Linzey JR, Wilson TJ, Sullivan SE, Thompson BG, Pandey AS. Frontal Sinus Breach During Routine Frontal Craniotomy Significantly Increases Risk of Surgical Site Infection: 10-Year Retrospective Analysis. Neurosurgery. 2017;0(0):1-8. doi:10.1093/neuros/nyx046.
Frontotemporal craniotomies are at particular risk for breaching the frontal sinus, especially when the patient has a large frontal sinus or the surgeon is attempting to expose anterior communicating (ACOM) artery aneurysms. Frontal sinus breach (FSB) has the potential to cause postoperative complications due to the introduction of microflora from the frontal sinus into the sterile environment of the intracranial compartment.
In this retrospective study, the authors are attempting to determine if FSB is a risk factor for developing cranial surgical site infections in patients undergoing craniotomies for clip ligation of anterior circulation aneurysms. They hypothesized that the surgical site infection (SSI) rate for craniotomies with an FSB would be significantly higher than for craniotomies without an FSB, given the contamination of the intracranial compartment during FSB. This study included 862 patients undergoing 910 craniotomies. Primary outcome of interest was occurrence of a cranial surgical site infection. Of the 910 craniotomies, 141 (15.5%) involved FSB. Of those involving FSB, 22 (15.6%) developed a cranial surgical site infection, compared to only 56 of the 769 without FSB (7.3%). Cranial surgical site infection requiring reoperation was much more likely in patients with FSB compared to those without a breach (7.8% vs 1.6%). Patients with FSBs had 2 times the odds of developing a cranial surgical site infection as those without FSB. The authors overall infection rate of 8.6% for craniotomies is comparable with other published data. In addition, the length of surgical procedure was associated with increased risk of infection, which supports previously published data. As expected, longer procedures were also more common in patients with FSB compared to those …
Horn A, Reich M, Vorwerk J, et al. Connectivity Predicts deep brain stimulation outcome in Parkinson disease. Ann Neurol. 2017;82(1):67-78. doi:10.1002/ana.24974.
The benefit of deep brain stimulation (DBS) for Parkinson disease (PD) may depend on connectivity between the stimulation site and other brain regions, but which regions and whether connectivity can predict outcome in patients remain unknown. The authors attempted to identify the structural and functional connectivity profile of effective DBS to the subthalamic nucleus (STN) and test its ability to predict outcome.
The authors utilized a training dataset of 51 PD patients with subthalamic nucleus DBS which was combined with publicly available human connectome data (diffusion tractography and resting state functional connectivity) to identify connections reliably associated with clinical improvement (motor score of the Unified Parkinson Disease Rating Scale [UPDRS]). This connectivity profile was then used to predict outcome in an independent cohort of 44 patients. Resting state functional connectivity data was obtained on 1,000 healthy subjects using a 3T Siemens (Erlangen, Germany) MRI, part of the Brain Genomics Superstruct Project (https://dataverse.harvard.edu/dataverse/GSP). MRI data from 90 patients were obtained from the Parkinson’s Progression Markers Initiative (PPMI) database. Scanning parameters can be found on the project website (www.ppmi-info.orgz). In the training dataset, connectivity between the DBS electrode and a distributed network of brain regions correlated with clinical response including structural connectivity to supplementary motor area and functional anticorrelation to primary motor cortex. This same connectivity profile predicted response in an independent patient cohort.
The authors cite four main conclusions: 1) a specific pattern of structural and functional connectivity with subthalamic nucleus DBS electrodes correlates with clinical outcome across patients in PD. 2) structural and functional connectivity are independent predictors of DBS response. 3) connectivity profiles derived from one patient cohort can predict clinical outcome in …