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Objective To determine the in-hospital cost implications of an endoscopic expanded endonasal approach (EEEA) for meningioma resection relative to the open transcranial approach.Methods All anterior skull base meningioma surgeries performed over a period from January 1st, 2015 to October 31th, 2017 were evaluated. The electronic medical record was reviewed for patient factors, tumor characteristics, and cost variables associated with each hospital stay and univariate analysis was performed using R software. All cost data were converted into August 2021-equivalent dollar amounts using the United States Bureau of Labor Statistics consumer price index.Results Thirty-five patients met study criteria, including 27 patients undergoing an open transcranial approach and 8 undergoing an EEEA. Average length of stay for patients undergoing an open approach was 9.3 days compared to 5.6 within the EEEA group (P= .126). The average total in-hospital cost of patient undergoing an EEEA was $35417.1 compared to $46406.9 among patients undergoing an open transcranial approach (P= .168). On univariate analysis, the cost of an open transcranial approach relative to the EEEA was $10989.8 (P= .411).Conclusions The open transcranial approach remained the dominant surgical approach to anterior skull base meningiomas over our study time period. However, despite limited patient numbers the EEEA was associated with decreased total in-hospital costs.

We argue that the study of single-cell subcellular organelle omics is needed to understand and regulate cell function. This requires and is being enabled by new technology development.

Graphical Abstract

A number of mitochondrial diseases arise from single-nucleotide variant (SNV) accumulation in multiple mitochondria. Here, we present a method for identification of variants present at the single-mitochondrion level in individual mouse and human neuronal cells, allowing for extremely high-resolution study of mitochondrial mutation dynamics. We identified extensive heteroplasmy between individual mitochondrion, along with three high-confidence variants in mouse and one in human that were present in multiple mitochondria across cells. The pattern of variation revealed by single-mitochondrion data shows surprisingly pervasive levels of heteroplasmy in inbred mice. Distribution of SNV loci suggests inheritance of variants across generations, resulting in Poisson jackpot lines with large SNV load. Comparison of human and mouse variants suggests that the two species might employ distinct modes of somatic segregation. Single-mitochondrion resolution revealed mitochondria mutational dynamics that we hypothesize to affect risk probabilities for mutations reaching disease thresholds.

Cranioplasty following craniectomy for trauma is a common, safe neurosurgical procedure that restores the natural cosmesis and protective barrier of the skull and may be instrumental in normalizing cerebrospinal fluid dynamics after decompressive surgery. Understanding the factors influencing patient selection and timing of cranioplasty, the available materials and methods of skull reconstruction, and the technical nuances is critical for a successful outcome. Neurosurgeons must be prepared to manage the complications specific to this operation. This article reviews the indications, preoperative assessment and timing, most commonly used materials, operative technique, postoperative care, and complication management for cranioplasty.

Background:Patients with an external ventricular drain (EVD) may not be readily mobilized because of concerns of catheter dislodgment and/or inappropriate cerebrospinal fluid drainage. Delayed mobilization may result in longer hospital stays and an increased risk for complications related to immobility. We aimed to determine the safety, feasibility, and outcome of an EVD mobilization protocol in patients with subarachnoid hemorrhage (SAH). Methods:A multidisciplinary group developed a formal algorithm for the mobilization of patients with SAH with EVDs. Outcome measures included intensive care unit (ICU) length of stay (LOS), day to first mobilization, and discharge disposition. Patients were prospectively enrolled during a 12-month period and compared with a historical control group of patients with SAH for the preceding 12-month period. Results:Thirty-nine of 45 (86.7%) patients were women. Mean age did not differ significantly between the preintervention (n = 19) and postintervention (n = 26) groups (59.6 vs 55.7). Number of EVD device days did not differ significantly between groups (16.3 vs 15, P= .422]. Of 101 attempted postintervention mobilization sessions, six were aborted for increased lethargy (1), pain (1), elevated intracranial pressure (1), drain malfunction (1), and hypotension (2). Twenty-four sessions were attempted but never initiated because of worsening neurologic examination (10), pulmonary instability (2), hemodynamic instability (2), medical instability (3), and provider request (1). No patient experienced catheter dislodgment. Mean ICU LOS was not different between groups (20.7 vs 18.2, P= .262). The day of first mobilization was significantly earlier in the postintervention group (18.7 vs 6.5, P< .0001). The percentage of patients discharged home or to acute rehabilitation was higher in the postintervention group (63.2% vs 88.5%, P= .018], when accounting for Hunt and Hess grade. Conclusions:The mobilization of patients with EVDs is safe and feasible; it may be associated with earlier mobilization, reduced ICU LOS, and better discharge disposition. No major complications were attributable to early mobilization.

Investigation of human CNS disease and drug effects has been hampered by the lack of a system that enables single-cell analysis of live adult patient brain cells. We developed a culturing system, based on a papain-aided procedure, for resected adult human brain tissue removed during neurosurgery. We performed single-cell transcriptomics on over 300 cells, permitting identification of oligodendrocytes, microglia, neurons, endothelial cells, and astrocytes after 3 weeks in culture. Using deep sequencing, we detected over 12,000 expressed genes, including hundreds of cell-type-enriched mRNAs, lncRNAs and pri-miRNAs. We describe cell-type- and patient-specific transcriptional hierarchies. Single-cell transcriptomics on cultured live adult patient derived cells is a prime example of the promise of personalized precision medicine. Because these cells derive from subjects ranging in age into their sixties, this system permits human aging studies previously possible only in rodent systems.

In the setting of recurrent infection and multiple failed reconstruction attempts, the choice of the ideal reconstructive material for salvage cranioplasty remains a source of controversy in the literature. The purpose of this study is to establish the safety and utility of antibiotic-impregnated polymethyl methacrylate (PMMA) for salvage cranioplasty.

OBJECTIVE To determine the correspondence of in vivo quantitative estimates of brain uptake of fluorine 18–labeled flutemetamol with immunohistochemical estimates of amyloid levels in patients who underwent previous biopsy. DESIGN Cross-sectional study of 18F-flutemetamol positron emission tomography (PET) findings in patients with prior cortical biopsy specimen stained for the presence or absence of amyloid plaques. SETTING University hospital. PATIENTS Seven patients who previously had a prior right frontal cortical biopsy at the site of ventriculoperitoneal placement for presumed normal pressure hydrocephalus were recruited. Inclusion criteria included an adequate biopsy specimen for detection and quantification of β-amyloid pathology and age older than 50 years. INTERVENTION All patients underwent an 18F-flutemetamol PET scan. MAIN OUTCOME MEASURES Quantitative measures of 18F-flutemetamol uptake (standardized uptake value ratio, a ratio of mean target cortex activity divided by that in a cerebellar reference region) were made at a location contralateral to the biopsy site and compared with estimates of amyloid load based on immunohistochemical and histological staining. RESULTS There was complete agreement between visual reads of 18F-flutemetamol PET scans (3 blinded readers with majority rule) and histology. A regression model, including time from biopsy as a covariate, demonstrated a significant relationship (P = .01) between 18F-flutemetamol uptake and percentage of area of amyloid measured by a monoclonal antibody raised against amyloid (NAB228). Similar results were found with the amyloid-specific monoclonal antibody 4G8 and Thioflavin S. CONCLUSION To our knowledge, these data are the first to demonstrate the concordance of 18F-flutemetamol PET imaging with histopathology, supporting its sensitivity to detect amyloid and potential use in the study and detection of Alzheimer disease.

Abstract—We present laboratory mid‐infrared absorption spectra (2.5 urn to 16.0 μm) of powdered calcium‐aluminum‐rich inclusions (CAIs) and matrix separated from the carbonaceous chondrites Allende (CV3.2), Vigarano (CV3.3), and Ornans (C03.3). Two groups of spectra with different features were found for the CAI: in the first group spectra are dominated by spinel, pyroxene, and sodalite ± nepheline, where main features occur at 9.3 μm, 10.3 μm, and 11.3 μm. In the second group, characteristic minerals are spinel and melilite with typical band maxima at 11.0 μm and 12.3 μm, and a broad feature between 14.0 μn and 15.0 μn. The position of the broad spinel feature probably depends on its iron content.

Traumatic brain injury is a leading cause of death and disability in the United States. Pathological examinations of humans and animal models after brain injury demonstrate hippocampal neuronal damage, which may contribute to cognitive impairments. Data from our laboratories have shown that, at 1 week after brain injury, mice possess significantly fewer neurons in all ipsilateral hippocampal subregions and a cognitive impairment. Since cognitive function is distributed across both cerebral hemispheres, the present paper explores the morphological and physiological response of the contralateral hippocampus to lateral brain injury. We analyzed the contralateral hippocampus using design-based stereology, Fluoro-Jade (FJ) histochemistry, and extracellular field recordings in mice at 7 and 30 days after lateral fluid percussion injury (FPI). At 7 days, all contralateral hippocampal subregions possess significantly fewer healthy neurons compared to sham-injured animals and demonstrate FJ-positive neuronal damage, but not at 30 days. Both the ipsilateral and contralateral dentate gyri demonstrate significantly increased excitability at 7 days post-injury, but only ipsilateral dentate gyrus hyperexcitability persists at 30 days compared to sham. In the contralateral hippocampus, the transient decrease in the number of healthy neurons, concomitant with FJ damage, and electrophysiological alterations establish a stunned period of cellular and circuit dysfunction. The return of healthy neuron number, absence of FJ damage, and sham level of excitability in the contralateral hippocampus suggest recovery of structure and function by 30 days after injury. The cognitive recovery observed after human traumatic brain injury may stem from a differential injury exposure and time course of recovery between homologous regions of the two hemispheres.

Traumatic brain injury (TBI) damages the hippocampus both in experimental animal models and in humans. In particular, the mechanical injury in combination with the genetic susceptibility to injury may result in neuronal loss from the hippocampus. This report explores the time-course of neuronal loss in the four primary subregions of the mouse hippocampus after a lateral fluid percussion injury (FPI) to the brain, and how subtle genetic differences between C57BL/6J and C57BL/10J mouse strains influence the extent and time course of neuronal loss. Using design-based stereological procedures, our results indicate negligible neuronal loss ipsilateral to the injury at 2 days postinjury in C57BL/6J mice, whereas a significant number (30–40%) of neurons are lost across all subregions of the hippocampus (dentate, hilus, area CA3, and area CA1) by 1 week, which does not appear to progress at 1 month, compared to sham. Additionally, neuronal counts after lateral FPI in a genetically similar, yet kainic acid–sensitive, mouse strain (C57BL/10J) showed no statistically significant differences in neuron number compared to the C57BL/6J strain in response to brain injury. Hippocampal neuronal loss after lateral FPI and its consequent circuit disruption may depend more on factors related to the mechanics and secondary consequences of the injury, as opposed to subtle genetic variations between inbred mouse strains. The loss of neurons appears to be restricted to the first week post-injury, and the remaining neurons may serve as a substrate for recovery.