Acta neurochirurgica
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Acta neurochirurgica · Sep 2015
Case ReportsSpontaneous subarachnoid hemorrhage and negative initial vascular imaging--should further investigation depend upon the pattern of hemorrhage on the presenting CT?
Multiple investigations are usually performed in patients with spontaneous SAH who have negative initial angiography. This study aimed to evaluate the most appropriate use of additional imaging studies and how this may be influenced by the findings of the initial CT. ⋯ Certain patterns of SAH are associated with a low yield of abnormalities on repeat imaging if the initial angiography is normal. The authors believe that the pattern of hemorrhage on the presenting CT should be used to guide the most appropriate use of further imaging modalities and present a diagnostic algorithm for this purpose.
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Acta neurochirurgica · Sep 2015
Stereotactic Gamma Knife surgery safety and efficacy in the management of symptomatic benign confined cavernous sinus meningioma.
Considering the proximity to cranial nerves from II to VI and the internal carotid artery microsurgery for cavernous sinus meningioma (CSM) has its limits of complete resection, with high potential tumor recurrences, cranial nerve and vascular morbidity. Gamma Knife surgery (GKS) is an advanced modality as primary treatment for patients harboring symptomatic benign confined CSM as well as adjuvant therapy to postoperative residual tumor giving a high rate of tumor control, stabilizing or even improving clinical condition with low morbidity. ⋯ Gamma Knife surgery is a safe and effective option for the treatment of cavernous sinus meningioma not only as an adjuvant to surgery but also as an alternative to surgical removal in tumors confined mainly to the cavernous sinus.
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Acta neurochirurgica · Sep 2015
Observational StudyComparison of pulsatile and static pressures within the intracranial and lumbar compartments in patients with Chiari malformation type 1: a prospective observational study.
In Chiari malformation type 1 (CMI), the obstruction of cerebrospinal fluid (CSF) flow through the foramen magnum is believed to cause alterations of intracranial pressure (ICP) pulsations. Foramen magnum decompression (FMD) is therefore considered a treatment of choice. However, the pathophysiology of CMI is poorly understood and it remains unknown how ICP alterations relate to symptoms and radiological findings. This study was undertaken to measure pulsatile pressure and its gradient between intracranial and lumbar compartments, and to determine its relationship to clinical and radiological findings. ⋯ In this cohort, the pulsatile ICP was elevated in 69 %. The intracranial-lumbar pulsatile pressure gradient was abnormal in 71 % and significantly higher in patients with syringomyelia. The elevated pulsatile ICP significantly correlated with pulsatile pressure gradient; no similar correlation was found for static ICP. We interpret the results as providing evidence of impaired intracranial compliance as an important pathophysiological mechanism in CMI.
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Acta neurochirurgica · Sep 2015
Review Meta AnalysisIntracranial meningiomas and seizures: a review of the literature.
Seizures are a common manifestation of brain tumors, but literature on the incidence of seizures before and after surgery for meningiomas is limited, and principles for use of antiepileptic drugs (AEDs) are controversial. ⋯ Seizures are a common manifestation of meningiomas, but about 80 % patients with preoperative seizures can be seizure free after tumor removal. Prospective controlled AED trials specifically on meningioma patients are much needed.
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Acta neurochirurgica · Sep 2015
Comparative StudyPrognostic value of FOUR and GCS scores in determining mortality in patients with traumatic brain injury.
The Glasgow Coma Scale (GCS) is considered the gold standard for assessment of unconsciousness in patients with traumatic brain injury (TBI) against which other scales are compared. To overcome the disadvantages of GCS, the Full Outline Of Unresponsiveness (FOUR) score was proposed. We aimed to compare the predictability of FOUR score and GCS for early mortality, after moderate and severe TBI. ⋯ The predictive value of the FOUR score on admission of patients with TBI is no better than the GCS score.