Functional cortical mapping and structural subcortical anatomy predicts intra-operative speech arrest: a nTMS-tractography study.

Objective: Cortical speech mapping using navigated Transcranial Magnetic Stimulation (nTMS) has a variable positive predictive value (PPV) when compared with intraoperative direct electrical stimulation.

Methods: This is a single centre prospective study of all patients undergoing pre-operative nTMS and tractography (frontal aslant tract (FAT) and arcuate fasciculus (AF)) for awake surgery between October 2018 and November 2023. We reviewed operative notes for speech arrest, collected data on demographics, histopathology and pre-/post-operative language assessment.

Anatomo-functional approach to multimodal motor mapping in diffuse glioma surgery: hierarchical networks.

Onco-functional balance during motor-eloquent diffuse glioma resection is challenging. This balance is personal according to individual background, treatment expectations and surgical experience. Nevertheless, preservation of muscle contraction in isolation is no longer an accepted outcome.

Neuroplasticity in glioblastoma: there is more to plasticity than just low grade glioma.

Neuroplasticity is well established in low grade glioma patients. Less is known about functional plasticity in glioblastomas. A 56-year-old lady presented with a recurrent speech deficit seventeen months after her initial craniotomy for a language eloquent glioblastoma (GBM).

Asymmetry of the Frontal Aslant Tract and Development of Supplementary Motor Area Syndrome.

The purpose of this study was to investigate preoperative interhemispheric differences of the FAT in relation to the onset of postoperative SMA syndrome. This was a single-center retrospective analysis of patients who underwent surgical resection of diffuse gliomas involving the SMA between 2018 and 2022. Inclusion criteria were availability of preoperative and postoperative Magnetic Resonance Imaging, no previous surgery, and no neurological deficits at presentation.

Ultra-early navigated transcranial magnetic stimulation for perioperative stroke: anatomo-functional report.

Navigated repetitive transmagnetic stimulation is a non-invasive and safe brain activity modulation technique. When combined with the classical rehabilitation process in stroke patients it has the potential to enhance the overall neurologic recovery. We present a case of a peri-operative stroke, treated with ultra-early low frequency navigated repetitive transmagnetic stimulation over the contralesional hemisphere.

Nonenhancing motor eloquent gliomas: navigated transcranial magnetic stimulation oncobiological signature.

Objective: Preoperative grading of nonenhancing motor eloquent gliomas is hampered by a lack of specific imaging surrogates. Tumor grading is crucial for the informed consent discussion before tumor resection. In this paper, the authors hypothesized that navigated transcranial magnetic stimulation (nTMS)-derived metrics could provide significant information to distinguish between high- and low-grade motor eloquent gliomas that present as nonenhancing tumors and therefore contribute to improving patient counseling, timing of treatment, preoperative planning, and intraoperative strategies.

Awake minimally invasive parafascicular approach to a language eloquent brain tumour-surgical video.

Deep-seated brain tumours are surgically challenging to access. When planning approaches to these lesions, it is important to take into account eloquent cortical areas, grey matter nuclei, and subcortical white matter tracts. Traditionally, access to deep-seated lesions would require brain retraction; however, this is associated with secondary brain damage, which may impair neurological function.

Severe vitamin C deficiency associated with continuous renal replacement therapy: A case report.

Hypovitaminosis C is prevalent in critically ill patients. Continuous renal replacement therapy (CRRT) clears vitamin C, increasing the risk for vitamin C deficiency. However, recommendations for vitamin C supplementation in critically ill patients receiving CRRT vary widely, from 250 mg/day to 12 g/day.

Delivering bad or difficult news. An innovative simulation-based education approach to prepare interdisciplinary fellowships.

Background: There is limited data on the effectiveness of training interventions to improve the delivery of bad news.

Methods: This preliminary research included pre-post assessments and an open-ended survey to evaluate the effectiveness and perceived value of training on delivering bad news for 26 first- and second-year fellows from five adult and pediatric fellowship programs.

Results: There was a significant increase in faculty assessment scores (34.

H3 G34-mutant high-grade gliomas: integrated clinical, imaging and pathological characterisation of a single-centre case series.

Background: Diffuse hemispheric glioma, H3 G34-mutant, is a novel paediatric tumour type in the fifth edition of the WHO classification of CNS tumours associated with an invariably poor outcome. We present a comprehensive clinical, imaging and pathological review of this entity.

Methods: Patients with confirmed H3 G34R-mutant high-grade glioma were included in a single-centre retrospective cohort study and examined for clinical, radiological and histo-molecular data.

Therapeutic Strategies and Challenges in the Management of Craniospinal Tumors in Pregnancy: A Ten-Year Retrospective Tertiary-Center Study, Systematic Review, and Proposal of Treatment Algorithms.

Objective: This study aims to review therapeutic strategies in the management of craniospinal tumors in pregnant patients and the factors that may influence the management along with their influence on maternal and fetal outcomes.

Methods: A retrospective single-center cohort study was performed at a tertiary neurosurgical referral center. Pregnant patients referred to the neuro-oncology multidisciplinary meeting (MDM) with craniospinal tumor were included.

Incidence and management of pneumothorax, pneumomediastinum, and subcutaneous emphysema in COVID-19.

Objective: The coronavirus disease 2019 (COVID-19) pandemic reached New York City in March 2020, leading to a state of emergency that affected many lives. Patients who contracted the disease presented with different phenotypes. Multiple reports have described the findings of computed tomography scans of these patients, several with pneumothoraces, pneumomediastinum, and subcutaneous emphysema.

Minimally invasive approach to a deep-seated motor eloquent brain tumour: a technical note.

Deep-seated brain tumours represent a unique neurosurgical challenge as they are often surrounded by eloquent structures. We describe a minimally invasive technique using tubular retractors and intraoperative neurophysiology monitoring for open biopsy of a deep-seated lesion surrounded by the corticospinal tract. We used preoperative functional mapping with diffusion tensor imaging tractography and navigated transcranial magnetic stimulation to identify a safe surgical corridor.

Intraoperative Sneezing Secondary to Indirect Olfactory Nerve Stimulation.

Sneezing is a poorly understood, protective reflex response. It's characterized by the following sequence: eye closure, inspiration, glottic closure, forced expiration with sudden glottic opening, and release of an elevated intrathoracic pressure creating a flow of explosive air through the nose. Studies have indicated an anatomic sneezing area of the brainstem corresponding to the central recipient zone of the nasal sensory neurons in the lateral medulla.

Intraoperative ultrasound to aid resection of a peritorcular meningioma: a technical note.

Surgery for meningiomas involving dural venous sinuses is challenging. We describe a case of a peritorcular meningioma involving major venous sinuses, which was removed using a venous sparing approach with the aid of intraoperative ultrasound. We found ultrasound to be a useful adjunct as it enabled us to get real-time information about the location of venous structures, their function and demonstrate dynamic changes in blood flow during surgery.

Percutaneous and Open Tracheostomy in Patients With COVID-19: The Weill Cornell Experience in New York City.

Objective: Report long-term tracheostomy outcomes in patients with COVID-19.

Study Design: Review of prospectively collected data.

Methods: Prospectively collected data were extracted for adults with COVID-19 undergoing percutaneous or open tracheostomy between April 4, 2020 and June 2, 2020 at a major medical center in New York City.

Implementation of Simulation Training During the COVID-19 Pandemic: A New York Hospital Experience.

Simulation played a critical role in our institution's response to the COVID-19 pandemic in New York City. With the rapid influx of critically ill patients, resource limitations, and presented safety concerns, simulation became a vital tool that provided solutions to the many challenges we faced. In this article, we describe how simulation training was deployed at our institution throughout the course of the pandemic, which included the period of our medical surge.

Percutaneous and Open Tracheostomy in Patients with COVID-19: Comparison and Outcomes of an Institutional Series in New York City.

Objective: The aim of this study was to report the safety, efficacy, and early results of tracheostomy in patients with COVID-19 and determine whether differences exist between percutaneous and open methods.

Summary Background Data: Prolonged respiratory failure is common in symptomatic patients with COVID-19, the disease process caused by infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Tracheostomy, although posing potential risk to the operative team and other healthcare workers, may be beneficial for safe weaning of sedation and ventilator support.