Neurosurgery Commons^™

The Ki-67 Proliferation Index And Recurrence Risk Of Intracranial Meningioma: A Multicenter, Retrospective Cohort Study Of 5,050 Patients, Christian Mirian, Lasse Rehné Jensen, Tareq A Juratli, Andrea Daniela Maier, Anders Broechner, Sverre H Torp, Helen A Shih, Ramin A Morshed, Jacob S Young, Stephen T Magill, Luca Bertero, Walter Stummer, Dorothee Cäcilia Spille, Benjamin Brokinkel, Soichi Oya, Satoru Miyawaki, Nobuhito Saito, Martin Proescholdt, Yasuhiro Kuroi, Konstantinos Gousias, Matthias Simon, Jennifer Moliterno, Ricardo Prat-Acin, Stéphane Goutagny, Vikram C Prabhu, John T Tsiang, Johannes Wach, Erdem Güresir, Junkoh Yamamoto, Young Zoon Kim, Joo Ho Lee, Daniel W Kim, Matthew Koshy, Karthikeyan Perumal, Mustafa K Baskaya, Donald M Cannon, Dennis C Shrieve, Chang-Ok Suh, Jong Hee Chang, Maria Kamenova, Sven Straumann, Jehuda Soleman, Ilker Y Eyüpoglu, Tony Catalan, Austin Lui, Philip V Theodosopoulos, Michael W Mcdermott, Fang Wang, Pedro Góes, Aria Jamshidi, Ricardo Komotar, Michael Ivan, Evan Luther, Luis Souhami, Marie-Christine Guiot, Tamás Csonka, Toshiki Endo, Olivia Claire Barrett, Randy Jensen, Tejpal Gupta, Akash J Patel, Tiemo J Klisch, Jun Won Kim, Francesco Maiuri, Valeria Barresi, María Dolores Tabernero, Simon Skyrman, Ian Law, David Scheie, Bjarne Winther Kristensen, Tina Nørgaard Munch, Torstein Meling, Kåre Fugleholm, Paul Blanche, Tiit Mathiesen

Faculty, Staff and Students Publications

Purpose: The Ki-67 proliferation index (Ki-67 PI) has been associated with meningioma recurrence, yet its clinical utility remains debated. Whether Ki-67 PI provides prognostic information across subgroups defined by both WHO grade and extent of resection remains to be investigated.

Methods: We analyzed 5,050 patients with intracranial meningiomas from the international PERNS cohort (42 centers, diagnosed between 1989-2019) who underwent surgical resection without postoperative radiotherapy. Ki-67 PI prognostic accuracy was assessed up to 10 years postoperatively by using ROC analyses and estimating its association with the risk of recurrence.

Results: Results demonstrated that the prognostic value of Ki-67 PI differed …

Androgen Activity In The Male Embryonic Hindbrain Drives Lethal Pfa Ependymoma, Jiao Zhang, Winnie Ong, Alexandra Rasnitsyn, Ricardo Daniel Gonzalez, Rodrigo Lopez Gutierrez, Polina Balin, Amr Saadeldin, Xiaochong Wu, Maria C Vladoiu, Vicente Santa-Maria Lopez, Fernando Gonzalez-Salinas, Navneesh Yadav, Dinesh Mohanakrishnan, Kannan Boosi Narayana Rao, Raja Gopal Reddy Mooli, Hinda Najem, Sebastian Pacheco, Kaitlin Kharas, Cory Richman, David Przelicki, Evan Y Wang, Haipeng Su, Rachel Naomi Curry, Runze Yang, Michelle Masayo Kameda-Smith, Bryn Livingston, David Scott, Zaili Luo, Mingyang Xia, Namal Abeysundara, Anders W Erickson, Ncedile Mankahla, Lucas Zhongming Hu, Chu Pan, Raul Suarez, Ning Huang, Yihao Wu, Hao Wang, Tajana Douglas, Jonelle Pallota, Steven Hébert, Karen Ng, Krystin Mantione, Heather Whetstone, Hassaan Maan, Hussein Lakkis, Juyeun Lee, Sadeesh K Ramakrishnan, Yanxin Pei, Yujie Tang, Frank Y Lin, Guillermo Aldave, Marco Gallo, Robert M Friedlander, Faiyaz Notta, Laura K Donovan, Murali Chintagumpala, Bo Wang, Yun Li, Daniel D De Carvalho, Zhaolei Zhang, Ying Mao, Wei Hua, Charles Eberhart, Calixto-Hope G Lucas, Sriram Venneti, Poul H Sorensen, Alberto Delaidelli, Hao Li, Wenhao Zhou, Jason Kirk, Dean G Tang, Tao Jiang, Hailong Liu, Justin D Lathia, Hiromichi Suzuki, Jeremy N Rich, Lincoln D Stein, Nada Jabado, Vijay Ramaswamy, Q Richard Lu, Amy B Heimberger, Craig Daniels, Kulandaimanuvel Antony Michealraj, Claudia L Kleinman, Michael D Taylor

Faculty, Staff and Students Publications

Posterior fossa type A (PFA) ependymoma is an unusual infantile brain tumour with few known somatic mutations, thought to be driven by epigenetic mechanisms1. PFA ependymoma has a markedly higher incidence and worse prognosis in male children than in female children2. The mechanisms that underlie these sex differences are at present unknown. Here we show that the cellular hierarchy of PFA ependymoma is less differentiated in male individuals than it is in female individuals. In the normal developing mouse hindbrain, male gliogenic progenitors are less differentiated than matched female sibling controls. To further parse the effects …

Dominant Clones Leverage Developmental Epigenomic States To Drive Ependymoma, Alisha S Kardian, Hua Sun, Siri Ippagunta, Nicholas Laboe, Srinidhi Varadharajan, Kwanha Yu, Hsiao-Chi Chen, Erik Emanus, Tuyu Zheng, Riley M Deneen, Jon P Connelly, Yong-Dong Wang, Jiangshan Zhan, Hengxi Liu, Kimberley Lowe, Taylor Bugbee, Rakesh Pathak, Amanda Bland, Sanya Mehta, Sophie Cochiolo, Amir Arabzade, Blake Holcomb, Kaitlin M Budd, Gabriele Kembuan, Tristen Wright, Emma Caesar, Maxwell Park, Amelia Hancock, David Gee, Joel Murdoch, Yi Xiao, Samuel K Mcbrayer, Thomas E Merchant, Jun Qi, Adam D Durbin, Lindsay A Schwarz, Li Wang, Andrew M Donson, Nicholas K Foreman, Sameer Agnihotri, Alfonso Lavado, Suzanne J Baker, David W Ellison, Hyun Kyoung Lee, Shondra M Pruett-Miller, Kelsey C Bertrand, Benjamin Deneen, Stephen C Mack

Faculty, Staff and Students Publications

ZFTA–RELA is the most recurrent genetic alteration seen in paediatric supratentorial ependymoma (EPN) and is sufficient to initiate tumours in mice1. Despite its oncogenic potential, ZFTA–RELA (ZR) is observed nearly exclusively in childhood EPN, with tumours located distinctly in the supratentorial brain of the central nervous system1. We proposed that specific chromatin modules accessible during brain development would render distinct cell lineage programs at direct risk of transformation by ZR. To test this hypothesis, we performed combined single-nucleus assay for transposase-accessible chromatin and RNA (snMultiome) sequencing of the developing mouse forebrain compared with ZR-driven mouse …

Mouse White Matter Matters: Cortical Origins And Spatial Organization Of Mouse White Matter Tracts, Sofia D Gordeev, Melissa Franch, Sarah R Heilbronner

Faculty, Staff and Students Publications

White matter—the fundamental structure underlying network connectivity—lies at the heart of the brain’s computational power. White matter is organized into fiber tracts, or bundles, in both human and nonhuman primate brains. These bundles consist of long-range axonal projections with a set of shared origin and termination points and exhibit a predictable organization. However, the organization of white matter in the mouse brain remains relatively unknown. This knowledge gap is surprising given the central role of mice in neuroscience, with mouse brains serving as the dominant model for transgenics, in vivo calcium imaging, and circuit manipulation. To address this gap, we …

Neurobiological Pathways Underlying Brain Tumor Progression: Basis For Oncogenicity And Opportunities For Immunotherapeutic Intervention, Carrie E. Andrews, Jenny Zilberberg, Raul Perez-Olle, David Andrews, Mark A. Exley

Department of Neurosurgery Faculty Papers

Both primary and metastatic brain tumors rely on signals from the surrounding environment for their survival and progression. In particular, the most common and lethal brain cancer, glioblastoma (GBM), derived from glial cells (astrocytes or microglia), has been shown to integrate into synaptic networks and to receive paracrine signals from neighbouring tumor microenvironment (TME) cells. There is increasing evidence that metastatic disease in the brain exhibits similar behavior. The TME both maintains malignant cells and is maintained by them, a process that relies on cancer stem cells (CSCs). These stem cells and their signaling mechanisms, including in the case of …

Outcomes Of Lumbar Fusion Surgery In Isthmic Versus Degenerative Spondylolisthesis: A Systematic Review And Meta-Analysis, Pavlos Texakalidis, Stavros Matsoukas, Constantine L. Karras, Christopher S. Ahuja, Najib El Tecle, Tyler R. Koski, Nader S. Dahdaleh

Department of Neurosurgery Faculty Papers

Lumbar spondylolisthesis can cause a significant disability due to back and lower extremity pain. Degenerative spondylolisthesis (DS) and isthmic spondylolisthesis (IS) are the two most common types. DS results from arthritic changes and degenerative disc disease, whereas IS occurs secondary to a pars interarticularis defect. This study compared surgical outcomes between IS and DS. A systematic literature review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty studies comprising 3136 patients were included (DS: 1944; IS: 1192). No differences were identified in terms of estimated blood loss (mean difference [MD]: 5.79, 95% …

Publication Productivity Among International Medical Graduates And U.S. Medical Graduates In Neurosurgery: A Comparative Assessment Using The Arms Race Control Score, Joanna M. Roy, Omar M. M. Mansoor, Samit Sen, Aaron C. Segura, Rithvik Naga Ganti, Basel Musmar, Gilberto Perez Rodriguez Garcia, Brett Henshey, Saarang Patel, Sruthi Ranganathan, Victor Gabriel El-Hajj, Stavropoula I. Tjoumakaris, M. Reid Gooch, Robert H. Rosenwasswer, Christian Bowers, Pascal Jabbour

Department of Neurosurgery Faculty Papers

BACKGROUND AND OBJECTIVES: The Arms Race Control Score (ARCS) was developed to provide a quantitative assessment of publications among residency applicants. International medical graduates (IMGs) often have higher numbers of publications compared to U.S medical graduates (US MDs). However, there is limited knowledge of publication quality and effort among IMGs and US MDs. Our study analyzes publication productivity among IMGs and US MDs using the ARCS.

METHODS: Applicants were selected from ACGME-accredited training programs that enrolled both IMG and US MD residents over the 2018-2024 match cycle. Programs without IMG residents in a given year were excluded from the analysis. …

Pharmacodynamics, Efficacy, And Safety Of Intraputaminal Eladocagene Exuparvovec Administered To Pediatric Patients With Aromatic L-Amino Acid Decarboxylase Deficiency Using An Mr-Compatible Cannula: 48 Weeks Of Follow-Up, Daniel J Curry, Phillip L Pearl, Scellig S D Stone, Donald L Gilbert, Sudhakar Vadivelu, Bruria Ben-Zeev, Matthew Vestal, Muhammad Zafar, Chun-Hwei Tai, Sheng-Che Chou, Zion Zibly, Lior Ungar, Mered Parnes, Mariam Hull, Lisa Emrick, Christian Werner, Alexis Krolick, Vinay Penematsa, Antonia Wang, Rezwanur Rahman, Lee Golden, Yin-Hsiu Chien, Paul Wuh-Liang Hwu

Faculty, Staff and Students Publications

Aromatic ʟ‐amino acid decarboxylase (AADC) deficiency is a rare pediatric neurotransmitter disorder that typically necessitates lifelong care, and that carries a risk of childhood mortality. Eladocagene exuparvovec gene therapy is designed to restore AADC production. Study GT‐002 (NCT04903288) is a phase 2, multicenter, open‐label trial assessing the pharmacodynamics, safety, and efficacy of eladocagene exuparvovec administered to the putamen bilaterally in pediatric patients with AADC deficiency using a magnetic resonance (MR)‐compatible cannula. Patients received eladocagene exuparvovec at 1.8 × 1011 vector genomes via the SmartFlow MR‐compatible cannula in a single operative session. Endpoints include the change from baseline in …

Clinical Outcomes Following Stereotactic Mri-Guided Laser Ablation In Children With Tuberous Sclerosis Complex And Intractable Epilepsy, Chelsey Ortman, Rohini Coorg, Irfan Ali, Dave Clarke, Gloria Diaz-Medina, Kimberly Houck, Akshat Katyayan, Laura Masters, Deepankar Mohanty, Anuranjita Nayak, Michael Quach, Vijay M Ravindra, James J Riviello, Sonali Sen, Elaine Seto, Danielle Takacs, Cristina Trandafir, John T Freiling, Karen Evankovich, Yingchao Yuan, Kalman A Katlowitz, Daniel Curry, Howard L Weiner, Anne Anderson

Faculty, Staff and Students Publications

Objective: In children with tuberous sclerosis complex (TSC) and drug-resistant epilepsy (DRE), magnetic resonance imaging-guided stereotactic laser ablation (SLA) therapy offers less-invasive treatment compared to craniotomy and resection. Our study seeks to further expand on the long-term outcomes in patients with TSC-related DRE who have undergone SLA.

Methods: Patients with TSC and DRE treated with SLA, between July 1, 2016 and January 1, 2022, at our institution were identified retrospectively. Reduction in number of anti-seizure medications (ASMs), developmental improvement as reported by the patients' families, seizure frequency measured in surgically targeted seizure type and total seizures per day, and Engel …

Merritt-Putnam Symposium | Tumor-Associated Epilepsy And Epilepsy-Associated Tumors: Exploring The Bidirectional Crosstalk Between Tumors And Seizures, Tracy A Bedrosian, Michael Wong, Erin L Heinzen, Benjamin Deneen, Catherine A Christian-Hinman

Faculty, Staff and Students Publications

Links between cancerous and noncancerous brain tumors and epilepsy have long been recognized. However, recent clinical and preclinical studies emphasize that not only do tumors impinge on surrounding brain tissue in ways that promote hyperexcitability and epileptogenesis, but that neural activity also influences tumor progression. In this review, inspired by the Merritt-Putnam Symposium of the 2025 meeting of the American Epilepsy Society, we present a cross-disciplinary dialog between cancer and epilepsy research, including discussion of tumors and epilepsies that are more prominent in pediatric versus adult populations. First, we discuss the neuropathology, genetics, and surgical outcomes of epileptogenic brain tumors, …

Imaging In Acute Neurovascular Emergencies: Optimizing Outcomes In Large Vessel Occlusion Stroke, Chandu Goli, Rohit Patel, Elliott Beard, Anna Liles, Saeed Saleh, Aleeza Namit, Alissa Ongaco, Kevin Steed Ph.D.

Annual Research Symposium

Purpose:

Large vessel occlusion (LVO) stroke is associated with high rates of morbidity and mortality, and patient outcomes are strongly influenced by rapid identification and timely reperfusion. Advances in acute neurovascular imaging have transformed stroke care by enabling precise patient selection, extending treatment windows, and accelerating clinical workflows. The purpose of this project is to evaluate how modern neurovascular imaging strategies influence treatment selection, workflow efficiency, and clinical outcomes in patients with acute LVO stroke.

Methods:

A narrative review of peer-reviewed literature published within the past decade was conducted. The review focused on CT-based imaging (non-contrast CT, CT angiography, CT …

Spatiotemporal Histogenesis Of The Developing Human Cerebellum Reveals Dynamic Layering Of Bergmann Glia, Guanyi He, Simon Du, Henry Tan, Sri Yellampally, Anders W Erickson, Virginia Fernandez, Ferechte Encha-Razavi, Kimberley A Phillips, Christine Haberler, Nicole Amberg, Victor Borrell, Paul A Northcott, Michael D Taylor, Kathleen J Millen, Parthiv Haldipur

Faculty, Staff and Students Publications

Bergmann glia (BG) are a specialized glial population essential for cerebellar development, yet their developmental timeline and molecular identity in the human cerebellum remain poorly understood. Here, we combined detailed histopathological analysis with spatial transcriptomics and single-nucleus RNA sequencing to generate a developmental atlas of human cerebellar BG. Histology revealed that BG emerge around 11 post-conception weeks (PCW), initially serving as a scaffold for Purkinje cells (PCs) migrating into the PC layer of the cerebellar cortex. Following the establishment of a multilayered PC arrangement, BG form a distinct parallel layer separated from the PCs by the lamina dissecans (LD), with …

Author Correction: Intracranial Directed Connectivity Links Subregions Of The Prefrontal Cortex To Major Depression, John Myers, Jiayang Xiao, Raissa K Mathura, Ben Shofty, Victoria Gates, Joshua Adkinson, Anusha B Allawala, Adrish Anand, Ron Gadot, Ricardo Najera, Hernan G Rey, Sanjay J Mathew, Kelly Bijanki, Garrett Banks, Andrew Watrous, Eleonora Bartoli, Sarah R Heilbronner, Nicole Provenza, Wayne K Goodman, Nader Pouratian, Benjamin Y Hayden, Sameer A Sheth

Faculty, Staff and Students Publications

No abstract provided.

Safety Of Carotid Endarterectomy In The Elderly And Octogenarian Population: A Nationwide Study Including 80,000 Patients, Victor Gabriel El-Hajj, Joanna Roy, Basel Musmar, Wi Jin Kim, Michael Rizzuto, Nathaniel Ellens, Rabab Alshahrani, Victor Staartjes, Adrian Elmi-Terander, Ramachandra Tummala, Stavropoula Tjoumakaris, Michael Gooch, Robert Rosenwasswer, Ziad Khabbaz, Pascal Jabbour

Department of Neurosurgery Faculty Papers

INTRODUCTION: Carotid endarterectomy (CEA) is an established procedure for stroke prevention in patients with carotid artery stenosis. While CEA is considered safe in younger patients, perioperative risks in octogenarians remain debated, with current guidelines classifying the procedure as "high-risk" in this patient population. This study aimed to evaluate short-term outcomes of CEA across age groups and to assess whether comorbidity burden better predicts outcomes than chronological age.

METHODS: The ACS-NSQIP database (2013-2020), was used to identify patients eligible for inclusion. The cohort was stratified based on age <  60, 60-80, and > 80 years. Propensity score matching and multivariable logistic regression were used to compare …

Fractionated Radiotherapy Adjuvant To Surgery Of Who-2 Meningioma With And Without Gross Total Resection: A Multicenter, Retrospective Cohort Study Of 1,452 Patients, Christian Mirian, Lasse Rehné Jensen, Adam Gorm Hoffmann, Tareq A Juratli, Andrea Daniela Maier, Pernilla Lindner, Anders Broechner, Sverre H Torp, Helen A Shih, Ramin A Morshed, Jacob S Young, Stephen T Magill, Walter Stummer, Dorothee Cäcilia Spille, Benjamin Brokinkel, Martin Proescholdt, Yasuhiro Kuroi, Konstantinos Gousias, Matthias Simon, Ricardo Prat-Acin, Stéphane Goutagny, Johannes Wach, Erdem Güresir, Junkoh Yamamoto, Young Zoon Kim, Joo Ho Lee, Daniel W Kim, Matthew Koshy, Donald M Cannon, Dennis C Shrieve, Chang-Ok Suh, Jong Hee Chang, Maria Kamenova, Sven Straumann, Jehuda Soleman, Ilker Y Eyüpoglu, Tony Catalan, Austin Lui, Philip V Theodosopoulos, Michael W Mcdermott, Pedro Góes, Fang Wang, Luis Souhami, Marie-Christine Guiot, Tamás Csonka, Toshiki Endo, Tejpal Gupta, Akash J Patel, Tiemo J Klisch, Jun Won Kim, Francesco Maiuri, Valeria Barresi, María Dolores Tabernero, Simon Skyrman, Mechthild Krause, Ian Law, Bjarne Winther Kristensen, Tina Nørgaard Munch, Torstein Meling, Kåre Fugleholm, Paul Blanche, Tiit Mathiesen

Faculty, Staff and Students Publications

Purpose

The role of adjuvant fractionated radiotherapy (aFRT) after gross total resection (GTR) of WHO-2 meningiomas remains unclear. We aimed to estimate the effect of aFRT on recurrence risk and survival following GTR and subtotal resection (STR).

Methods

We analyzed 1452 patients with WHO-2 from our international, multicenter database (followed between 1989 and 2019). Outcomes were recurrence (10-year follow-up) and death (5-year follow-up). Risk estimates were obtained using competing risks and survival analysis. Average treatment effects were estimated by G-computation, adjusted for potential confounding by age, sex, Simpson grade, Ki-67 proliferation index, location, country group (universal healthcare or not), …

Interrelationship Between Body Mass Index, Venous Sinus Pressures, Craniospinal Elastance, And Intracranial Pressure In Idiopathic Intracranial Hypertension, Rachel Wang, Ba, Bs, Scott W. Keith, Phd, Pascal M. Jabbour, Md, Stavropoula I. Tjoumakaris, Md, Michael J. Marmura, Md, Michael R. Gooch, Md, Hsiangkuo Yuan, Md, Phd

Alpha Omega Alpha Research Symposium Posters

Purpose: To investigate the interrelationship between body mass index (BMI), venous sinus pressure (VSP), and craniospinal elastance in determining lumbar puncture opening pressure (LP OP) in idiopathic intracranial hypertension (IIH).

Methods: A single-center retrospective chart review was conducted to identify patients who received venous manometry (8/2021-11/2025) followed by LP within 7 days before stenting. VSPs were measured at standardized locations, including the torcula (TP) and sigmoid/jugular (SIJ) sinuses. Elastance was calculated as (OP – closing pressure)/volume of CSF removed. Statistical analysis (JASP 0.19.3) was performed using generalized linear model (Gaussian identity; scaled center) to assess relationships between LP OP, BMI, …

Deep Brain Stimulation Response Circuits In Obsessive-Compulsive Disorder, Andreas Horn, Ningfei Li, Garance M Meyer, Ron Gadot, Nicole R Provenza, Sameer A Sheth

Faculty, Staff and Students Publications

In the field of deep brain stimulation (DBS), two major themes are currently making significant progress. First, the framework of connectomic DBS, in which circuits that are associated with improvements of specific symptoms are described and targeted to improve and potentially personalize treatment. Second, the concept of brain sensing and adaptive DBS, which aims at identifying neural biomarkers that may guide stimulation in a closed-loop fashion.

In DBS for Obsessive Compulsive Disorder (OCD), substantial progress has been made on both ends, over the last five years. Together, results begin to draw a picture of exactly which circuit is …

Integrated Transcriptomic Landscape Of Medulloblastoma And Ependymoma Reveals Novel Tumor Subtype-Specific Biology, Sonali Arora, Nicholas Nuechterlein, Matt Jensen, Gregory Glatzer, Philipp Sievers, Srinidhi Varadharajan, Andrey Korshunov, Felix Sahm, Stephen C Mack, Michael D Taylor, Taranjit S Gujral, Eric C Holland

Faculty, Staff and Students Publications

Background: Medulloblastoma and ependymoma are common pediatric central nervous system tumors with significant molecular and clinical heterogeneity. While molecular subgrouping has enabled classification into molecular subtypes, the extent of heterogeneity within these subgroups remains poorly defined.

Methods: We collected bulk RNA sequencing data from 888 medulloblastoma and 370 ependymoma tumors to establish a comprehensive reference landscape. After rigorous batch effect correction, normalization, and dimensionality reduction, we generated a unified landscape to explore gene expression, signaling pathways, RNA fusions, and copy number variations.

Results: Our transcriptional analysis revealed distinct clustering patterns, including two primary ependymoma compartments, EPN-E1 and EPN-E2, each with …

Can Tanzanian Neurosurgeons Access Tanzanian Neurosurgical Literature? A Systematic Review And Survey Of Neurosurgical Publications, Romani R. Sabas, Julie Woodfield, Chibuikem Anthony Ikwuegbuenyi, Magalie Cadieux, Consolata Shayo, Zarina Shabhay, Happiness Rabiel, Beverly Cheserem, Joel Bwemelo, Drew N. Wright

General Surgery, East Africa

Background and Objectives: Free and open access to research data and findings promotes equity in access to healthcare knowledge and equity in patient care and treatment. To benefit the health care of the population studied, research findings must be accessible to clinicians, academics, and policymakers serving those populations. The aim of this study was to assess the extent of published Tanzanian neurosurgical data and its accessibility to those practicing within the country.

Methods: A systematic review of all published neurosurgical studies from Tanzania was conducted. Authorship, funding, and open-access status were recorded. Tanzanian neurosurgeons were surveyed by telephone or in …

Rethinking The Centrality Of Brain Areas In Understanding Functional Organization, Benjamin Yost Hayden, Sarah R Heilbronner, Seng Bum Michael Yoo

Faculty, Staff and Students Publications

Parcellation of the cerebral cortex into functionally modular brain areas is foundational to cognitive and systems neuroscience. Here, we question the central status of brain areas from the perspectives of neuroanatomy and electrophysiology. We argue that the major ostensible determinants of brain function, such as cytoarchitecture and connectivity, seldom produce convergent parcellations. Brain areas themselves are just one of several equally important organizing principles; others include macroscale gradients, distributed networks, layers, columns and patches. We further argue that the evidence for a close correspondence between areal parcellation and cognitive function is weaker than is generally supposed. Indeed, many important cognitive …

What Needs To Be Standardized For Reliable, Reproducible, And Robust Tractography?, Jon Haitz Legarreta, Simona Schiavi, Wei Tang, Garrett Banks, Matthew Cieslak, Kurt Schilling, Alberto De Luca, Jacques-Donald Tournier, John Kruper, Francois Rheault, Stamatios N Sotiropoulos, Franco Pestilli, Jelle Veraart, Joseph Yuan-Mou Yang, Maxime Descoteaux, Sarah Heilbronner, Ariel Rokem

Faculty, Staff and Students Publications

Tractography is a key component of efforts to map brain connectivity. As a rapidly evolving field of neuroscience, current tractography methods are diverse, often varying across research laboratories and different software pipelines. Therefore, it suffers from a lack of standardization, leading to inconsistencies in results, which can limit reproducibility and affect the robustness needed for research and clinical applications of these methods. Variability in data acquisition procedures, inconsistencies in spatial referencing schemes and implementations, and anatomical heterogeneity-at the individual level, across the lifespan, and across species-hinder comparative analyses. Additionally, the lack of consensus on best practices complicates the development of …

Teriparatide Use In Osteopenic Patients Undergoing Single-Level Lumbar Fusion Associated With Decreased 2-Year Revision Rates, Mitchell K. Ng, Ariel N. Rodriguez, Abigail Razi, Ahmed K. Emara, Brian T. Ford, Ameer Tabbaa, Divya Gouni, Jacquelyn J. Xu, Paul G. Mastrokostas, Jad Bou Monsef, Afshin E. Razi

Rothman Institute Papers

Context:  Low bone density is common among lumbar fusion patients and increases the risks of pseudarthrosis, hardware failure, and revision. Teriparatide improves bone mass and fusion in osteoporosis, but its benefit in osteopenia or normal bone remains uncertain.

Aims:  To evaluate the association between teriparatide exposure and (1) postoperative complications, (2) 90-day readmission, and (3) 2-year reoperation, stratified by bone health status (osteoporotic, osteopenic, and normal) in patients undergoing single-level lumbar fusion.

Setting and Design:  A retrospective cohort study using the PearlDiver database from 2010 to 2021 identified patients undergoing single-level lumbar fusion.

Subjects and Methods:  Patients on teriparatide were …

Safety And Effectiveness Of Bolt-Mounted Versus Tunnelled External Ventricular Drains: A Systematic Review, Meta-Analysis And Trial-Sequential Analysis, Shaan Patel, Shiva A. Nischal, Ayush Sinha, Kush Kale, Pious D. Patel, Jack Jallo, Srinivas K. Prasad

Department of Neurosurgery Faculty Papers

BACKGROUND: External ventricular drains (EVDs) are fundamental to neurocritical care, yet substantial procedural heterogeneity persists, particularly regarding bolt-mounted versus tunnelled catheter fixation. The relative safety and effectiveness of these approaches remain unclear, with conflicting data from observational studies and a lack of trial-level evidence.

OBJECTIVE: To compare bolt-mounted and tunnelled EVDs across accuracy, reoperation, and key safety outcomes using systematic review, meta-analysis, and trial-sequential analysis.

METHODS: Following PRISMA guidelines, PubMed, Embase, and CENTRAL databases were searched (November 2025) for randomised or observational studies comparing bolt-mounted with tunnelled EVDs in adults. Two reviewers independently screened studies, extracted data, and assessed risk …

Does Adding An Interbody Cage In L4–L5 Posterolateral Fusion For Degenerative Spondylolisthesis And Stenosis Improve Clinical Outcome?, Enrico Aimar, Lucrezia Di Stefano, Federico Longhitano, Alberto Bona, Marco Meloni, Tommaso Alfiero, Federica Valente, Roberta Bonomo, Giulio Bonomo, Flavio Tancioni, Guglielmo Iess

Department of Neurosurgery Faculty Papers

INTRODUCTION: As the population ages, L4-L5 degenerative spondylolisthesis is increasingly common. Posterolateral fusion was long standard; interbody cages are widely used for perceived higher fusion rates.

RESEARCH QUESTION: Does adding an interbody cage to posterolateral fusion improve outcomes or reduce complications in elderly patients with grade I spondylolisthesis and severe stenosis?

MATERIALS AND METHODS: We retrospectively studied 319 adults aged 60-85 who underwent single-level L4-L5 fusion (2011-2018) after failed conservative care. Patients received posterior lumbar fusion (PLIF, n = 155) or posterolateral lumbar fusion (PLF, n = 164). Primary outcomes were Oswestry Disability Index (ODI) change and complications over a …

Turnover Time In Neuroangiography Suites: Comparison Between Cases Performed At An Ambulatory Neurosurgery Center Versus A Tertiary Hospital, Pui Man Rosalind Lai, Vinay Jaikumar, Erika L. Leasher, Varun Sridhar, Gustavo M. Cortez, Aimee C. Degaetano, Elad I. Levy

EVMS School of Health Professions Faculty Publications

Background:

Efficient turnover time (TOT) and adherence to first-start time (FST) in operating and angiography suites are critical for optimizing workflow, reducing costs, and maximizing patient satisfaction. Hospitals face challenges in maintaining these metrics due to operational constraints and unexpected emergent cases. Our goal was to compare TOT, FST, and total admission time for elective cases performed in angiography suites at an ambulatory neurosurgery center (ANSC) versus a tertiary hospital (TH).

Methods:

We conducted a retrospective analysis of data for patients who underwent elective diagnostic or interventional neuroendovascular procedures at the TH or ANSC from January 2024 through October 2024. …

Autologous Peripheral Nerve Tissue Grafts Implanted Into The Nucleus Basalis Of Meynert And Substantia Nigra At The Time Of Bilateral Deep Brain Stimulation In Parkinson Disease: A Report Of 2 Cases, Samuel R. Daly, Jorge E. Quintero, Lisa M. Koehl, Elizabeth Roslyn Wallace, Zain Guduru, Julie A. Gurwell, Tripp Hines, Jaimie Hixson, Saad Hulou, John T. Slevin, Frederick A. Schmitt, Greg A. Gerhardt, Craig G. Van Horne

Neurosurgery Faculty Publications

Background and Objectives: Cholinergic degeneration in the nucleus basalis of Meynert (NBM) is implicated in the cognitive impairment seen in Parkinson disease (PD) and is being examined as a potential therapeutic target. We have previously shown the safety of delivering investigational autologous cell-based therapy, ie, peripheral nerve tissue (PNT), to the substantia nigra (SN) at the time of deep brain stimulation (DBS) surgery in PD (DBS-Plus). In this study, we assessed the safety and feasibility of simultaneously delivering that PNT to both the NBM and SN at the time of DBS.

Methods: Two patients with idiopathic PD and mild cognitive …

Advancing Cns Tumor Management: Novel Modalities In Surgery, Radiation, And Chemotherapy, Armin David Tavakkoli

Dartmouth College Ph.D Dissertations

Most tumors affecting the brain and spine are managed through a combination of surgical resection, radiation, and chemotherapy; however, operative morbidity from invasive surgery, the narrow therapeutic window of conventional radiotherapy, and poor blood-brain barrier penetration of systemic agents are critical barriers that hinder long term tumor control. This thesis presents three complementary strategies to advance brain and spine tumor therapy. First, we investigate laser interstitial thermal therapy (LITT) in the treatment of spinal tumors with metastatic epidural spinal cord compression, replacing “separation surgery” with a minimally invasive, image-guided approach that maximizes tumor ablation while preserving neurologic function. Second, we …

Association Between Perioperative Patient-Reported Outcomes And Upper Extremity Functional Performance In Degenerative Cervical Myelopathy, Harshit Arora, Hassan Darabi, Vishwajeet Singh, Aysha Alsahlawi, Jared T. Wilcox, Francis Farhadi

Neurosurgery Faculty Publications

Background: Degenerative cervical myelopathy (DCM) is caused by chronic compression of the cervical spinal cord. Individuals usually present with a combination of upper extremity dysfunction, imbalance, and bladder dysfunction, which impact overall quality of life. Various questionnaires like mJOA, Nurick, NDI, and DCM-72 have been used for disease stratification. Our study aims to evaluate the clinical correlation between self-reported measures and objective upper extremity assessments and to derive the minimal clinically important difference (MCID) for individuals with DCM.

Methods: A prospective two-center study of consecutive patients diagnosed with DCM was undertaken. A comprehensive assessment of upper extremity functioning including dexterity, …

A Narrative Review Of Bertolotti's Syndrome: Etiology, Classification, Diagnosis, And Treatment, Matyas Abel Tsegaye, Andrea Muffly

Rehabilitation Sciences Faculty Publications

Bertolotti's syndrome is a congenital condition characterized by chronic low back pain stemming from a lumbosacral transitional vertebra (LSTV). Because the condition is frequently overlooked, patients often face years of delayed diagnosis before the true source of their pain is identified. Furthermore, current information regarding the biological origins and clinical management of the condition remain scattered. To address this knowledge gap, this narrative review aims to provide a comprehensive overview of Bertolotti’s syndrome by consolidating these disparate sources and suggesting new connections. We synthesize the latest understanding of this condition, ranging from its genetic origins to modern clinical management. We …

Frontline Aspiration Versus Stent Retriever Thrombectomy For M2 Occlusions: Insights From The Star Registry, Michael Gaub, Rahim Abo Kasem, Ilko Maier, Ansaar Rai, Pascal Jabbour, Joon-Tae Kim, Brian Howard, Ali Alawieh, Stacey Quintero Wolfe, Robert M Starke, Marios-Nikos Psychogios, Amir Shaban, Nitin Goyal, Justin Dye, Ali Alaraj, Mohamad Ezzeldin, Shinichi Yoshimura, David Fiorella, Omar Tanweer, Daniele G Romano, Pedro Navia, Hugo Cuellar, Isabel Fragata, Adam Polifka, Joshua Osbun, Fazeel Siddiqui, Mark Moss, Kaustubh Limaye, Maxim Mokin, Charles Matouk, Min S Park, Waleed Brinjikji, Ergun Daglioglu, Richard Williamson, David J Altschul, Christopher S Ogilvy, Roberto Crosa, Michael R Levitt, Benjamin Gory, Alexandra Paul, Peter Kan, Walter Casagrande, Shakeel Chowdhry, Michael F Stiefel, Ramesh Grandhi, Alejandro Spiotta, Justin Mascitelli

Faculty, Staff and Students Publications

Background: Recent trials have furthered uncertainty regarding the endovascular benefit for medium vessel occlusions (MeVO). Stent retrievers (SR) were employed in the first attempt in most interventional arm participants. We sought to compare outcomes in acute MCA M2 occlusions between frontline aspiration and SR, and to delineate procedural and anatomical covariates associated with differential treatment effect.

Methods: Retrospective analysis of a multicenter stroke thrombectomy cohort identified cases of MT for M2 occlusions. Unmatched and propensity score-matched (PSM) cohorts were generated comparing frontline aspiration to standalone and combined SR. The primary outcome was functional independence (mRS 0-2) at 90 days. Recanalization, …