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BACKGROUND: Intracerebral hemorrhage (ICH) is a potentially devastating condition with elevated early mortality rates, poor functional outcomes, and high costs of care. Standard of care involves intensive supportive therapy to prevent secondary injury. To date, there is no randomized control study demonstrating benefit of early evacuation of supratentorial ICH. METHODS: The Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH) Trial was designed to evaluate the minimally invasive trans-sulcal parafascicular surgery (MIPS) approach, a technique for safe access to deep brain structures and ICH removal using the BrainPath® and Myriad® devices (NICO Corporation, Indianapolis, IN). ENRICH is a multi-centered, two-arm, randomized, adaptive comparative-effectiveness study, where patients are block randomized by ICH location and Glasgow Coma Score (GCS) to early ICH evacuation using MIPS plus standard guideline-based management vs. standard management alone to determine if MIPS results in improved outcomes defined by the utility-weighted modified Rankin score (UWmRS) at 180 days as the primary endpoint. Secondary endpoints include clinical and economic outcomes of MIPS using cost per quality-adjusted life years (QALYs). The inclusion and exclusion criteria aim to capture a broad group of patients with high risk of significant morbidity and mortality to determine optimal treatment strategy. DISCUSSION: ENRICH will result in improved understanding of the benefit of MIPS for both lobar and deep ICH affecting the basal ganglia. The ongoing study will lead to Level-I evidence to guide clinicians treatment options in the management of acute treatment of ICH. TRIAL REGISTRATION: This study is registered with clinicaltrials.gov (Identifier: NCT02880878).

In this paper, we show that incentives to convert temporary contracts into permanent ones might be less effective when the employment protection legislation associated with temporary contracts is lax. Drawing upon rich administrative data and using a difference-in-differences methodology, we estimate that workers at their first work experience hired on more flexible contracts undergo a reduction in the conversion rate to permanent employment of 6.3 percentage points after the implementation of the incentives (and of 3.2 percentage points over a year), compared to peers hired on more rigid contracts. This reduced conversion rate, which results in a 17% wage penalty even 2 years into their professional journey, points to a significant negative impact of flexible temporary jobs on the future prospects of young workers. [ABSTRACT FROM AUTHOR]

This paper examines the causal effect of a traumatic event experienced by pregnant women on the life-long labor market outcomes of their offspring. We exploit a unique natural experiment that involved randomly placed Nazi raids in municipalities in Italy during WWII. We link administrative data on male private sector workers to information about Nazi raids and war casualties. Our results suggest that prenatal exposure to traumatic events affects offspring earnings throughout the working career and in retirement. The lower earnings are due to lower educational attainment, the type of jobs held, and interruptions in working careers due to unemployment. We further find that prenatal exposure exacerbates the adverse effects of later-life job loss on earnings. We use a medical database on health expenditures to interpret the effect estimates. The prenatally exposed have higher medical expenditures on diseases of the nervous system and mental disorders, indicating that stress is likely to be an important factor driving our findings. [ABSTRACT FROM AUTHOR]

This article discusses spheno-orbital meningiomas (SOM), a type of brain tumor that affects the sphenoid bone and can cause symptoms such as proptosis, visual impairment, diplopia, and headaches. The study aims to identify correlations between the extent of tumor resection and the risk of recurrence, specifically focusing on the bony tumor portion (BTP) and the soft tumor portion (STP). The results suggest that the extent of resection of the STP may reduce the recurrence rate of SOM, while the same may not be true for the BTP. The authors recommend a patient-based surgical strategy that prioritizes safe maximal resection of the STP while preserving neurological functions. [Extracted from the article]

This article discusses the trends in surgical management and postoperative complications of olfactory neuroblastoma (ONB), a rare sinonasal malignancy. The study conducted a retrospective review of 47 patients diagnosed with ONB between 1995 and 2022. The findings show a decline in the use of transcranial surgery for ONB resection, with an increasing preference for endoscopic endonasal approaches (EEA). The implementation of EEA was associated with a reduced rate of postoperative complications. However, the study notes that longer follow-up durations are needed to accurately assess disease-free survival. [Extracted from the article]

This article, titled "Management of Adenoid Cystic Carcinoma with Trigeminal Nerve Invasion," explores the clinical presentation, management, and outcomes of adenoid cystic carcinoma (ACC) with involvement of the trigeminal nerve (CN V). The study conducted a systematic review of the literature and included 36 articles out of 1,480. The results showed that the mandibular nerve and its branches were most frequently involved, and management options included surgery alone, radiotherapy alone, or a combination of both. The timing of diagnosis and the specific branch of CN V involved were found to impact the prognosis, and the authors recommend using combined surgery and radiotherapy for improved outcomes. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores predictors of resistance to dopamine agonist (DA) therapy in patients with prolactinomas. Prolactinomas are the most common type of pituitary adenomas and can cause hormonal imbalances. The study conducted a retrospective review of medical records and found that 24% of patients did not respond to DA therapy. However, the analysis did not identify any specific patient characteristics, hormonal levels, or radiological findings that correlated with DA therapy failure. The study suggests that patients with large or cystic prolactinomas or elevated prolactin levels may still be considered for DA therapy. Further research is needed to identify molecular predictors of DA response. [Extracted from the article]

This article compares two surgical approaches, the supraorbital (SO) and superior eyelid transorbital endoscopic (SL-TOE) approaches, for lesions in the opticocarotid cistern. The study used anatomical dissections on cadaveric heads and measured the area of exposure (AoE), surgical freedom (SF), and angle of attack (AoA) for each approach. The results showed that while the AoE was similar for both approaches, the SO approach provided greater surgical maneuverability based on SF and AoA measurements. Surgeons should consider these factors when choosing between the two approaches for lesions in the opticocarotid cistern. [Extracted from the article]

This article discusses a new surgical approach called the biportal endoscopic transorbital and transmaxillary transsphenoidal (bpTONES-EATT) approach, which aims to address lesions in the spheno-orbital and middle cranial fossa regions. The study conducted ex vivo experiments using cadaveric specimens and radiological records to assess the feasibility of this approach compared to the traditional uniportal EATT approach. The results showed that the biportal approach provided adequate exposure of the targeted regions while minimizing tissue injury and morbidity. However, further clinical studies are needed to validate its safety and efficacy. [Extracted from the article]