The Top 100 Most Cited Journal Articles on Hydrocephalus.

Hydrocephalus represents a significant burden of disease, with more than 383,000 new cases annually worldwide. When the magnitude of this condition is considered, a centralized archive of pertinent literature is of great clinical value. From a neurosurgical standpoint, hydrocephalus is one of the most frequently treated conditions in the field. The focus of this study was to identify the top 100 journal articles specific to hydrocephalus using bibliometric analysis. Using the Journal of Citation Report database, 10 journals were identified. The Web of Science Core Collection was then searched using each journal name and the search term "hydrocephalus." The results were ordered by "Times Cited" and searched by the number of citations. The database contained journal articles from 1976 to 2021, and the following variables were collected for analysis: journal, article type, year of publication, and the number of citations. Journal articles were excluded if they had no relation to hydrocephalus, mostly involved basic science research, or included animal studies. Ten journals were identified using the above criteria, and a catalog of the 100 most cited publications in the hydrocephalus literature was created. Articles were arranged from highest to lowest citation number, with further classification by journal, article type, and publication year. Of the 100 articles referenced, 38 were review articles, 24 were original articles, 15 were comparative studies, 11 were clinical trials, six were multi-center studies, three were cross-sectional, and three were case reports with reviews. Articles were also sorted by study type and further stratified by etiology. If the etiology was not specified, studies were instead subcategorized by treatment type. Etiologies such as aqueductal stenosis, tumors, and other obstructive causes of hydrocephalus were classified as obstructive (n=6). Communicating (n=15) included idiopathic, normal pressure hydrocephalus, and other non-obstructive etiologies. The category "other" (n=3) was assigned to studies that included etiologies, populations, and/or treatments that did not fit into the classifications previously outlined. Through our analysis of highly cited journal articles focusing on different etiologies and the surgical or medical management of hydrocephalus, we hope to elucidate important trends. By establishing the 100 most cited hydrocephalus articles, we contribute one source, stratified for efficient referencing, to facilitate clinical care and future research on hydrocephalus.

Bihemispheric posterior inferior cerebellar artery in a cadaver with Chiari I malformation.

Typically, patients with Chiari I malformations (CM I) do not have other intracranial anatomical variations, especially vascular derailments. Here, we report the findings of a cadaveric specimen found to have CM I and cerebellar tonsils supplied by a single posterior inferior cerebellar artery (PICA) i.e., a bihemispheric PICA. An adult male cadaver was found to have CM I. It was also noted that the left PICA descended inferiorly to the level of C1 and that there was absence of the right PICA. The territory of the right PICA was supplied by the left PICA. The tonsillar component of the left PICA gave rise to a branch that crossed to the right inferior cerebellum and herniated cerebellar tonsil. A bihemispheric PICA is very rare. To our knowledge, this is the first report of this vascular variation in combination with CM I. Such a variation should be kept in mind, especially during posterior fossa decompression for symptomatic CM I as unilateral PICA injury could have catastrophic results.

Anatomical study of the internal carotid venous plexus: new findings with application to skull base surgery.

OBJECTIVE: The venous plexus (internal carotid venous plexus) surrounding the petrous part of the internal carotid artery (ICAp) is said to be one drainage pathway of the cavernous sinus. These veins have many potential clinical implications including iatrogenic hemorrhage during surgical approaches to the skull base and carotid-cavernous fistulas. Because there are few morphological data about this venous plexus at the skull base, this descriptive/quantitative study was performed to elucidate its anatomy. METHODS: Six latex-injected cadaveric heads (twelve sides) were dissected via a superior craniotomy approach in which the ICAp was exposed by drilling away the overlying bone. A venous plexus surrounding parts of the ICAp in all sides was documented along with the positions of its major tributaries and their connections. RESULTS: The veins were most concentrated near the junction of the ICAp and the cavernous part of the internal carotid artery, and usually along the medial and lateral sides of the ICAp. Tributaries included branches joining the basilar venous plexus posteriorly and branches joining the veins surrounding the foramen ovale anteriorly. CONCLUSION: Detailed knowledge of the anatomy of this venous plexus surrounding the ICAp is useful for interpreting imaging of the skull base and valuable for surgeons operating in this part of the cranium.

Detethering the superficial temporal artery: Application to tension free superficial temporal artery-middle cerebral artery bypasses.

Extracranial-intracranial bypass has been shown to be effective in the surgical treatment of moyamoya disease, complex aneurysms, and tumors that involve proximal vasculature in carefully selected patients. Branches of the superficial temporal artery (STA) are used commonly for the bypass surgery; however, an appropriate length of the donor vessel must be harvested to avoid failure secondary to anastomotic tension. The goal of this cadaveric study was to investigate quantitatively operative techniques that can increase the STA length available to facilitate tension-free STA-middle cerebral artery (MCA) bypass. We conducted a cadaveric study using a total of 16 sides in eight cadavers. Measurements of the STA trunk with its frontal branch (STAfb) were taken before and after skeletonization and detethering of the STA with the STAfb and mobilization of the parietal branch of the STA. A final measurement of the STA with the STAfb was taken for the free length gained toward visible proximal cortical branches of the MCA. Paired student's t-tests were used to compare the mean length before and after mobilization and unpaired t-tests to analyze according to laterality. The mean length of the STA with the STAfb was 9.0 cm prior to modification. After skeletonization and mobilization, the mean lengths increased significantly to 10.5 and 11.3 cm, respectively (p < 0.05). Especially in the cases that had the coiled and tortuous STA, skeletonization was considerably effective to increase the length of the STA with the STAfb. After simulating a bypass by bringing the STAfb to the recipient MCA site, the mean extended length of the STA with the STAfb was 3.0 cm. There were no statistically significant differences between sides in all measurements. We report a significant increase in the mean STA length available (3.0 cm) following skeletonization and mobilization. Clinical applications of the extended length of the STA with the STAfb may facilitate tension-free STA-MCA bypasses and improve outcomes. Further studies are needed in a clinical context.

An anatomical model for studying cerebellar tonsillar herniation related to raised intracranial pressure.

Brain herniation is one of the most feared complications of many neurological pathologies. However, current understanding of the mechanisms behind brain herniation syndromes is poor. By investigating the correlations between raised intracranial pressure (ICP) and herniation of the cerebellar tonsils, we hope to develop a model that can be used to study intracranial fluid dynamics and its effects on brain tissue. This will facilitate evaluation of patients with elevated ICP and development of novel treatments including surgical approaches for decompressing the posterior cranial fossa and upper cervical spine. A standard suboccipital surgical approach was used to expose the foramen magnum and observe movements of the cerebellar tonsils in fresh cadavers. A urinary Foley catheter balloon in the parietal extradural space was used to simulate a mass effect while ICP was monitored. The baseline anatomy differed widely among the cadaver specimens. However, and overall, we found that as ICP rises, the cerebellar tonsils descend through the foramen magnum at a rate of 0.3 mm per 1 mmHg increase in ICP. A mean descent of 6.2 mm was observed for a mean ICP increase of 17 mmHg. In this cadaveric study, we present a method and model for exploring brain herniation syndromes in the context of ICP changes. This could allow for further models to study the effects of other neuropathologies on the cerebellar tonsils, including posterior cranial fossa mass lesions and cerebellar hemorrhage.

Can anatomical feasibility studies drive neurosurgical procedures and reach patients faster than traditional translational research?

Often, surgical techniques are practiced and studied in the anatomy laboratory. Occasionally, new surgical methods are developed with cadaveric anatomical studies. Some cadaveric feasibility studies, if published, might go on to be used by surgeons from around the world for improved patient care. Herein, we review our experience with 37 published anatomical feasibility studies over an 18-year period (2002-2020) and analyze the literature for published examples of surgical application of these same anatomical studies. We found that, for cadaveric anatomical feasibility studies within 7 years of their publication date, approximately 22% will be used in neurosurgery with the clinical applications published. Of these studies awarded clinical citation within 7 years of publication, the median time to that citation was approximately 3.4 years. As the average time for translational research to reach patient care is 17 years, cadaveric anatomical studies in this series reached patient care much sooner than traditional translational research. Cadaveric anatomical studies, based on our experience, can drive neurosurgical procedures.

Novel Use of Nerve Branch to Sartorius as Donor for Intrapelvic Neurotization of the Sciatic Nerve and Its Contributions.

BACKGROUND: Sciatic nerve injuries are relatively infrequent but extremely disabling for the patient. As injury to this nerve is relatively infrequent, there is little about its repair in the literature, especially within the pelvis. METHODS: Twelve adult embalmed cadavers (24 sides) underwent exposure of the anteromedial thigh, inguinal region, and pelvic cavity. The sartorius muscle was identified in the anterior thigh, and its nerve branches from the femoral nerve were isolated and traced proximally to the femoral nerve trunk. The isolated sartorius nerve branches were further traced to the pelvic part of the femoral nerve. Next, the lumbosacral plexus was dissected on the posterior aspect of the pelvis so that its constituent parts were seen and followed distally to also visualize the most proximal part of the sciatic nerve. The previously dissected nerve branches to sartorius were then transposed to these constituent parts, and the ability for a tension-free anastomosis between these 2 nerves was evaluated. RESULTS: The branches ranged in diameter from 1.89 to 3.1 mm (2.88 mm). The average length of the nerves was 17.3 cm. Transposition of these branches to all ventral rami of the lumbosacral plexus in the pelvis and proximal sciatic (intrapelvic) nerve was possible on all cadaveric sides. CONCLUSIONS: Our cadaveric study found that nerve branches to the sartorius muscle can be transposed intrapelvically to the lumbosacral plexus and could provide tension-free anastomoses for neurotization procedures in patients with nerve injury.

Anatomical Study of the Posterior Spinal Artery Branches to the Medulla Oblongata.

BACKGROUND: The posterior spinal arteries (PSAs), branches of the intracranial segment of the vertebral artery or posterior inferior cerebellar artery, run bilaterally along the spinal cord and are integral to the blood supply primarily to the posterior one third of this structure. However, a less well-described distribution of the PSAs is their supply to the posterior medulla. The purpose of this study is to examine the medullary branches of the PSA anatomically. METHODS: We conducted a cadaveric study to evaluate for branches of the PSA supplying the medulla oblongata. RESULTS: All 14 sides had medullary branches arising from the PSAs. The average number of branches supplying the medulla oblongata on each side was 6. Most of these branches traveled laterally to anastomose with medullary branches arising from the anterior spinal artery. Additionally, lateral and ascending branches were noted. CONCLUSIONS: Physicians who interpret imaging of the craniocervical junction, in particular arteriograms, should be aware of ascending medullary branches arising from the anterior spinal artery. Additionally, neurosurgeons operating this region must be careful in dissecting over the posterior medulla and manipulating the cerebellar tonsils, as in telovelar approaches to the fourth ventricle, in order to avoid iatrogenic injury to these vessels. Additionally, variable stroke patterns involving the vertebral artery or posterior inferior cerebellar artery might include ischemia to the medulla oblongata via PSA branches, and this anatomy should be kept in mind by interventionalists, radiologists, and neurologists alike.

The Top 100 Most Cited Journal Articles in Pediatric Neurosurgery.

With the many papers published in the field of pediatric neurosurgery, it is often difficult to recognize those that have the most impact on future papers, i.e., citable papers. However, citation analysis allows one to better understand which papers are impacting the field the most. Therefore, the current study aimed to evaluate this literature. The Journal Citation Report database was searched for publications with the words "pediatric neurosurgery" or "pediatric neuro" in the title. Using the Web of Science Core Collection, the top 100 journal articles in pediatric neurosurgery from the selected journals were identified and citation analysis was used to identify the most impactful articles. A search was performed on Web of Science Core Collection by searching for each journal under "Publication Name" and using the Boolean "OR" function to separate fields. The results were ordered by the "Times Cited" category, which provided a list of all the articles from the eight journals appearing in the most cited order. The timeline used was from 1976 to 2021. The top 100 most cited articles were extracted from this list for analysis. The following variables were collected from each scientific article: publication journal, impact factor of journal, title, number of citations, year and month of publication, and type of article. Eight journals were identified on the basis of our search criteria and the articles were sorted by most cited; 1609 pediatric neurosurgery journal articles were screened to select the 100 most cited since 1976. This compilation could serve to help clinicians and researchers to familiarize themselves with the journal articles included in terms of study type, study field, journal of publication, and recurring authors.

The proximal humeral attachment of the lateral head of the triceps brachii: a cadaveric study and potential site for radial nerve compression.

BACKGROUND: Knowledge of potential compression sites of peripheral nerves is important to the clinician and surgeon alike. One anatomical location for potential compression of the radial nerve, which is rarely mentioned in the literature, is at the proximal humeral attachment of the lateral head of the triceps brachii at the level of the proximal spiral groove. As no anatomical studies have been devoted to this band, the present study was conducted. METHODS: Ten adult fresh-frozen cadavers were dissected and the lateral head's attachment onto the posterior humerus evaluated for a band. This anatomy and its relation to the radial nerve during range of motion of the elbow and forearm were evaluated. RESULTS: A band was found on 15 of 20 arms. On five sides, the band was comprised of grossly muscle fibers of the lateral head of the triceps brachii and was not tendinous. The bands were crescent-shaped, straight, and duplicated on nine, five, and one arm, respectively. The length of the bands ranged from 1.1 to 2.2 cm (mean 1.54 cm). The width of the bands ranged from 0.5 to 1.1 cm (mean 0.8 cm). With elbow extension and the forearm in neutral, all bands were lax. With elbow extension and the forearm supinated, the bands became tauter less the muscular bands. In elbow extension and with the forearm in supination, the bands became most taut less the muscular bands. CONCLUSIONS: The presence of a fibrous band extending from the lateral head of the triceps brachii is common and should be among the differential diagnoses of anatomical sites for potential proximal radial nerve compression when other more common locations are ruled out.