse skull-base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull-base surgery have produced the International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR:ESBS).

Methods: Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence-based review or evidence-based review with recommendations format. Subsequently, each topic was written and then reviewed by skull-base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus.

Results: The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull-base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated.

Conclusion: A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence-based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull-base community to embrace these opportunities and collaboratively address these shortcomings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/alr.22326DOI Listing
July 2019

The Educational Quality of Neurosurgical Resources on YouTube.

World Neurosurg 2019 Oct 2;130:e660-e665. Epub 2019 Jul 2.

Otolaryngology, Facial Plastics and Reconstructive Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.

Background: YouTube has rapidly become one of the most widely accessed educational platforms of our time. Over 1 billion hours of YouTube content are viewed every day, including neurosurgical videos. To date, there has never been a qualitative analysis of neurosurgical content on YouTube.

Methods: By evaluating the search interest of neurosurgical terms via Google Trends, we selected 8 search terms to assess on YouTube. For each term, we selected the top 20 videos, 10 when sorting by view count and 10 when sorting by relevance. Using the DISCERN criteria, we evaluated 131 unique YouTube videos to assess bias and overall educational quality. In addition, we categorized each video based on its intended utility and the credentials of the video's commentator. The number of views, average DISCERN scores, and bias scores were compared between search terms and between video categories.

Results: There were 131 unique and 29 duplicate videos. The videos received 143,538,363 combined views (1,104,141 average). The average video age was 4.6 years (range, 66 days to 12.5 years). The term "brain surgery" received the most total views (62,339,885), with an average DISCERN score of 1.65 overall and 2 for bias. The average DISCERN score was 2.02 overall and 2.39 for bias. There were 45 advertisements for either hospitals, physicians, or companies, totaling 18,052,873 views and averaging a DISCERN score of 2.04.

Conclusions: YouTube is a frequently viewed but biased source for neurosurgical information. Advertisements are frequently disguised as educational material, and few videos provide references or sources for their information.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2019.06.184DOI Listing
October 2019