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NEUROSURGERY BLOG
J Neurosurg 134:1703–1710, 2021. Language lateralization is a major concern in some patients with pharmacoresistant epilepsy who will face surgery; in these patients, hemispheric dominance testing is essential to avoid further complications.NEUROSURGERY BLOG
Neurosurgery 88:931–941, 2021. Spontaneous intracranial hypotension (SIH) is usually caused by a spinal cerebrospinal fluid (CSF) leak. CSF-venous fistula is an underdiagnosed cause of spinal CSF leak, as it is challenging to identify on myelography. ABOUT - NEUROSURGERY BLOG About. This is a space open to the neurosurgical community. Created on August 19, 2009, its mission is to collect useful information related to neurosurgery in one repository. Only scientifically relevant information will be posted.NEUROSURGERY BLOG
Neurosurgery 86:763–768, 2020. Degenerative cervical myelopathy (DCM) is a progressive disease resulting fromcervical cord compression. The modified JapaneseOrthopaedic Association (mJOA) is commonly used to grade myelopathic symptoms, but its persistent postoperative improvement has not been previously explored.NEUROSURGERY BLOG
J Neurosurg 125:24–32, 2016. Craniopharyngiomas are associated with a high rate of recurrence. The surgical management of recurrent lesions has been among the most challenging neurosurgical procedures because of the craniopharyngioma’s complex topographical relationship with surrounding structures.NEUROSURGERY BLOG
Neurosurgery, Volume 85, Issue 1, July 2019, Pages 75–83. Geometric factors of intracranial aneurysms and surrounding vasculature could affect the risk of aneurysm rupture. However, large-scale assessments of morphological parameters correlated with intracranial aneurysm rupture in a location-specific manner are scarce.NEUROSURGERY BLOG
Neurosurgery 81:129–134, 2017. Sagittal balance in adult spinal deformity is a major predictor of quality of life. A temporary loss of paraspinalmuscle force and somatic pain following spine surgery may limit a patient’s ability to maintain posture. NOTICE - NEUROSURGERY BLOG AANS Special Announcement. August 19, 2009 The AANS Announces New Policy for Abstract Submissions for its Annual Meeting The Scientific Program Committee (SPC) of the AANS wishes to alert you to a new change in policy for the submission of abstracts to the AANS Annual Meeting. All neurosurgeons and residents whose abstracts are accepted by Continue reading "Notice"NEUROSURGERY BLOG
Neurosurg Focus 43 (6):E5, 2017. The subtraction of lumbar lordosis (LL) from the pelvic incidence (PI) offers an estimate of the LL required for a given PI value.NEUROSURGERY BLOG
Neurosurgery 88:1103–1110, 2021 The modified Spetzler-Martin (SM) grading system proposes that grade III arteriovenous malformation (AVM) subtypes are associated with variable microsurgical risks, with small AVMs (III−) having lower risk and medium/eloquent AVMs (III+)having higher risk.
NEUROSURGERY BLOG
J Neurosurg 134:1703–1710, 2021. Language lateralization is a major concern in some patients with pharmacoresistant epilepsy who will face surgery; in these patients, hemispheric dominance testing is essential to avoid further complications.NEUROSURGERY BLOG
Neurosurgery 88:931–941, 2021. Spontaneous intracranial hypotension (SIH) is usually caused by a spinal cerebrospinal fluid (CSF) leak. CSF-venous fistula is an underdiagnosed cause of spinal CSF leak, as it is challenging to identify on myelography. ABOUT - NEUROSURGERY BLOG About. This is a space open to the neurosurgical community. Created on August 19, 2009, its mission is to collect useful information related to neurosurgery in one repository. Only scientifically relevant information will be posted.NEUROSURGERY BLOG
Neurosurgery 86:763–768, 2020. Degenerative cervical myelopathy (DCM) is a progressive disease resulting fromcervical cord compression. The modified JapaneseOrthopaedic Association (mJOA) is commonly used to grade myelopathic symptoms, but its persistent postoperative improvement has not been previously explored.NEUROSURGERY BLOG
J Neurosurg 125:24–32, 2016. Craniopharyngiomas are associated with a high rate of recurrence. The surgical management of recurrent lesions has been among the most challenging neurosurgical procedures because of the craniopharyngioma’s complex topographical relationship with surrounding structures.NEUROSURGERY BLOG
Neurosurgery, Volume 85, Issue 1, July 2019, Pages 75–83. Geometric factors of intracranial aneurysms and surrounding vasculature could affect the risk of aneurysm rupture. However, large-scale assessments of morphological parameters correlated with intracranial aneurysm rupture in a location-specific manner are scarce.NEUROSURGERY BLOG
Neurosurgery 81:129–134, 2017. Sagittal balance in adult spinal deformity is a major predictor of quality of life. A temporary loss of paraspinalmuscle force and somatic pain following spine surgery may limit a patient’s ability to maintain posture. NOTICE - NEUROSURGERY BLOG AANS Special Announcement. August 19, 2009 The AANS Announces New Policy for Abstract Submissions for its Annual Meeting The Scientific Program Committee (SPC) of the AANS wishes to alert you to a new change in policy for the submission of abstracts to the AANS Annual Meeting. All neurosurgeons and residents whose abstracts are accepted by Continue reading "Notice"NEUROSURGERY BLOG
Neurosurg Focus 43 (6):E5, 2017. The subtraction of lumbar lordosis (LL) from the pelvic incidence (PI) offers an estimate of the LL required for a given PI value.NEUROSURGERY BLOG
Neurosurgery 88:1103–1110, 2021 The modified Spetzler-Martin (SM) grading system proposes that grade III arteriovenous malformation (AVM) subtypes are associated with variable microsurgical risks, with small AVMs (III−) having lower risk and medium/eloquent AVMs (III+)having higher risk.
PSEUDARTHROSIS IN ANTERIOR CERVICAL DISCECTOMY AND FUSION J Neurosurg Spine 33:717–726, 2020 The goal of this study was to evaluate the incidence of pseudarthrosis after the treatment of cervical degenerative disc disease (CDDD) with anterior cervical discectomy and fusion (ACDF) in which self-locking, stand-alone intervertebral cages filled with hydroxyapatite were used. METHODS The authors performed a retrospective cohort study of 49 LONG-TERM RADIOGRAPHIC OUTCOMES OF EXPANDABLE VERSUS J Neurosurg Spine 34:471–480, 2021. Potential advantages of using expandable versus static cages during transforaminal lumbar interbody fusion (TLIF) are not fully established. CONGRESS OF NEUROLOGICAL SURGEONS SYSTEMATIC REVIEW AND Neurosurgery 88:437–442, 2021. Managing cancer pain once it is refractory to conventional treatment continues to challenge caregivers committed to serving those who are suffering from a USING SMARTPHONE-BASED ACCELEROMETER DATA TO OBJECTIVELY Mobile application, Outcome measurements, Spinal fusion Neurosurgery 88:763–772, 2021. In order to deliver optimal patient care, spine surgeons must integrate technological changes to arrive at novel measures of functional outcomes. SURGICAL TREATMENT OF MENINGIOMAS LOCATED IN THE ROLANDIC J Neurosurg 133:107–118, 2020 Surgical treatment of convexity meningiomas is usually considered a low-risk procedure. Nevertheless, the risk of postoperative motor deficits is higher (7.1%–24.7% of all cases) for lesions located in the rolandic region, especially when an arachnoidal cleavage plane with the motor pathway is not identifiable. The authors analyzed the possible role of CEREBROSPINAL FLUID-VENOUS FISTULAS: A SYSTEMATIC REVIEW Neurosurgery 88:931–941, 2021. Spontaneous intracranial hypotension (SIH) is usually caused by a spinal cerebrospinal fluid (CSF) leak. CSF-venous fistula is an underdiagnosed cause of spinal CSF leak, as it is challenging to identify on myelography. RADICAL RESECTION OF NONGERMINOMATOUS PINEAL REGION TUMORS Acta Neurochir (2014) 156:2253–2262 The role of radical resection for nongerminomatous pineal region tumors is still controversial. The purpose of this study was to present the surgical results in a large series and evaluate the feasibility of radical surgical strategy. Methods We retrospectively reviewed the records of 143 patients with nongerminomatous pineal region tumors surgically FENESTRATION OF THE LAMINA TERMINALIS DURING ANEURYSM J Neurosurg 119:629–633, 2013. Fenestration of the lamina terminalis (FLT) during aneurysm surgery for subarachnoid hemorrhage can, in theory, improve CSF circulation from the lateral and third ventricles to the cortical subarachnoid space, which may, in turn, decrease theincidence of
ASYMPTOMATIC SPINAL CORD COMPRESSION: IS SURGERY NECESSARY Neurosurgery 88:955–960, 2021. Advising athletes with asymptomatic cervical canal stenosis on their return to active play is a topic of considerable debate, with ACUTE HUMAN BRAIN RESPONSES TO INTRACORTICAL Front.Neuroeng. 7:24, 1-6. The emerging field of neuroprosthetics is focused on the development of new therapeutic interventions that will be able to restore some lost neural function by selective electrical stimulation or by harnessing activity recorded from populations ofneurons.
NEUROSURGERY BLOG
Neurosurgery 88:E445–E451, 2021. Use of a closed-incisional negative pressure therapy (ci-NPT) dressing is an emerging strategy to reduce surgical site infections (SSIs) inNEUROSURGERY BLOG
Neurosurgery 88:931–941, 2021. Spontaneous intracranial hypotension (SIH) is usually caused by a spinal cerebrospinal fluid (CSF) leak. CSF-venous fistula is an underdiagnosed cause of spinal CSF leak, as it is challenging to identify on myelography. ABOUT - NEUROSURGERY BLOG About. This is a space open to the neurosurgical community. Created on August 19, 2009, its mission is to collect useful information related to neurosurgery in one repository. Only scientifically relevant information will be posted.NEUROSURGERY BLOG
J Neurosurg 125:24–32, 2016. Craniopharyngiomas are associated with a high rate of recurrence. The surgical management of recurrent lesions has been among the most challenging neurosurgical procedures because of the craniopharyngioma’s complex topographical relationship with surrounding structures.NEUROSURGERY BLOG
Neurosurgery, Volume 85, Issue 1, July 2019, Pages 75–83. Geometric factors of intracranial aneurysms and surrounding vasculature could affect the risk of aneurysm rupture. However, large-scale assessments of morphological parameters correlated with intracranial aneurysm rupture in a location-specific manner are scarce.NEUROSURGERY BLOG
Acta Neurochir (2016) 158:1125–1128. Circumferential arthrodesis is commonly used to treat degenerative lumbar diseases. Minimally invasive techniques may enable faster recovery and reduce the incidence of postoperative infections. NOTICE - NEUROSURGERY BLOG AANS Special Announcement. August 19, 2009 The AANS Announces New Policy for Abstract Submissions for its Annual Meeting The Scientific Program Committee (SPC) of the AANS wishes to alert you to a new change in policy for the submission of abstracts to the AANS Annual Meeting. All neurosurgeons and residents whose abstracts are accepted by Continue reading "Notice"NEUROSURGERY BLOG
Acta Neurochir (2016) 158:677–683. A variety of methods are used for estimating pituitary tumour size in clinical practice and in research. Quantitative methods, such as maximum tumour dimension, and qualitative methods, such as Hardy and Knosp grades, are well established but do not give an accurate assessment of the tumourvolume.
WWW.NEUROSURGERY-BLOG.COM JFIF - , C ! ' "#%%% ),($+!$%$ C $ $$$$$ } !1A Qa "q 2 #B R $3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w !1 AQ aq "2 B #3R br$4 % &'()*56789
NEUROSURGERY BLOG
Neurosurgery 88:1103–1110, 2021 The modified Spetzler-Martin (SM) grading system proposes that grade III arteriovenous malformation (AVM) subtypes are associated with variable microsurgical risks, with small AVMs (III−) having lower risk and medium/eloquent AVMs (III+)having higher risk.
NEUROSURGERY BLOG
Neurosurgery 88:E445–E451, 2021. Use of a closed-incisional negative pressure therapy (ci-NPT) dressing is an emerging strategy to reduce surgical site infections (SSIs) inNEUROSURGERY BLOG
Neurosurgery 88:931–941, 2021. Spontaneous intracranial hypotension (SIH) is usually caused by a spinal cerebrospinal fluid (CSF) leak. CSF-venous fistula is an underdiagnosed cause of spinal CSF leak, as it is challenging to identify on myelography. ABOUT - NEUROSURGERY BLOG About. This is a space open to the neurosurgical community. Created on August 19, 2009, its mission is to collect useful information related to neurosurgery in one repository. Only scientifically relevant information will be posted.NEUROSURGERY BLOG
J Neurosurg 125:24–32, 2016. Craniopharyngiomas are associated with a high rate of recurrence. The surgical management of recurrent lesions has been among the most challenging neurosurgical procedures because of the craniopharyngioma’s complex topographical relationship with surrounding structures.NEUROSURGERY BLOG
Neurosurgery, Volume 85, Issue 1, July 2019, Pages 75–83. Geometric factors of intracranial aneurysms and surrounding vasculature could affect the risk of aneurysm rupture. However, large-scale assessments of morphological parameters correlated with intracranial aneurysm rupture in a location-specific manner are scarce.NEUROSURGERY BLOG
Acta Neurochir (2016) 158:1125–1128. Circumferential arthrodesis is commonly used to treat degenerative lumbar diseases. Minimally invasive techniques may enable faster recovery and reduce the incidence of postoperative infections. NOTICE - NEUROSURGERY BLOG AANS Special Announcement. August 19, 2009 The AANS Announces New Policy for Abstract Submissions for its Annual Meeting The Scientific Program Committee (SPC) of the AANS wishes to alert you to a new change in policy for the submission of abstracts to the AANS Annual Meeting. All neurosurgeons and residents whose abstracts are accepted by Continue reading "Notice"NEUROSURGERY BLOG
Acta Neurochir (2016) 158:677–683. A variety of methods are used for estimating pituitary tumour size in clinical practice and in research. Quantitative methods, such as maximum tumour dimension, and qualitative methods, such as Hardy and Knosp grades, are well established but do not give an accurate assessment of the tumourvolume.
WWW.NEUROSURGERY-BLOG.COM JFIF - , C ! ' "#%%% ),($+!$%$ C $ $$$$$ } !1A Qa "q 2 #B R $3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w !1 AQ aq "2 B #3R br$4 % &'()*56789
NEUROSURGERY BLOG
Neurosurgery 88:1103–1110, 2021 The modified Spetzler-Martin (SM) grading system proposes that grade III arteriovenous malformation (AVM) subtypes are associated with variable microsurgical risks, with small AVMs (III−) having lower risk and medium/eloquent AVMs (III+)having higher risk.
LASER ABLATION OF ABNORMAL NEUROLOGICAL TISSUE USING Neurosurgery 86:538–547, 2020 Stereotactic laser ablation (SLA) has demonstrated potential utility for a spectrum of difficult to treat neurosurgical pathologies in multiple small and/or retrospective single-institutional series. Here, we present the safety profile of SLA of intracranial lesions from the Laser Ablation of Abnormal Neurological Tissue using Robotic NeuroBlate System (LAANTERN PSEUDARTHROSIS IN ANTERIOR CERVICAL DISCECTOMY AND FUSION J Neurosurg Spine 33:717–726, 2020 The goal of this study was to evaluate the incidence of pseudarthrosis after the treatment of cervical degenerative disc disease (CDDD) with anterior cervical discectomy and fusion (ACDF) in which self-locking, stand-alone intervertebral cages filled with hydroxyapatite were used. METHODS The authors performed a retrospective cohort study of 49 LONG-TERM RADIOGRAPHIC OUTCOMES OF EXPANDABLE VERSUS J Neurosurg Spine 34:471–480, 2021. Potential advantages of using expandable versus static cages during transforaminal lumbar interbody fusion (TLIF) are not fully established.NEUROSURGERY BLOG
J Neurosurg 124:432–439, 2016. The drainage of the superficial middle cerebral vein (SMCV) has previously been classified into 4 subtypes. Extradural procedures and dural incisions during the anterior transpetrosal approach (ATPA) may interrupt the route of drainage from the SMCV. A NOVEL ROBOT-GUIDED MINIMALLY INVASIVE TECHNIQUE FOR J Neurosurg 132:150–158, 2020 As decisions regarding tumor diagnosis and subsequent treatment are increasingly based on molecular pathology, the frequency of brain biopsies is increasing. Robotic devices overcome limitations of frame-based and frameless techniques in terms of accuracy and usability. The aim of the present study was to present a novel, minimally invasive, robot-guided biopsy WWW.NEUROSURGERY-BLOG.COM JFIF - , C ! ' "#%%% ),($+!$%$ C $ $$$$$ } !1A Qa "q 2 #B R $3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w !1 AQ aq "2 B #3R br$4 % &'()*56789
THE NEW NEUROMETABOLIC CASCADE OF CONCUSSION Critical studies are underway to better link the acute pathobiology of concussion with potential mechanisms of chronic cell death, dysfunction, and neurodegeneration. This “new and improved” article summarizes in a translational fashion and updates what is known about the acute neurometabolic changes after concussive braininjury.
RADICAL RESECTION OF NONGERMINOMATOUS PINEAL REGION TUMORS Acta Neurochir (2014) 156:2253–2262 The role of radical resection for nongerminomatous pineal region tumors is still controversial. The purpose of this study was to present the surgical results in a large series and evaluate the feasibility of radical surgical strategy. Methods We retrospectively reviewed the records of 143 patients with nongerminomatous pineal region tumors surgically WWW.NEUROSURGERY-BLOG.COM JFIF ICC_PROFILE appl mntrRGB XYZ 3 acspAPPLAPPL -appl desc Pbdscm cprt 8#wtpt \ rXYZ p gXYZ bXYZ rTRC aarg vcgt 0ndin >chad H,mmod t(bTRC gTRC aabg aagg desc WWW.NEUROSURGERY-BLOG.COM JFIF , , XICC_PROFILE HLino mntrRGB XYZ 1acspMSFTIEC sRGB -HP cprt P3desc lwtpt bkpt rXYZ gXYZ , bXYZ @ dmnd Tpdmdd vued L view $lumi meas $tech 0 rTRC gTRC bTRCNEUROSURGERY BLOG
Neurosurgery 88:E445–E451, 2021. Use of a closed-incisional negative pressure therapy (ci-NPT) dressing is an emerging strategy to reduce surgical site infections (SSIs) inNEUROSURGERY BLOG
Neurosurgery 88:931–941, 2021. Spontaneous intracranial hypotension (SIH) is usually caused by a spinal cerebrospinal fluid (CSF) leak. CSF-venous fistula is an underdiagnosed cause of spinal CSF leak, as it is challenging to identify on myelography. ABOUT - NEUROSURGERY BLOG About. This is a space open to the neurosurgical community. Created on August 19, 2009, its mission is to collect useful information related to neurosurgery in one repository. Only scientifically relevant information will be posted.NEUROSURGERY BLOG
J Neurosurg 125:24–32, 2016. Craniopharyngiomas are associated with a high rate of recurrence. The surgical management of recurrent lesions has been among the most challenging neurosurgical procedures because of the craniopharyngioma’s complex topographical relationship with surrounding structures.NEUROSURGERY BLOG
Neurosurgery, Volume 85, Issue 1, July 2019, Pages 75–83. Geometric factors of intracranial aneurysms and surrounding vasculature could affect the risk of aneurysm rupture. However, large-scale assessments of morphological parameters correlated with intracranial aneurysm rupture in a location-specific manner are scarce. NOTICE - NEUROSURGERY BLOG AANS Special Announcement. August 19, 2009 The AANS Announces New Policy for Abstract Submissions for its Annual Meeting The Scientific Program Committee (SPC) of the AANS wishes to alert you to a new change in policy for the submission of abstracts to the AANS Annual Meeting. All neurosurgeons and residents whose abstracts are accepted by Continue reading "Notice" WWW.NEUROSURGERY-BLOG.COM JFIF - , C ! ' "#%%% ),($+!$%$ C $ $$$$$ } !1A Qa "q 2 #B R $3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w !1 AQ aq "2 B #3R br$4 % &'()*56789
WWW.NEUROSURGERY-BLOG.COM JFIF ICC_PROFILE appl mntrRGB XYZ 3 acspAPPLAPPL -appl desc Pbdscm cprt 8#wtpt \ rXYZ p gXYZ bXYZ rTRC aarg vcgt 0ndin >chad H,mmod t(bTRC gTRC aabg aagg desc WWW.NEUROSURGERY-BLOG.COMTRANSLATE THIS PAGE JFIF C ! ' "#%%% ),($+!$%$ } !1A Qa "q 2 #B R $3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyzNEUROSURGERY BLOG
Neurosurgery 88:1103–1110, 2021 The modified Spetzler-Martin (SM) grading system proposes that grade III arteriovenous malformation (AVM) subtypes are associated with variable microsurgical risks, with small AVMs (III−) having lower risk and medium/eloquent AVMs (III+)having higher risk.
NEUROSURGERY BLOG
Neurosurgery 88:E445–E451, 2021. Use of a closed-incisional negative pressure therapy (ci-NPT) dressing is an emerging strategy to reduce surgical site infections (SSIs) inNEUROSURGERY BLOG
Neurosurgery 88:931–941, 2021. Spontaneous intracranial hypotension (SIH) is usually caused by a spinal cerebrospinal fluid (CSF) leak. CSF-venous fistula is an underdiagnosed cause of spinal CSF leak, as it is challenging to identify on myelography. ABOUT - NEUROSURGERY BLOG About. This is a space open to the neurosurgical community. Created on August 19, 2009, its mission is to collect useful information related to neurosurgery in one repository. Only scientifically relevant information will be posted.NEUROSURGERY BLOG
J Neurosurg 125:24–32, 2016. Craniopharyngiomas are associated with a high rate of recurrence. The surgical management of recurrent lesions has been among the most challenging neurosurgical procedures because of the craniopharyngioma’s complex topographical relationship with surrounding structures.NEUROSURGERY BLOG
Neurosurgery, Volume 85, Issue 1, July 2019, Pages 75–83. Geometric factors of intracranial aneurysms and surrounding vasculature could affect the risk of aneurysm rupture. However, large-scale assessments of morphological parameters correlated with intracranial aneurysm rupture in a location-specific manner are scarce. NOTICE - NEUROSURGERY BLOG AANS Special Announcement. August 19, 2009 The AANS Announces New Policy for Abstract Submissions for its Annual Meeting The Scientific Program Committee (SPC) of the AANS wishes to alert you to a new change in policy for the submission of abstracts to the AANS Annual Meeting. All neurosurgeons and residents whose abstracts are accepted by Continue reading "Notice" WWW.NEUROSURGERY-BLOG.COM JFIF - , C ! ' "#%%% ),($+!$%$ C $ $$$$$ } !1A Qa "q 2 #B R $3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w !1 AQ aq "2 B #3R br$4 % &'()*56789
WWW.NEUROSURGERY-BLOG.COM JFIF ICC_PROFILE appl mntrRGB XYZ 3 acspAPPLAPPL -appl desc Pbdscm cprt 8#wtpt \ rXYZ p gXYZ bXYZ rTRC aarg vcgt 0ndin >chad H,mmod t(bTRC gTRC aabg aagg desc WWW.NEUROSURGERY-BLOG.COMTRANSLATE THIS PAGE JFIF C ! ' "#%%% ),($+!$%$ } !1A Qa "q 2 #B R $3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyzNEUROSURGERY BLOG
Neurosurgery 88:1103–1110, 2021 The modified Spetzler-Martin (SM) grading system proposes that grade III arteriovenous malformation (AVM) subtypes are associated with variable microsurgical risks, with small AVMs (III−) having lower risk and medium/eloquent AVMs (III+)having higher risk.
LASER ABLATION OF ABNORMAL NEUROLOGICAL TISSUE USING Neurosurgery 86:538–547, 2020 Stereotactic laser ablation (SLA) has demonstrated potential utility for a spectrum of difficult to treat neurosurgical pathologies in multiple small and/or retrospective single-institutional series. Here, we present the safety profile of SLA of intracranial lesions from the Laser Ablation of Abnormal Neurological Tissue using Robotic NeuroBlate System (LAANTERN VITAMIN D—A NEW PERSPECTIVE IN TREATMENT OF CEREBRAL Neurosurgery 88 (3) 2021: 674–685. Cerebral vasospasm (CVS) is a frequent complication after subarachnoid hemorrhage (SAH), with no sufficient therapy and a complex pathophysiology. CHIARI MALFORMATION AND SYRINGOMYELIA J Neurosurg Spine 31:619–628, 2019 Chiari malformation was first described over a century ago, and consists of posterior fossa anomalies that generally share the feature of cerebellar tonsillar descent through the foramen magnum. Our understanding of this disorder was initially based on autopsy studies, and has been greatly enhanced by the advent of MRI. The Continue reading "Chiari TEAR-DROP TECHNIQUE IN ILIAC SCREW PLACEMENT: A TECHNICAL Acta Neurochirurgica (2021) 163:1577–1581. Instrumentation of the lumbosacral region is one of the more challenging regions due to the complex anatomical structures and biomechanical forces. A NOVEL ROBOT-GUIDED MINIMALLY INVASIVE TECHNIQUE FOR J Neurosurg 132:150–158, 2020 As decisions regarding tumor diagnosis and subsequent treatment are increasingly based on molecular pathology, the frequency of brain biopsies is increasing. Robotic devices overcome limitations of frame-based and frameless techniques in terms of accuracy and usability. The aim of the present study was to present a novel, minimally invasive, robot-guided biopsy ACCESS TO MECKEL’S CAVE FOR BIOPSIES OF INDETERMINATE Neurosurgical Review (2021) 44:249–259 Accessing Meckel’s cave (MC) is surgically challenging. Open approaches are complex and often correlated with high morbidity. Endoscopic approaches emerged in the last decade as feasible alternatives to open approaches, especially for sampling indeterminate lesions. This article first analyses available routes to approach Meckel’s cave VENOUS AIR EMBOLISM IN THE SITTING POSITION IN CRANIAL Acta Neurochir (2017) 159:339–346 There is an ongoing debate about the sitting position (SP) in neurosurgical patients. The SP provides a number of advantages as well as severe complications such as commonly concerning venous air embolism (VAE). The best monitoring system for the detection of VAE is still controversial. Methods: In this retrospective analysis we Continue reading "Venous PROGNOSTIC NOMOGRAM FOR MICROVASCULAR DECOMPRESSION Neurosurgical Review (2021) 44:571–577. This study aimed to establish an effective prognostic nomogram for microvascular decompression (MVD)–treated trigeminal neuralgia (TN). THE NEW NEUROMETABOLIC CASCADE OF CONCUSSION Critical studies are underway to better link the acute pathobiology of concussion with potential mechanisms of chronic cell death, dysfunction, and neurodegeneration. This “new and improved” article summarizes in a translational fashion and updates what is known about the acute neurometabolic changes after concussive braininjury.
CAVERNOUS MALFORMATION OF BRAINSTEM, THALAMUS, AND BASAL Neurosurgery 72:573–589, 2013 Cavernous malformations (CMs) in deep locations account for 9% to 35% of brain malformations and are surgically challenging. OBJECTIVE: To study the clinical features and outcomes following surgery for deep CMs and the complication of hypertrophic olivary degeneration (HOD). METHODS: Clinical records, radiological findings, operative details, andNEUROSURGERY BLOG
Neurosurgery 88:E445–E451, 2021. Use of a closed-incisional negative pressure therapy (ci-NPT) dressing is an emerging strategy to reduce surgical site infections (SSIs) inNEUROSURGERY BLOG
Neurosurgery 88:931–941, 2021. Spontaneous intracranial hypotension (SIH) is usually caused by a spinal cerebrospinal fluid (CSF) leak. CSF-venous fistula is an underdiagnosed cause of spinal CSF leak, as it is challenging to identify on myelography. ABOUT - NEUROSURGERY BLOG About. This is a space open to the neurosurgical community. Created on August 19, 2009, its mission is to collect useful information related to neurosurgery in one repository. Only scientifically relevant information will be posted.NEUROSURGERY BLOG
J Neurosurg 125:24–32, 2016. Craniopharyngiomas are associated with a high rate of recurrence. The surgical management of recurrent lesions has been among the most challenging neurosurgical procedures because of the craniopharyngioma’s complex topographical relationship with surrounding structures.NEUROSURGERY BLOG
Neurosurgery, Volume 85, Issue 1, July 2019, Pages 75–83. Geometric factors of intracranial aneurysms and surrounding vasculature could affect the risk of aneurysm rupture. However, large-scale assessments of morphological parameters correlated with intracranial aneurysm rupture in a location-specific manner are scarce.NEUROSURGERY BLOG
Neurosurgery 79:279–285, 2016. Stereotactic radiosurgery (SRS) is an increasingly common modality used with surgery for resectable brainmetastases (BM).
NOTICE - NEUROSURGERY BLOG AANS Special Announcement. August 19, 2009 The AANS Announces New Policy for Abstract Submissions for its Annual Meeting The Scientific Program Committee (SPC) of the AANS wishes to alert you to a new change in policy for the submission of abstracts to the AANS Annual Meeting. All neurosurgeons and residents whose abstracts are accepted by Continue reading "Notice" WWW.NEUROSURGERY-BLOG.COM JFIF - , C ! ' "#%%% ),($+!$%$ C $ $$$$$ } !1A Qa "q 2 #B R $3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w !1 AQ aq "2 B #3R br$4 % &'()*56789
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Neurosurgery 88:1103–1110, 2021 The modified Spetzler-Martin (SM) grading system proposes that grade III arteriovenous malformation (AVM) subtypes are associated with variable microsurgical risks, with small AVMs (III−) having lower risk and medium/eloquent AVMs (III+)having higher risk.
NEUROSURGERY BLOG
Neurosurgery 88:E445–E451, 2021. Use of a closed-incisional negative pressure therapy (ci-NPT) dressing is an emerging strategy to reduce surgical site infections (SSIs) inNEUROSURGERY BLOG
Neurosurgery 88:931–941, 2021. Spontaneous intracranial hypotension (SIH) is usually caused by a spinal cerebrospinal fluid (CSF) leak. CSF-venous fistula is an underdiagnosed cause of spinal CSF leak, as it is challenging to identify on myelography. ABOUT - NEUROSURGERY BLOG About. This is a space open to the neurosurgical community. Created on August 19, 2009, its mission is to collect useful information related to neurosurgery in one repository. Only scientifically relevant information will be posted.NEUROSURGERY BLOG
J Neurosurg 125:24–32, 2016. Craniopharyngiomas are associated with a high rate of recurrence. The surgical management of recurrent lesions has been among the most challenging neurosurgical procedures because of the craniopharyngioma’s complex topographical relationship with surrounding structures.NEUROSURGERY BLOG
Neurosurgery, Volume 85, Issue 1, July 2019, Pages 75–83. Geometric factors of intracranial aneurysms and surrounding vasculature could affect the risk of aneurysm rupture. However, large-scale assessments of morphological parameters correlated with intracranial aneurysm rupture in a location-specific manner are scarce.NEUROSURGERY BLOG
Neurosurgery 79:279–285, 2016. Stereotactic radiosurgery (SRS) is an increasingly common modality used with surgery for resectable brainmetastases (BM).
NOTICE - NEUROSURGERY BLOG AANS Special Announcement. August 19, 2009 The AANS Announces New Policy for Abstract Submissions for its Annual Meeting The Scientific Program Committee (SPC) of the AANS wishes to alert you to a new change in policy for the submission of abstracts to the AANS Annual Meeting. All neurosurgeons and residents whose abstracts are accepted by Continue reading "Notice" WWW.NEUROSURGERY-BLOG.COM JFIF - , C ! ' "#%%% ),($+!$%$ C $ $$$$$ } !1A Qa "q 2 #B R $3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w !1 AQ aq "2 B #3R br$4 % &'()*56789
WWW.NEUROSURGERY-BLOG.COMTRANSLATE THIS PAGE JFIF C ! ' "#%%% ),($+!$%$ } !1A Qa "q 2 #B R $3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyzNEUROSURGERY BLOG
Neurosurgery 88:1103–1110, 2021 The modified Spetzler-Martin (SM) grading system proposes that grade III arteriovenous malformation (AVM) subtypes are associated with variable microsurgical risks, with small AVMs (III−) having lower risk and medium/eloquent AVMs (III+)having higher risk.
NEURONAVIGATION ARCHIVES J Neurosurg 133:107–118, 2020. Surgical treatment of convexity meningiomas is usually considered a low-risk procedure. Nevertheless, the risk of postoperative motor deficits is higher (7.1%–24.7% of all cases) for lesions located in the rolandic region, especially when an arachnoidal cleavage plane with the motor pathway is notidentifiable.
NEUROPHYSIOLOGY ARCHIVES Acta Neurochirurgica (2021) 163:1213–1226. Surgical treatment of tumors, epileptic foci or of vascular origin, requires a detailed individual pre-surgical workup and intraoperative surveillance of brain functions to minimize the risk of post-surgical neurological deficits and decline of quality of life. LASER ABLATION OF ABNORMAL NEUROLOGICAL TISSUE USING Neurosurgery 86:538–547, 2020 Stereotactic laser ablation (SLA) has demonstrated potential utility for a spectrum of difficult to treat neurosurgical pathologies in multiple small and/or retrospective single-institutional series. Here, we present the safety profile of SLA of intracranial lesions from the Laser Ablation of Abnormal Neurological Tissue using Robotic NeuroBlate System (LAANTERN TEAR-DROP TECHNIQUE IN ILIAC SCREW PLACEMENT: A TECHNICAL Acta Neurochirurgica (2021) 163:1577–1581. Instrumentation of the lumbosacral region is one of the more challenging regions due to the complex anatomical structures and biomechanical forces. PSEUDARTHROSIS IN ANTERIOR CERVICAL DISCECTOMY AND FUSION J Neurosurg Spine 33:717–726, 2020 The goal of this study was to evaluate the incidence of pseudarthrosis after the treatment of cervical degenerative disc disease (CDDD) with anterior cervical discectomy and fusion (ACDF) in which self-locking, stand-alone intervertebral cages filled with hydroxyapatite were used. METHODS The authors performed a retrospective cohort study of 49 LONG-TERM RADIOGRAPHIC OUTCOMES OF EXPANDABLE VERSUS J Neurosurg Spine 34:471–480, 2021. Potential advantages of using expandable versus static cages during transforaminal lumbar interbody fusion (TLIF) are not fully established. POSTERIOR FORAMINOTOMY VERSUS ANTERIOR DECOMPRESSION AND J Neurosurg Spine 32:344–352, 2020 The long-term efficacy of posterior foraminotomy compared with anterior cervical decompression and fusion (ACDF) for the treatment of degenerative disc disease with radiculopathy has not been previously investigated in a population-based cohort. METHODS All patients in the national Swedish Spine Register (Swespine) from January 1, 2006, until November COMPLICATIONS OF OCCIPITOCERVICAL FUSION: A 316 CASES Eur Spine J (2014) 23:1720–1724 Disorders in occipitocervical region are difficult to treat. Complications often occur after fusion surgery and may be life-threatening in severe cases. This study is to investigate the causes and treatment strategies for the postoperative complications of occipitocervical fusion. Methods Between May 1985 and May 2011, 316 patients with various REVISITING THE RULES FOR FREEHAND VENTRICULOSTOMY: A J Neurosurg 128:1250–1257, 2018. Frontal ventriculostomy is one of the most frequent and standardized procedures in neurosurgery. However, many first and subsequent punctures miss the target, and suboptimal placement or misplacement of the catheter is common. The authors therefore reexamined the landmarks and rules to determine theentry
CEREBRAL VENOUS SINUS THROMBOSIS ON UNENHANCED CT Neurosurg Q 2015;25:154–160 The aim of the study was to investigate computed tomography (CT) signs of cerebral venous sinus thrombosis (CVST), so as to increase clinicians’ awareness of CVST and improve the sensitivity of the diagnosis. Materials and Methods: We retrospectively analyzed all the CVST cases primary diagnosed by CT and confirmed further by magnetic Continue readingNEUROSURGERY BLOG
DAILY BIBLIOGRAPHIC REVIEW OF THE NEUROSURGERY DEPARTMENT. LA FE UNIVERSITY HOSPITAL. VALENCIA, SPAINSearch
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LUMBAR DISC EXTRUSIONS REDUCE FASTER THAN BULGING DISCS DUE TO AN ACTIVE ROLE OF MACROPHAGES IN SCIATICA Posted on 07/01/2020by cba
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ACTA NEUROCHIRURGICA (2020) 162:79–85 This retrospective observational histological study aims to associate the size and type of disc herniation with the degree of macrophage infiltration in disc material retrieved during disc surgery in patients with sciatica. Methods Disc tissue of 119 sciatica patients was embedded in paraffin and stained with hematoxylin and CD68. Tissue samples were categorized as mild (0–10/cm2), moderate (10–100/cm2), and considerable (> 100/cm2) macrophage infiltration. All 119 patients received an MRI at baseline, and 108 received a follow-up MRI at 1-year. MRIs were reviewed for the size and type of the disc herniations, and for Modic changes in the vertebral endplates. Results Baseline characteristics and duration of symptoms before surgery were comparable in all macrophage infiltration groups. The degree of macrophage infiltration was not associated with herniation size at baseline, but significantly associated with reduction of size of the herniated disc at 1-year post surgery. Moreover, the degree of macrophage infiltration was higher in extrusion in comparison with bulging (protrusion) of the disc. Results were comparable in patients with and without Modic changes. Conclusion Macrophage infiltration was positively associated with an extruded type of disc herniation as well as the extent of reduction of the herniated disc during 1-year follow-up in patients with sciatica. This is an indication that the macrophages play an active role in reducing herniated discs. An extruded disc herniation has a larger surface for the macrophages to adhere to, which leads to more sizereduction.
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disc herniation
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inflammation
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Macrophages
, magnetic
resonance imaging
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Modic changes
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sciatica |
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STROKE THROMBECTOMIES USING ADAPT WITH INCREASING ASPIRATION CATHETERSIZE
Posted on 06/01/2020by cba
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NEUROSURGERY 86:61–70, 2020 Endovascular thrombectomy is currently the standard of care for acute ischemic stroke (AIS). Although earlier trials on endovascular thrombectomy were performed using stent retrievers, recently completed the contact aspiration vs stent retriever for successful revascularization (ASTER) and a comparison of direct aspiration versus stent retriever as a first approach (COMPASS) trials have shown the noninferiority of direct aspiration. OBJECTIVE: To report the largest experience withADAPT thrombectomy and compare the impact of advancement in reperfusion catheter technologieson outcomes.
METHODS:We reviewed a retrospective database of AIS patients who underwent ADAPT thrombectomy between January 2013 and November 2017 at the Medical University of South Carolina. Demographics and baseline characteristics, technical variables, and radiological and clinical outcomes were reviewed. RESULTS: Among 510 patients (mean age: 67.7, 50.6% females), successful recanalization at first pass was achieved in 61.8%, and with aspiration only in 77.5%.Mean procedure time was 27.4 min, and the rate of good outcomes (mRS 0-2) at 90 d was 42.9%. The rate of recanalization with aspiration only was significantly higher, and procedure timewas significantly lower in patients treated with larger catheters (ACE 064 and ACE 068) compared to smaller catheters (5MAX and ACE, P<.05). Therewere no differences in complication rates or postoperative parenchymal hemorrhage across groups (P > .05); however, use of ACE 068 was an independent predictor of good outcomes at 90 d on multivariate regression analysis (odds ratio = 1.6, P< .05). CONCLUSION: Refinement of ADAPT thrombectomy by incorporating reperfusion catheters with higher inner diameters and thus higher aspiration forces is associated with better outcomes, shorter procedure times, and lower likelihood of using additional devices without impacting complication rates.SHARE THIS:
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RUPTURE RISK OF SMALL UNRUPTURED CEREBRAL ANEURYSMS Posted on 03/01/2020by cba
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J NEUROSURG 132:69–78, 2020OBJECTIVE
The annual rupture rate of small (3–4 mm) unruptured cerebral aneurysms (UCAs) is 0.36% per year, however, the proportion of small ruptured aneurysms < 5 mm is 35%. This discrepancy is explained by the hypothesis that most acute subarachnoid hemorrhage (SAH) is from recently formed, unscreened aneurysms, but this hypothesis is without definitive proof. The authors aimed to clarify the actual number of screened, ruptured small aneurysms and risk factors for rupture.METHODS
The Unruptured Cerebral Aneurysm Study Japan, a project of the Japan Neurosurgical Society, was designed to clarify the natural course of UCAs. From January 2001 through March 2004, 6697 UCAs among 5720 patients were prospectively registered. At registration, 2839 patients (49.6%) had 3132 (46.8%) small UCAs of 3–4 mm. The registered, treated, and rupture numbers of these small aneurysms and the annual rupture rate were investigated. The rate was assessed per aneurysm. The characteristics of patients and aneurysms were compared to those of larger unruptured aneurysms (≥ 5 mm). Cumulative rates of SAH were estimated per aneurysm. Risk factors underwent univariate and multivariate analysis.RESULTS
Treatment and rupture numbers of small UCAs were 1132 (37.1% of all treated aneurysms) and 23 (20.7% of all ruptured aneurysms), respectively. The registered, treated, rupture number, and annual rupture rates were 1658 (24.8%), 495 (16.2%), 11 (9.9%), and 0.30%, respectively, among 3-mm aneurysms, and 1474 (22.0%), 637 (20.9%), 12 (10.8%), and 0.45%, respectively, among 4-mm aneurysms. Multivariate risk-factor analysis revealed that a screening brain checkup (hazard ratio 4.1, 95% confidence interval 1.2–14.4), history of SAH (HR 10.8, 95% CI 2.3–51.1), uncontrolled hypertension (HR 5.2, 95% CI 1.8–15.3), and location on the anterior communicating artery (ACoA; HR 5.0, 95% CI 1.6–15.5) were independent predictors ofrupture.
CONCLUSIONS
Although the annual rupture rate of small aneurysms was low, the actual number of ruptures was not low. Small aneurysms that ruptured during follow-up could be detected, screened, and managed based on each risk factor. Possible selection criteria for treating small UCAs include a history of SAH, uncontrolled hypertension, location on the ACoA, and young patients. Further large prospective and longitudinaltrials are needed.
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SAFETY OF OUTPATIENT ANTERIOR CERVICAL DISCECTOMY AND FUSION: A SYSTEMATIC REVIEW AND META-ANALYSIS Posted on 02/01/2020by cba
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NEUROSURGERY 86:30–45, 2020 Anterior cervical discectomy and fusion (ACDF) is being increasingly offered on an outpatient basis. However, the safety profile of outpatient ACDF remains poorly defined. OBJECTIVE: To review the medical literature on the safety ofoutpatient ACDF.
METHODS: We systematically reviewed the literature for articles published before April 1, 2018, describing outpatient ACDF and associated complications, including incidence of reoperation, stroke, thrombolytic events, dysphagia, hematoma, and mortality. A random-effects analysis was performed comparing complications between the inpatient and outpatient groups. RESULTS: We identified 21 articles that satisfied the selection criteria, of which 15 were comparative studies. Most of the existing studies were retrospective, with a lack of level I or II studies on this topic. We found no statistically significant difference between inpatient and outpatient ACDF in overall complications, incidence of stroke, thrombolytic events, dysphagia, and hematoma development. However, patients undergoing outpatient ACDF had lower reported reoperation rates (P < .001), mortality (P < .001), and hospitalization duration (P < .001). CONCLUSION: Our meta-analysis indicates that there is a lack of high level of evidence studies regarding the safety of outpatient ACDF. However, the existing literature suggests that outpatient ACDF can be safe, with low complication rates comparable to inpatient ACDF in well-selected patients. Patients with advanced age and comorbidities such as obesity and significant myelopathy are likely not suitable for outpatient ACDF. Spine surgeons must carefully evaluate each patient to decide whether outpatient ACDF is a safe option. Higher quality, large prospective randomized control trials are needed to accurately demonstrate the safety profile of outpatient ACDF.SHARE THIS:
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Outpatient
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FLOW DIVERSION TREATMENT OF COMPLEX BIFURCATION ANEURYSMS BEYOND THE CIRCLE OF WILLIS: COMPLICATIONS, ANEURYSM SAC OCCLUSION, REABSORPTION, RECURRENCE, AND JAILED BRANCH MODIFICATION AT FOLLOW-UP Posted on 31/12/2019by cba
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J NEUROSURG 131:1751–1762, 2019 The purpose of this study is to present the authors’ medium-term results, with special emphasis on complications, occlusion rate of the aneurysm sac (digital subtraction angiography and MRI), and the fate of cortical branches and perforating arteries covered (“jailed”) by the flow diverter (FD) stent. METHODS Between January 2010 and September 2017, 29 patients (14 female) with 30 aneurysms were treated with an FD stent. Twenty-one aneurysms were at the middle cerebral artery bifurcation, 8 were in the anterior communicating artery region, and 1 was a pericallosal artery bifurcation. Thirty-five cortical branches were covered. A single FD stent was used in all patients. Symptomatic and asymptomatic periprocedural and delayed complications were reported. DSA and MRI controls were analyzed to evaluate modification of the aneurysm sac and jailed branches. RESULTS Permanent morbidity was 3.4% (1/29), due to a jailed branch occlusion, with a modified Rankin Scale (mRS) score of 2 at the last follow-up. Mortality and permanent complication with poor prognosis (mRS score > 2) rates were 0%. The mean follow-up time for DSA and MRI (mean ± SD) was 21 ± 14.5 months (range 3–66 months) and 19 ± 16 months (range 3–41 months), respectively. The mean time to aneurysm sac occlusion (available for 24 patients), including stable remodeling, was 11.8 ± 6 months (median 13, range 3–27 months). The overall occlusion rate was 82.1% (23/28), and it was 91.7% (22/24) in the group of patients with at least 2 DSA control sequences. One recanalization occurred at 41 months posttreatment. At the time of publication, at the latest follow-up, 7 (20%) of 35 covered branches were occluded, 18 (51.4%) showed a decreased caliber, and the remaining 10 (28.5%) were unchanged. MRI T2-weighted sequences showed complete sac reabsorption in 7/29 aneurysms (24.1%), and the remaining lesions were either smaller (55.2%) or unchanged (17.2%). MRI revealed asymptomatic and symptomatic ischemic events in perforator territories in 7/28 (25%) and 4/28 (14.3%) patients, respectively, which were reversible within 24 hours. CONCLUSIONS Flow diversion of bifurcation aneurysms is feasible, with low rates of permanent morbidity and mortality and high occlusion rates; however, recurrence may occur. Caliber reduction and asymptomatic occlusion of covered cortical branches as well as silent perforator stroke are common. Ischemic complications may occur with no identified predictable factors. MRI controls should be required in all patients to evaluate silent ischemic lesions and aneurysm sac reabsorption over time.SHARE THIS:
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Like Loading... Posted in Uncategorized|
Tagged Endovascular treatment,
Flow diverter
,
interventional neurosurgery,
Intracranial aneurysm,
magnetic resonance imaging,
Recurrence
, vascular
disorders
|
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STEM CELL INJECTIONS FOR AXIAL BACK PAIN: A SYSTEMATIC REVIEW OF ASSOCIATED RISKS AND COMPLICATIONS WITH A CASE ILLUSTRATION OF DIFFUSE HYPERPLASTIC GLIOSIS RESULTING IN CAUDA EQUINA SYNDROME Posted on 30/12/2019by cba
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J NEUROSURG SPINE 31:906–913, 2019 Axial low-back pain is a disease of epidemic proportions that exerts a heavy global toll on the active workforce and results in more than half a trillion dollars in annual costs. Stem cell injections are being increasingly advertised as a restorative solution for various degenerative diseases and are becoming more affordable and attainable by the public. There have been multiple reports in the media of these injections being easily available abroad outside of clinical trials, but scientific evidence supporting them remains scarce. The authors present a case of a serious complication after a stem cell injection for back pain and provide a systematic review of the literature of the efficacy of this treatment as well as the associated risks andcomplications.
METHODS A systematic review of the literature was performed using the PubMed, Google Scholar, and Scopus online electronic databases to identify articles reporting stem cell injections for axial back pain in accordance with the PRISMA guidelines. The primary focus was on outcomes and complications. A case of glial hyperplasia of the roots of the cauda equina directly related to stem cell injections performed abroad is also reported. RESULTS The authors identified 14 publications (including a total of 147 patients) that met the search criteria. Three of the articles presented data for the same patient population with different durations of follow-up and were thus analyzed as a single study, reducing the total number of studies to 12. In these 12 studies, follow-up periods ranged from 6 months to 6 years, with 50% having a follow-up period of 1 year or less. Most studies reported favorable outcomes, although 36% used subjective measures. There was a tendency for pain relief to wane after 6 months to 2 years, with patients seeking a surgical solution. Only 1 study was a randomized controlledtrial (RCT).
CONCLUSIONS There are still insufficient data to support stem cell injections for back pain. Additional RCTs with longterm follow-up are necessary before statements can be made regarding the efficacy andsafety.
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Tagged allogeneic stem cells,
back pain ,
Cauda equina syndrome,
disability in the United States,
global disability
,
Lumbar , stem
cell complications
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stem cell injection
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COMPLICATIONS ASSOCIATED WITH SURGERY FOR THORACIC DISC HERNIATION: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS Posted on 27/12/2019by cba
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WORLD NEUROSURGERY Volume 132, December 2019, Pages 334-342 A systematic review and network meta-analysis (Prospero ID CRD42018106936) were performed. Objective: The selection of the appropriate surgical approach for the management of thoracic disc herniation (TDH) is often challenging because of the frequency and variability of the associated complications. We evaluated the safety of the surgical approaches for TDH by estimating the mortality (Q1) and morbidity (Q2), and frequency of the most common complications (Q3). Methods: We searched the medical literature for randomized controlled trials and observational studies reporting on the management of TDH. Postoperative complications were the outcome of interest. The absolute and relative risk estimates, along with the rank probability scores, were estimated for each approach, through a network meta-analysis. The results were read in the light of the quality of the availableevidence.
Results: Fifteen studies with a total of 1036 patients fulfilled our eligibility criteria. Three deaths were reported. The overall morbidity was as high as 29%, largely attributed to medical (21%; 95% confidence interval , 10%–38%), surgical site (11%; 95% CI, 5%–22%), cerebrospinal fluid–related (8%; 95% CI, 3%–8%), and neurologic complications (5%; 95% CI, 1%–24%). The anterior and lateral approaches were associated with a higher risk for medical and surgical complications compared with the posterolateral approach. Conclusions: Surgery for TDH is associated with minimal mortality but significant morbidity, with large variations among the available approaches. An understanding of the perioperative complications rates is important to develop complication avoidance strategies and to aid accurate patient-to-doctor communication.SHARE THIS:
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REVIEW OF RISKS AND COMPLICATIONS OF EXTREME LATERAL INTERBODY FUSION(XLIF)
Posted on 26/12/2019by cba
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SURG NEUROL INT 2019;10:237 Extreme lateral interbody fusions (XLIF) and Minimally Invasive (MIS) XLIF were developed to limit the vascular injuries associated with anterior lumbar interbody fusion (ALIF), and minimize the muscular/ soft tissue trauma attributed to transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), and posterolateral lumbar fusion (PLF). Methods: Nevertheless, XLIF/MIS XLIF pose significant additional risks and complications that include; multiple nerve injuries (e.g. lumbar plexus, ilioinguinal, iliohypogastric, genitofemoral, lateral femoral cutaneous, and subcostals (to the anterior abdominal muscles: abdominal oblique), and sympathectomy), major vascular injuries, bowel perforations/postoperative ileus, seromas, pseudarthrosis, subsidence,and reoperations.
Results: The risks of neural injury with XLIF/MIS XLIF (up to 30-40%) are substantially higher than for TLIF, PLIF, PLF, and ALIF. These neural injuries included: lumbar plexus injuries (13.28%); new sensory deficits (0-75% (21.7%-40%); permanent 62.5%); motor deficits (0.7-33.6%-40%); iliopsoas weakness (9%-31%: permanent 5%), anterior thigh/groin pain (12.5-34%), and sympathectomy (4%-12%). Additional non-neurological complications included; subsidence (10.3%-13.8%), major vascular injuries (0.4%), bowel perforations, recurrent seroma, malpositioning of the XLIF cages, a 45% risk of cage-overhang, pseudarthrosis (7.5%), and failure to adequately decompress stenosis. In one study, reviewing 20 publications and involving 1080 XLIF patients, the authors observed “Most (XLIF) studies are limited by study design, sample size, and potential conflicts of interest.” Conclusion: Many new neurological deficits and other adverse events/complications are attributed to MIS XLIF/ XLIF. Shouldn’t these significant risk factors be carefully taken into consideration before choosing to perform MIS XLIF/XLIF?SHARE THIS:
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Like Loading... Posted in complications,
Spine ,
Surgical technique
| Tagged Extreme lateral interbody fusion (XLIF): Complications,
Lumbar plexus injuries,
Major injuries
, Minor
injuries
, Nerve
root injuries
|
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AN INTERNATIONAL RADIOSURGERY RESEARCH FOUNDATION MULTICENTER RETROSPECTIVE STUDY OF GAMMA VENTRAL CAPSULOTOMY FOR OBSESSIVECOMPULSIVE DISORDER
Posted on 24/12/2019by cba
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_NEUROSURGERY_, VOLUME 85, ISSUE 6, DECEMBER 2019, PAGES 808–816 Obsessive compulsive disorder (OCD) across its full spectrum of severity is a psychiatric illness affecting ∼2% to 3% of the general population and results in significant functional impairment. There are few large patient series regarding Gamma ventral capsulotomy (GVC). OBJECTIVE: To evaluate clinical outcomes of severe medically refractory OCD treated with GVC. METHODS: This is an international, multicenter, retrospective cohort study. Forty patients with pre-GVC Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores ≥ 24 (indicating severe OCD) were included. GVC was performed with 1 or 2 isocenters with a median maximum dose of 135 Gy (range, 120-180 Gy). Patients were deemed “responders” to GVC if there was ≥35% reduction of follow-up Y-BOCS scores, and considered in remission if their Y-BOCS scores were ≤16. The median follow-up was 36 mo (range, 6-96 mo). RESULTS: The median pre-SRS Y-BOCS score was 35 (range, 24-40). Eighteen patients (45%) were considered “responders,” and 16 (40%) of them were in remission at their last follow-up. Nineteen patients (47.5%) remained stable with Y-BOCS of 33 (range, 26-36) following GVC, whereas 3 patients (7.5%) experienced worsening in Y-BOCS scores. Patients treated with 2 isocenters were more likely to have improvement in Y-BOCS score at 3 and 5 yr (P < .0005). Ten patients (25%) experienced post-GVC mood disturbance and neurological complications in 3 patients (7.5%). One patient developed radiation necrosis with edema that improved with steroids. CONCLUSION: GVC serves as a reasonable treatment strategy for severe medical refractory OCD. Patients treated with 2 isocenters were more likely to have substantial improvement in OCD.SHARE THIS:
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Tagged gamma-knife
, OCD
, Stereotactic
radiosurgery
,
Ventral capsulotomy
,
Y-BOCS | Leave
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MIDLINE LUMBAR INTERBODY FUSION (MIDLIF) WITH CORTICAL SCREWS Posted on 23/12/2019by cba
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ACTA NEUROCHIRURGICA (2019) 161:2415–2420 A variety of surgical techniques can be used to achieve lumbar spinal fusion for management of degenerative conditions. Transforaminal lumbar interbody fusion (TLIF) is the most popular technique; however, midline lumbar interbody fusion (MIDLIF) is a valid alternative to the more traditional pedicle screw trajectory with potential advantages. The aim of this study is to evaluate the clinical outcomes from a cohort of patients submitted to MIDLIF in a single hospital during the surgical team’s initial learning period. Methods The first 30 consecutive patients who underwent single- or two-level MIDLIF surgery for lumbar degenerative disease were included in this retrospective study. Patients’ demographics, surgical data, length of hospitalisation, and perioperative complications were analysed. Preoperative and postoperative radiographic parameters were obtained. Validated questionnaires, Core Outcome Measure Index for the back, Euro-QoL 5-Dimensional Questionnaire, and Oswestry Disability Index, were used for clinical assessment. Results Mean surgery time was 278.53 ± 82.16 min and mean hospitalisation time was 6.17 ± 3.51 days. Six patients experienced complications, four of which being dural tears with no consequences, and two required reoperations during the mean follow-up of 25.23 ± 9.74 months. Preoperative and postoperative radiological parameters did not demonstrate significant differences. All clinical parameters significantly improved after surgery (p < 0.001). A complexity score was developed to more accurately compare the different procedures, and it strongly correlated with surgery duration (r = 0.719, p < 0.001). Furthermore, a moderate correlation was found between a developed Duration Index and the patient’s order number (r = − 0.539, p =0.002).
Conclusions In our initial experience, MIDLIF showed to be effective in significantly improving the patients’ functional status, pain scores, and quality of life. The technique seems safe, with an acceptably low complication rate. Hence, MIDLIF can be considered as a promising alternative to more traditional TLIF and PLIF techniques even at the beginning of the learning curve.SHARE THIS:
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Tagged Cortical bone trajectory screws,
Learning curve
,
Lumbar arthrodesis
,
MIDLIF ,
Midline lumbar interbody fusion,
Minimally invasive spine surgery| Leave a reply
3D ULTRASOUND–GUIDED RESECTION OF LOW-GRADE GLIOMAS: PRINCIPLES ANDCLINICAL EXAMPLES
Posted on 20/12/2019by cba
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NEUROSURG FOCUS 47 (6):E9, 2019 3D ultrasound (US) is a convenient tool for guiding the resection of low-grade gliomas, seemingly without deterioration in patients’quality of life.
This article offers an update of the intraoperative workflow and the general principles behind the 3D US acquisition of high-qualityimages.
The authors also provide case examples illustrating the technique in two small mesial temporal lobe lesions and in one insular glioma. Due to the ease of acquiring new images for navigation, the operations can be guided by updated image volumes throughout the entire course ofsurgery.
The high accuracy offered by 3D US systems, based on nearly realtime images, allows for precise and safe resections. This is especially useful when an operation is performed through very narrow transcortical corridors.SHARE THIS:
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Like Loading... Posted in Intraoperative Imaging,
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Tagged 3D ultrasound, LGG
, Navigated
ultrasound
,
surgical setup
|
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PATIENT-SPECIFIC 3-DIMENSIONALLY PRINTED MODELS FOR NEUROSURGICAL PLANNING AND EDUCATION Posted on 19/12/2019by cba
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NEUROSURG FOCUS 47 (6):E12, 2019 Advances in 3-dimensional (3D) printing technology permit the rapid creation of detailed anatomical models. Integration of this technology into neurosurgical practice is still in its nascence, however. One potential application is to create models depicting neurosurgical pathology. The goal of this study was to assess the clinical value of patientspecific 3D printed models for neurosurgical planning andeducation.
METHODS The authors created life-sized, patient-specific models for 4 preoperative cases. Three of the cases involved adults (2 patients with petroclival meningioma and 1 with trigeminal neuralgia) and the remaining case involved a pediatric patient with craniopharyngioma. Models were derived from routine clinical imaging sequences and manufactured using commercially available software and hardware. RESULTS Life-sized, 3D printed models depicting bony, vascular, and neural pathology relevant to each case were successfully manufactured. A variety of commercially available software and hardware were used to create and print each model from radiological sequences. The models for the adult cases were printed in separate pieces, which had to be painted by hand, and could be disassembled for detailed study, while the model for the pediatric case was printed as a single piece in separate-colored resins and could not be disassembled for study. Two of the models were used for patient education, and all were used for presurgical planning by the surgeon. CONCLUSIONS Patient-specific 3D printed models are useful to neurosurgical practice. They may be used as a visualization aid for surgeons and patients, or for education of trainees.SHARE THIS:
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Like Loading... Posted in Education,
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Tagged 3D printing
,
educational aids
,
medical modeling
,
operative planning
,
stereolithography
|
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TOTAL UNCINECTOMY OF THE CERVICAL SPINE WITH AN OSTEOTOME Posted on 18/12/2019by cba
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J NEUROSURG SPINE 31:831–834, 2019 Total uncinate process resection or uncinectomy is often required in the setting of severe foraminal stenosis or cervical kyphosis correction. The proximity of the uncus to the vertebral artery, nerve root, and spinal cord makes this a challenging undertaking. Use of a high-speed burr or ultrasonic bone dissector can be associated with direct injury to the vertebral artery and thermal injury to the surrounding structures. The use of an osteotome is a safe and efficient method of uncinectomy. Here the authors describe their technique, which is illustrated with an intraoperative video.SHARE THIS:
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Like Loading... Posted in Spine, Surgical
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| Tagged cervical deformity,
Cervical spine
,
Foraminal stenosis
,
osteotomy ,
Surgical technique
,
Uncinate process
,
uncinectomy
, UP
, Vertebral artery
|
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5-AMINOLEVULINIC ACID FLUORESCENCE-GUIDED RESECTION OF 18F-FET-PET POSITIVE TUMOR BEYOND GADOLINIUM ENHANCING TUMOR IMPROVES SURVIVAL INGLIOBLASTOMA
Posted on 17/12/2019by cba
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NEUROSURGERY 85:E1020–E1029, 2019 The value of early postoperative 18F-FET-PET in patients with glioblastoma (GBM) is unclear. Five-aminolevulinic acid (5-ALA) is used for fluorescence-guided resections in these patients and previous data suggest that fluorescence and 18F-FET-PET both demarcate larger tumor volumes than gadolinium enhanced magnet resonance imaging (MRI). OBJECTIVE: To correlate fluorescence with enhancing volumes on postoperative MRI and 18F-FET-PET tumor volumes, and determine the value of postoperative 18F-FET-PET for predicting survival through observational study. METHODS: GBM patients underwent fluorescence-guided resection after administration of 5-ALA followed by early postoperative MRI and 18F-FET-PET for determination of residual tissue volumes. All patients were treated with standard temozolomide radiochemotherapy and monitored for progression-free and overall survival (PFS, OS). RESULTS: A total of 31 patients were included. For functional reasons, residual 5-ALA derived fluorescent tissue was left unresected in 18 patients with a median 18F-FETPET volume of 17.82 cm3 (interquartile range 6.50-29.19). In patients without residual fluorescence, median 18F-FET-PET volume was 1.20 cm3 (interquartile range 0.87-5.50) and complete resection of gadolinium enhancing tumor was observed in 100% of patients. A 18F-FET-PET volume of above 4.3 cm3 was associated with worse OS (logrank P-value≤.05), also in patients with no residual contrast enhancing tumor on MRI. More patients in whom fluorescencing tissue had been removed completely had postoperative 18F-FET-PET tumor volumes below 4.3 cm3. CONCLUSION: Postoperative 18F-FET-PET volumes predict OS and PFS. Resection of 5-ALA derived fluorescence beyond gadolinium enhancing tumor tissue leads to lower postoperative 18F-FET-PET tumor volumes and improved OS and PFS without additional deficits.SHARE THIS:
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Like Loading... Posted in Intraoperative Imaging,
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Tagged (18F)fluoroethyltyrosine,
Aminolevulinic acid
,
Fluorescence
,
Gadolinium
,
Glioblastoma
, Tumor
burden |
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OUTCOMES OF RETREATMENT FOR INTRACRANIAL ANEURYSMS—A META-ANALYSIS Posted on 16/12/2019by cba
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NEUROSURGERY. 2019 DEC 1;85(6):750-761 Long-term results from the International Subarachnoid Hemorrhage Trial (ISAT) and Barrow Ruptured Aneurysm Trial (BRAT) indicate considerably higher retreatment rates for aneurysms treated with coiling compared to clipping, but do not report the outcome of retreatment. OBJECTIVE: To evaluate retreatment related outcomes. METHODS: A meta-analysis in accordance with PRISMA guidelines was conducted using Medline search engines PubMed and EMBASE to identify articles describing outcomes after retreatment for intracranial aneurysms. Pooled prevalence rates for complete occlusion rate and mortality were calculated. Outcomes of different treatment and retreatment combinations were not compared because of indication bias. RESULTS: Twenty-five articles that met the inclusion criteria were included in the metaanalysis. Surgery after coiling had a pooled complete occlusion rate of 91.2% (95% confidence interval : 87.0-94.1) and a pooled mortality rate of 5.6% (95% CI: 3.7-8.3). Coiling after coiling had a pooled complete occlusion rate of 51.3% (95% CI: 22.1-78.0) and a pooled mortality rate of 0.8% (95% CI: 0.15-3.7). Surgery after surgery did not provide a pooled estimate for complete occlusion as only one study was identified but had a pooled mortality rate of 5.9% (95% CI: 3.1-11.2). Coiling after surgery had a pooled complete occlusion rate of 56.1% (95% CI: 11.4-92.7) and a pooled mortality rate of 9.3% (95% CI: 4.1- 19.9). All pooled incidence rates were produced using random-effect models. CONCLUSION: Surgical retreatment was associated with a high complete occlusion rate but considerable mortality. Conversely, endovascular retreatment was associated with low mortality but also a low completeocclusion rate.
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Vascular
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Tagged Cerebral aneurysm,
Clipping ,
Coiling ,
meta-analysis
,
Retreatment
,
Subarachnoid hemorrhage| Leave a reply
NASOGASTRIC TUBE FEEDING INTO BRAIN AFTER ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL SURGERY Posted on 13/12/2019by cba
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WORLD NEUROSURG. (2019) 132:4-6 The endoscopic endonasal transsphenoidal (EET) approach for skull base tumors has become increasingly popular. We know that bone defects in the skull base can cause cerebrospinal fluid rhinorrhea, but for patients who need to be intubated through the nose, the tube can enter the brain through a skull base bone defect. Nasogastric tube feeding into the brain is a rare occurrence, and this situation can occur only in the case of a skull base defect. We treated a patient with an unusual complication after the EET approach for pituitary adenoma resection. This particular case suggests that bone defects after EET surgery can not only cause cerebrospinal fluid rhinorrhea but also allow the entry of a nasogastric tube into the brain. For patients with a history of EET surgery, endoscopy-assisted gastric tube implantation can be performed if necessary.SHARE THIS:
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UPFRONT MAGNETIC RESONANCE IMAGING-GUIDED STEREOTACTIC LASER-ABLATION IN NEWLY DIAGNOSED GLIOBLASTOMA: A MULTICENTER REVIEW OF SURVIVAL OUTCOMES COMPARED TO A MATCHED COHORT OF BIOPSY-ONLY PATIENTS Posted on 12/12/2019by cba
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NEUROSURGERY. 2019 DEC 1;85(6):762-772 Laser ablation (LA) is used as an upfront treatment in patients with deep seated newly diagnosed Glioblastoma (nGBM). OBJECTIVE: To evaluate the outcomes of LA in patients with nGBM and compare them with a matched biopsy-only cohort. METHODS: Twenty-four nGBM patients underwent upfront LA at Cleveland clinic, Washington University in St. Louis, and Yale University (6/2011-12/2014) followed by chemo/radiotherapy. Also, 24 out of 171 nGBM patients with biopsy followed by chemo/radiotherapy were matched based on age (< 70 vs ≥ 70), gender, tumor location (deep vs lobar), and volume (<11 cc vs ≥11 cc). Progression-free survival (PFS), overall survival (OS), and disease-specific PFS and OS were outcome measures. Three prognostic groups were identified based on extent of tumor ablation by thermal-damage-threshold (TDT)-lines. RESULTS: The median tumor volume in LA (n = 24) and biopsy only (n = 24) groups was 9.3 cm3 and 8.2 cm3 respectively. Overall, median estimate of OS and PFS in LA cohort was 14.4 and 4.3 mo compared to 15.8 mo and 5.9 mo for biopsy only cohort. On multivariate analysis, favorable TDT-line prognostic groups were associated with lower incidence of disease specific death (P = .03) and progression (P = .05) compared to other groups including biopsy only cohort. Only age (<70 yr, P=.02) and tumor volume (<11 cc, P=.03) were favorable prognostic factors for OS. CONCLUSION: Themaximum tumor coverage by LA followed by radiation/chemotherapy is an effective treatment modality in patientswith nGBM, compared to biopsy only cohort. The TDT-line prognostic groups were independent predictor of disease specific death and progression after LA.SHARE THIS:
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Like Loading... Posted in MRI, Oncology
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Tagged brain tumor
, GBM
, LITT
, minimally
invasive
,
NeuroBlate
, Novel
treatment
|
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SOMATOSENSORY FUNCTIONAL MRI TRACTOGRAPHY FOR INDIVIDUALIZED TARGETING OF DEEP BRAIN STIMULATION IN PATIENTS WITH CHRONIC PAIN AFTER BRACHIALPLEXUS INJURY
Posted on 11/12/2019by cba
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ACTA NEUROCHIRURGICA (2019) 161:2485–2490 The optimal targets for deep brain stimulation (DBS) in patients with refractory chronic pain are not clearly defined. We applied sensory functional MRI (fMRI)- and diffusion tensor imaging (DTI)-based DBS in chronic pain patients into 3 different targets to ascertain the most beneficial individual stimulation site. Methods Three patients with incapacitating chronic pain underwent DBS into 3 targets (periventricular gray (PVG), ventroposterolateral thalamus (VPL), and posterior limb of the internal capsule according to fMRI and DTI (PLIC). The electrodes were externalized and double-blinded tested for several days. Finally, the two electrodes with the best pain reduction were kept for permanent stimulation. The patients were then followed up for 12 months. Outcome measures comprised the numerical rating scale (NRS), short-form McGill’s score (SF-MPQ), and health-related quality of life (SF-36). Results Continuous pain (mean NRS 6.6) was reduced to NRS 3.6 after 12 months. Only with stimulation of the PLIC pain attacks, that occurred at least 3 times a week (mean NRS 9.6) resolved in 2 patients and improved in one patient concerning both intensity (NRS 5) and frequency (twice a month). The mean SF-MPQ decreased from 92.7 to 50. The health-related quality of life improved considerably. Conclusion fMRI- and DTI-based DBS to the PLIC was the only target with a significant effect on pain attacks and seems to be the most promising target in chronic pain patients after brachial plexus injury. The combination with PVG or VPL can further improve patients’ outcome especially in terms of reducing the continuouspain.
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Like Loading... Posted in MRI, Pain
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Chronic pain
, Deep
Brain Stimulation
,
Neuromodulation
, PLIC
| Leave a reply
TREATMENT OUTCOMES AND DOSE RATE EFFECTS FOLLOWING GAMMA KNIFE STEREOTACTIC RADIOSURGERY FOR VESTIBULAR SCHWANNOMAS Posted on 10/12/2019by cba
NEUROSURGERY 85:E1084–E1094, 2019 Gamma Knife radiosurgery (GKRS; Elekta AB) remains a well-established treatment modality for vestibular schwannomas. Despite highly effective tumor control, further research is needed toward optimizing long-term functional outcomes. Whereas dose-rate effects may impact post-treatment toxicities given tissue dose-response relationships, potential effects remain largely unexplored. OBJECTIVE: To evaluate treatment outcomes and potential dose-rate effects following definitive GKRS for vestibular schwannomas. METHODS: We retrospectively reviewed 419 patients treated at our institution between 1998 and 2015, characterizing baseline demographics, pretreatment symptoms, and GKRS parameters. The cohort was divided into 2 dose-rate groups based on the median value (2.675 Gy/min). Outcomes included clinical tumor control, radiographic progression-free survival, serviceable hearing preservation, hearing loss, and facial nerve dysfunction (FND). Prognostic factors were assessed using Cox regression. RESULTS: The study cohort included 227 patientswith available follow-up. Following GKRS 2-yr and 4-yr clinical tumor control rates were 98% (95% CI: 95.6%-100%) and 96% (95% CI: 91.4%-99.6%), respectively. Among 177 patients with available radiographic follow-up, 2-yr and 4-yr radiographic progression-free survival rateswere 97% (95% CI: 94.0%-100.0%) and 88% (95% CI: 81.2%-95.0%). The serviceable hearing preservation rate was 72.2% among patients with baseline Gardner-Robertson class I/II hearing and post-treatment audiological evaluations. Most patients experienced effective relief from prior headaches (94.7%), tinnitus (83.7%), balance issues (62.7%), FND (90.0%), and trigeminal nerve dysfunction (79.2%), but not hearing loss (1.0%). Whereas GKRS provided effective tumor control independently of dose rate, GKRS patients exposed to lower dose rates experienced significantly better freedom from post-treatment hearing loss and FND (P = .044). CONCLUSION:Whereas GKRS provides excellent tumor control and effective symptomatic relief for vestibular schwannomas, dose-rate effectsmay impact post-treatment functional outcomes. Further research remainswarranted.
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Like Loading... Posted in Cranial nerves,
Gamma Knife radiosurgery | Tagged Acoustic neuroma,
Dose rate ,
Gamma knife radiosurgery,
Neurosurgery
,
Radiation oncology
,
Stereotactic radiosurgery,
Vestibular schwannoma OUTCOMES OF ENDOSCOPIC DISCECTOMY COMPARED WITH OPEN MICRODISCECTOMY AND TUBULAR MICRODISCECTOMY FOR LUMBAR DISC HERNIATIONS: AMETA-ANALYSIS
Posted on 09/12/2019by cba
J NEUROSURG SPINE 31:802–815, 2019 Endoscopic discectomy (ED) has been advocated as a less-invasive alternative to open microdiscectomy (OM) and tubular microdiscectomy (TM) for lumbar disc herniations, with the potential to decrease postoperative pain and shorten recovery times. Large-scale, objective comparisons of outcomes between ED, OM, and TM, however, are lacking. The authors’ objective in this study was to conduct a meta-analysis comparing outcomes of ED, OM, and TM. METHODS The PubMed database was searched for articles published as of February 1, 2019, for comparative studies reporting outcomes of some combination of ED, OM, and TM. A meta-analysis of outcome parameters was performed assuming random effects. RESULTS Twenty-six studies describing the outcomes of 2577 patients were included. Estimated blood loss was significantly higher with OM than with both TM (p = 0.01) and ED (p < 0.00001). Length of stay was significantly longer with OM than with ED (p < 0.00001). Return to work time was significantly longer in OM than with ED (p = 0.001). Postoperative leg (p = 0.02) and back (p = 0.01) VAS scores, and Oswestry Disability Index scores (p = 0.006) at latest follow-up were significantly higher for OM than for ED. Serum creatine phosphokinase (p = 0.02) and C-reactive protein (p < 0.00001) levels on postoperative day 1 were significantly higher with OM than with ED. CONCLUSIONS Outcomes of TM and OM for lumbar disc herniations are largely equivalent. While this analysis demonstrated that several clinical variables were significantly improved in patients undergoing ED when compared with OM, the magnitude of many of these differences was small and of uncertain clinical relevance, and several of the included studies were retrospective and subject to a high risk of bias. Further high-quality prospective studies are needed before definitive conclusions can be drawn regarding the comparative efficacy of the various surgical treatments for lumbar disc herniations.SHARE THIS:
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* Oncology
(460)
* Outcome
(362)
* Pain
(94)
* Pathogenesis
(5)
* Pediatrics
(68)
* Pituitary
(65)
* Radiation Therapy
(4)
* radiosurgery
(67)
* Randomized clinical trial(42)
* RCT (20)
* Review Article
(9)
* Robotics
(25)
* skull base surgery(97)
* Spinal navigation
(4)
* Spine
(512)
* Stereotactic neurosurgery(32)
* Surgical Anatomy
(50)
* Surgical technique(443)
* Survey
(2)
* Syringomyelia
(3)
* Technology
(41)
* Telemedicine
(1)
* Training
(1)
* Trauma
(48)
* Ultrasound
(4)
* Uncategorized
(120)
* Vascular
(574)
* Virtual Reality
(8)
TOTAL VIEWS
* 0
BLOG STATS
* 476,700 hits
ARCHIVES
Archives Select Month January 2020 December 2019 November 2019 October 2019 September 2019 August 2019 July 2019 June 2019 May 2019 April 2019 March 2019 February 2019 January 2019 December 2018 November 2018 October 2018 September 2018 August 2018 July 2018 June 2018 May 2018 April 2018 March 2018 February 2018 January 2018 December 2017 November 2017 October 2017 September 2017 August 2017 July 2017 June 2017 May 2017 April 2017 March 2017 February 2017 January 2017 December 2016 November 2016 October 2016 September 2016 August 2016 July 2016 June 2016 May 2016 April 2016 March 2016 February 2016 January 2016 December 2015 November 2015 October 2015 September 2015 August 2015 July 2015 June 2015 May 2015 April 2015 March 2015 February 2015 January 2015 December 2014 November 2014 October 2014 September 2014 August 2014 July 2014 June 2014 May 2014 April 2014 March 2014 February 2014 January 2014 December 2013 November 2013 October 2013 September 2013 August 2013 July 2013 June 2013 May 2013 April 2013 March 2013 February 2013 January 2013 December 2012 November 2012 October 2012 September 2012 August 2012 July 2012 June 2012 May 2012 April 2012 March 2012 February 2012 January 2012 December 2011 November 2011 October 2011 September 2011 August 2011 July 2011 June 2011 May 2011 April 2011 March 2011 February 2011 January 2011 December 2010 November 2010 October 2010 September 2010 August 2010 July 2010 June 2010 May 2010 April 2010 March 2010 February 2010 January 2010 December 2009 November 2009 October 2009 September 2009 August 2009CALENDAR
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CATEGORIES
Categories Select Category Academic (13) anatomy (88) Augmented reality (6) Clinical Guide (24) Clinical Trial (30) complications (150) Cranial nerves (29) Cranioplasty (2) CSF disorders (7) Developmental Malformations (73) Education (11) Endoscopy (158) Endovascular (20) Epilepsy (63) Ethics (1) Evidence-based (11) Functional (151) Gamma Knife radiosurgery (14) hydrocephalus (156) Infections (34) intracranial pressure (5) Intraoperative Imaging (66) Laboratory investigation (55) meta-analysis (56) Metabolic disorders (2) Movement Disorders (11) MRI (97) Neuronavigation (58) Neurophysiology (24) neurorradiology (62) O-arm (5) Oncology (460) Outcome (362) Pain (94) Pathogenesis (5) Pediatrics (68) Pituitary (65) Radiation Therapy (4) radiosurgery (67) Randomized clinical trial (42) RCT (20) Review Article (9) Robotics (25) skull base surgery (97) Spinal navigation (4) Spine (512) Stereotactic neurosurgery (32) Surgical Anatomy (50) Surgical technique (443) Survey (2) Syringomyelia (3) Technology (41) Telemedicine (1) Training (1) Trauma (48) Ultrasound (4) Uncategorized (120) Vascular (574) VirtualReality (8)
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