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Neurosurgical Review

Alba Scerrati, Giovanni Sabatino, Giuseppe Maria Della Pepa, Alessio Albanese, Enrico Marchese, Alfredo Puca, Alessandro Olivi, Carmelo Lucio Sturiale
Thrombosed aneurysms of the middle cerebral artery (MCA) usually show large dimension and complex morphology with neck sclerosis and perforating vessels originating from the sac. Only limited experiences from case reports or small mixed series including thrombosed aneurysms in different locations are available in literature. To systematically review all the pertinent literature, a comprehensive literature review with the search terms "MCA, aneurysm, and thrombosis" and a pooled analysis including our institutional series were performed...
May 22, 2018: Neurosurgical Review
Hui-Hui Sun, Xin Hong, Bing Liu, Jia-Qu Cui, Zhao-Ming Zhou, Xin-Hui Xie, Xiao-Tao Wu
This study was aimed to analyze the survival of patients with spinal chordomas. Patients' data in the Surveillance, Epidemiology, and End Results (SEER) database were retrieved and analyzed statistically. There were 765 patients with spinal chordomas between 1974 and 2013. The overall survival did not improve significantly over decades for patients receiving surgery and radiotherapy (SR) (P = 0.221). There were significant differences in overall survival among subgroups of patients receiving surgery (S), radiotherapy (R), and neither S nor R (NSR) (P = 0...
May 7, 2018: Neurosurgical Review
Ali Tayebi Meybodi, Michael T Lawton
Stereotactic radiosurgery (SRS) and endovascular techniques are commonly used for treating brain arteriovenous malformations (bAVMs). They are usually used as ancillary techniques to microsurgery but may also be used as solitary treatment options. Careful patient selection requires a clear estimate of the treatment efficacy and complication rates for the individual patient. As such, classification schemes are an essential part of patient selection paradigm for each treatment modality. While the Spetzler-Martin grading system and its subsequent modifications are commonly used for microsurgical outcome prediction for bAVMs, the same system(s) may not be easily applicable to SRS and endovascular therapy...
May 4, 2018: Neurosurgical Review
Zhiqin Lin, Meng Zhao, Xiangrong Li, Junmei Wang, Ping Qiu, Folin Lan, Celin Guan, Dongxia Liao, Dongwei Shen, Jing Lu, Shuanglin Que, Zhongli Jiang
Microcystic meningioma (MM) is a rare subtype of intracranial meningiomas, with clinical and radiologic features not well characterized in the literature. Based on our experience, we propose a classification system of intracranial MMs. We reviewed the medical records, radiographic studies, and operative notes of a group of consecutive patients with intracranial MM. The mean age of the 69 patients was 46.8 ± 10.6 years (range, 21-75 years). Three types of intracranial MMs could be identified. Type 1 MMs presented as a solid lesion, hypointense or isointense on T1WI, hyperintense on T2WI, and homogeneous or heterogeneous enhancement, and were found in 43 patients (67...
May 2, 2018: Neurosurgical Review
Tokunori Kanazawa, Hirokazu Fujiwara, Hidenori Takahashi, Yuya Nishiyama, Yuichi Hirose, Saeko Tanaka, Kazunari Yoshida, Hikaru Sasaki
Recent advance in molecular characterization of gliomas showed that patient prognosis and/or tumor chemosensitivity correlate with certain molecular signatures; however, this information is available only after tumor resection. If molecular information is available by routine radiological examinations, surgical strategy as well as overall treatment strategy could be designed preoperatively.With the aim to establish an imaging scoring system for preoperative diagnosis of molecular status in lower-grade gliomas (WHO grade 2 or 3, LrGGs), we investigated 8 imaging features available on routine CT and MRI in 45 LGGs (discovery cohort) and compared them with the status of 1p/19q codeletion, IDH mutations, and MGMT promoter methylation...
April 26, 2018: Neurosurgical Review
Kenichiro Asano, Kosuke Katayama, Kiyohide Kakuta, Hiroki Ohkuma
Screwdriver slipping from the tapping screw head (screwdriver slip) represents a very dangerous situation that leads to the risk of entry into the intracranial operation field. We have developed a screwdriver stopper device to attach to the top of the screwdriver in order to prevent intracranial penetration injuries. We performed 48 craniotomies in our institute. The instrument is made from clear acrylic with a central hole (diameter, 3 mm). We checked the number of screwdriver slip events, as a precursor to intracranial penetration injury, in screwdrivers from five different companies, and compared the results...
April 25, 2018: Neurosurgical Review
Edward Christopher, Michael T C Poon, Laurence J Glancz, Peter J Hutchinson, Angelos G Kolias, Paul M Brennan
Increasing age and lower pre-operative Glasgow coma score (GCS) are associated with worse outcome after surgery for chronic subdural haematoma (CSDH). Only few studies have quantified outcomes specific to the very elderly or comatose patients. We aim to examine surgical outcomes in these patient groups. We analysed data from a prospective multicentre cohort study, assessing the risk of recurrence, death, and unfavourable functional outcome of very elderly (≥ 90 years) patients and comatose (pre-operative GCS ≤ 8) patients following surgical treatment of CSDH...
April 21, 2018: Neurosurgical Review
Josephine R Coury, Brittany N Davis, Christoforos P Koumas, Giovanna S Manzano, Amir R Dehdashti
Craniopharyngiomas (CPs) are rare, benign tumors derived from Rathke's pouch, known for their high recurrence rates and associated morbidity and mortality. Despite significant investigation on risk factors for recurrence, a lack of consensus persists. Recent research suggests that specific histopathological and molecular characteristics are prognostic for disease progression. In this systematic review, we analyzed and consolidated key features of CPs that contribute to increased recurrence rates. This systematic review was performed in accordance with PRISMA guidelines...
April 17, 2018: Neurosurgical Review
Christian A Bohoun, Kentaro Naito, Toru Yamagata, Samantha Tamrakar, Kenji Ohata, Toshihiro Takami
Although spinal instrumentation technique has undergone revolutionary progress over the past few decades, it may still carry significant surgery-related risks. The purpose of the present study was to assess the radiological accuracy of spinal screw instrumentation using a hybrid operating room (OR) and quantify the related radiation exposure. This retrospective study included 33 cases of complex spine fusion surgeries that were conducted using a hybrid OR with a flat panel detector (FPD) angiography system...
April 16, 2018: Neurosurgical Review
Saadat Kamran, Abdul Salam, Naveed Akhtar, Atlantic D'soza, Ashfaq Shuaib
Identification of factors in malignant middle cerebral artery (MMCA) stroke patients that may be useful in selecting patients for DHC. This study was a retrospective multicenter study of patients referred for DHC based on the criteria of the randomized control trials of DHC in MMCA stroke. Demographic, clinical, and radiology data were analyzed. Patients who underwent DHC were compared to those who survived without surgery. Two hundred three patients with MMCA strokes were identified: 137 underwent DHC, 47 survived without DHC, and 19 refused surgery and died...
April 12, 2018: Neurosurgical Review
Manjul Tripathi, Aman Batish, Narendra Kumar, Chirag Kamal Ahuja, Arun S Oinam, Rupinder Kaur, Rajasekhar Narayanan, Jenil Gurnaani, Amanjot Kaur
Gamma knife radiosurgery (GKRS) has emerged as a suitable primary treatment option for confined cavernous sinus tumors (CSTs) and residual/recurrent benign tumors extending from the surrounding neighborhood. The aim of this review was to further investigate the safety and efficacy of single-fraction GKRS for primary confined CSTs (hemangioma, meningioma, and schwannoma). This was a retrospective analysis of 16 patients of CSTs, primarily treated with GKRS between 2009 and 2017. The patients underwent follow-up clinical and radiological evaluation at a regular interval...
April 9, 2018: Neurosurgical Review
Torstein R Meling, Michele Da Broi, David Scheie, Eirik Helseth
To identify differences between skull base meningiomas (SBM) and non-skull base meningiomas (NSBM). All adult patients (18.0-69.9 years) operated for intracranial meningiomas between 1990 and 2010 at our institution were investigated. Al-Mefty's definition was used to dichotomize tumors into SBM and NSBM. Overall, 1148 consecutive patients were identified. Median age at surgery was 54.2 years [18.1-69.9]. Median follow-up was 7.4 years [0.0-20.9]. There were 562 patients (49%) with SBM and 586 (51%) with NSBM...
April 7, 2018: Neurosurgical Review
Aysun Uz
There are still different descriptions of the segmentation of the posterior cerebral artery, although there is a radiological and anatomical consensus on the segmentation of the anterior and the middle cerebral artery. This study aims to define the most appropriate localization for origin and end points of the segments through reviewing the segmentation of the posterior cerebral artery. The segments and the cortical branches originating from those segments of the 40 posterior cerebral arteries of 20 cadaver brains were examined under operating microscope...
April 6, 2018: Neurosurgical Review
Brian Fiani, Syed A Quadri, Mudassir Farooqui, Alessandra Cathel, Blake Berman, Jerry Noel, Javed Siddiqi
Whenever any new technology is introduced into the healthcare system, it should satisfy all three pillars of the iron triangle of health care, which are quality, cost-effectiveness, and accessibility. There has been quite advancement in the field of spine surgery in the last two decades with introduction of new technological modalities such as CAN and surgical robotic devices. MAZOR SpineAssist/Renaissance was the first robotic system to be approved for the use in spine surgeries in the USA in 2004. In this review, the authors sought to determine if the current literature supports this technology to be cost-effective, accessible, and improve the quality of care for individuals and populations by increasing the likelihood of desired health outcomes...
April 3, 2018: Neurosurgical Review
Dorothee Mielke, Vesna Malinova, Onnen Moerer, Patricia Suntheim, Martin Voit, Veit Rohde
We retrospectively compared the outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients treated in a neurosurgical ICU (nICU) between 1990 and 2005 with that of patients treated in a general ICU (gICU) between 2005 and 2013 with almost identical treatment strategies. Among other parameters, we registered the initial Hunt and Hess grade, Fisher score, the incidence of vasospasm, and outcome. A multivariate analysis (logistic regression model) was performed to adjust for different variables. In total, 755 patients were included in this study with 456 patients assigned to the nICU and 299 patients to the gICU...
March 30, 2018: Neurosurgical Review
Patrick Schuss, Alexis Hadjiathanasiou, Simon Brandecker, Christian Wispel, Valeri Borger, Ági Güresir, Hartmut Vatter, Erdem Güresir
Patients presenting with spontaneous, non-aneurysmal subarachnoid hemorrhage (SAH) achieve better outcomes compared to patients with aneurysmal SAH. Nevertheless, some patients develop shunt-dependent hydrocephalus during treatment course. We therefore analyzed our neurovascular database to identify factors determining shunt dependency after non-aneurysmal SAH. From 2006 to 2016, 131 patients suffering from spontaneous, non-aneurysmal SAH were admitted to our department. Patients were stratified according to the distribution of cisternal blood into patients with perimesencephalic SAH (pSAH) versus non-perimesencephalic SAH (npSAH)...
March 29, 2018: Neurosurgical Review
Le-Bao Yu, Dong Zhang, Shao-Hua Yang, Ji-Zong Zhao
Giant intrapetrous internal carotid aneurysms (petrous ICA aneurysm) are rare. A giant petrous ICA aneurysm presenting with otorrhagia and coil exposure to the external auditory meatus (EAM) after endovascular treatment has never been documented before. The authors report here a case of successful surgical trapping with bypass intervention of a giant petrous ICA aneurysm presenting with coil exposure after endovascular treatment. A 58-year-old man presented with persistent otorrhagia having been admitted to our hospital because of the recurrence of a giant petrous ICA aneurysm after repeated embolization treatments with coils...
March 23, 2018: Neurosurgical Review
Carmine Antonio Donofrio, Filippo Gagliardi, Marcella Callea, Camillo Ferrari da Passano, Maria Rosa Terreni, Andrea Cavalli, Alfio Spina, Stefania Acerno, Michele Bailo, Samer K Elbabaa, Pietro Mortini
Pilocytic astrocytomas (PAs) are benign glial tumors and one of the most common childhood posterior fossa tumors. Spontaneous intratumoral hemorrhage in PAs occurs occasionally, in about 8-20% of cases. Cerebellar hemorrhages in pediatric population are rare and mainly due to head injuries, rupture of vascular malformations, infections, or hematological diseases. We have investigated the still controversial and unclear pathophysiology underlying intratumoral hemorrhage in PAs. Bleeding in low-grade tumors might be related to structural abnormalities and specific angio-architecture of tumor vessels, such as degenerative mural hyalinization, "glomeruloid" endothelial proliferation, presence of encased micro-aneurysms, and glioma-induced neoangiogenesis...
March 22, 2018: Neurosurgical Review
Junhong Li, Ruofei Liang, Chen Song, Yufan Xiang, Yanhui Liu
Growing evidence from recent studies have revealed that long non-coding RNA (lncRNA) might be a useful prognostic biomarker for glioma; we therefore conducted the current meta-analysis to evaluate prognostic and clinicopathological predictive value of lncRNA expression for glioma patients. Eligible studies were identified through multiple research strategies in PubMed, EMBASE, Web of Science, and Cochrane Library up to May 2017. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were utilized to calculate patient's survival...
March 21, 2018: Neurosurgical Review
Marcel A Kamp, Maxine Dibué-Adjei, Jan F Cornelius, Philipp J Slotty, Hans-Jakob Steiger, Sebastian A Ahmadi, Marion Rapp, Michael Sabel
The oncological impact of cytoreductive surgery for malignant glioma has been analyzed in a few prospective, randomized studies; however, the impact of different cytoreductive surgical techniques of cerebral tumors remains controversial. Despite retrospective analyses revealing an oncological impact of complete surgical resection in cerebral metastases and low-grade glioma, the oncological impact of further extension of resection to a supramarginal resection remains disputable lacking high-grade evidence: supramarginal resections have yet to be analyzed in malignant glioma...
March 20, 2018: Neurosurgical Review
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