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Introduction The middle fossa craniotomy (MFCs) is commonly utilized for spontaneous cerebrospinal fluid (CSF) leaks, encephaloceles, and superior semicircular canal dehiscence (SSCD). This study compares postoperative outcomes of MFCs with and without LD use. Methods A retrospective cohort study of adults over the age of 18 years presenting for the repair of nonneoplastic CSF leak, encephalocele, or SSCD via MFC from 2009 to 2021 was conducted. The main exposure of interest was the placement of an LD. The primary outcome was the presence of postoperative complications (acute/delayed neurologic deficit, meningitis, intracranial hemorrhage, and stroke). Secondary outcomes included operating room (OR) time, length of stay, recurrence, and need for reoperation. Results In total, 172 patients were included, 96 of whom received an LD and 76 who did not. Patients not receiving an LD were more likely to receive intraoperative mannitol (n = 24, 31.6% vs. n = 16, 16.7%, p = 0.02). On univariate logistic regression, LD placement did not influence overall postoperative complications (OR: 0.38, 95% confidence interval [CI]: 0.05–2.02, p = 0.28), CSF leak recurrence (OR: 0.75, 95% CI: 0.25–2.29, p = 0.61), or need for reoperation (OR: 1.47, 95% CI: 0.48–4.96, p = 0.51). While OR time was shorter for patients not receiving LD (349 ± 71 vs. 372 ± 85 minutes), this difference was not statistically significant (p = 0.07). Conclusion No difference in postoperative outcomes was observed in patients who had an intraoperative LD placed compared to those without LD. Operative times were increased in the LD cohort, but this difference was not statistically significant. Given the similar outcomes, we conclude that LD is not necessary to facilitate safe MCF for nonneoplastic skull base pathologies. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Neurological Surgery, explores the genetic underpinnings of vestibular schwannoma (VS), a type of brain tumor. The study conducted a transcriptome-wide association study (TWAS) using genetic models of gene expression to identify gene-level associations with VS. The researchers identified 63 novel genes with genetically-determined expression associations with VS, including DNPH1, which has been previously associated with tinnitus. These findings provide new insights into the biological mechanisms associated with VS and may lead to the development of targeted therapies for this condition. [Extracted from the article]

This article explores the management of trigeminal schwannomas, which are benign tumors that can develop along the trigeminal nerve. The study analyzes 49 cases of trigeminal schwannomas at a large academic medical center, examining patient demographics, tumor characteristics, treatment strategies, and associated complications. The findings reveal that management approaches varied, with some patients undergoing observation, microsurgery, or radiation therapy. The study suggests that subtotal resection may be a valuable strategy for managing large, growing, and symptomatic tumors, but it carries a higher risk of requiring additional intervention. [Extracted from the article]