Acta neurochirurgica
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Acta neurochirurgica · Dec 2018
External validation of cerebral aneurysm rupture probability model with data from two patient cohorts.
For a treatment decision of unruptured cerebral aneurysms, physicians and patients need to weigh the risk of treatment against the risk of hemorrhagic stroke caused by aneurysm rupture. The aim of this study was to externally evaluate a recently developed statistical aneurysm rupture probability model, which could potentially support such treatment decisions. ⋯ The model's performance measures indicated a good generalizability for data acquired at different clinical institutions. Combining the model-based and similarity-based approach could further improve the assessment and interpretation of new cases, demonstrating its potential use for clinical risk assessment.
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Acta neurochirurgica · Dec 2018
Risk factors for growth of conservatively managed unruptured intracranial aneurysms.
Unruptured intracranial aneurysms (UIAs) occur in 2-3% of the adult population, but, once discovered, do not always require treatment. Untreated patients are usually followed with serial imaging to identify interval growth. In this study, we assessed the risk and risk factors for growth in a homogenous series of patients with conservatively managed UIAs. ⋯ Conservatively managed UIAs in patients without prior history of SAH have a 2.9% risk of growth per aneurysm-year. UIAs greater than 5 mm in diameter, those located at the basilar artery apex, or patients who experience a decrease in BMI are more likely to grow and warrant closer follow-up. The risk of aneurysm growth is increased in the few years after diagnosis and decreases afterward.
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Acta neurochirurgica · Dec 2018
Case ReportsEight-year survival of a recurrent glioblastoma patient treated with molecularly tailored therapy: a case report.
Treatment options for recurrent glioblastoma are scarce; targeted therapy trials were disappointing, probably due to enrollment of patients without molecular selection. We treated with bevacizumab and erlotinib a 66-year-old male suffering from recurrent glioblastoma, IDH-wildtype and MGMT unmethylated, after three neurosurgeries. ⋯ Notably, histology of further recurrence after therapy was reminiscent of sarcoma. We suggest a thorough molecular screening for personalization of targeted therapy in recurrent glioblastoma.
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Acta neurochirurgica · Dec 2018
Review Meta AnalysisRadiosurgery and fractionated radiotherapy for cavernous sinus meningioma: a systematic review and meta-analysis.
Radiosurgery (RS) and fractionated radiotherapy (FRT) are part of the therapeutic armamentarium for the management of cavernous sinus meningiomas. We propose a systematic review of the local tumor control and clinical outcomes after monofractionated radiosurgical treatment, including gamma knife radiosurgery (GKRS) and linear accelerator (Linac RS), or fractionated radiotherapy. ⋯ RS achieved a twice-higher rate of tumor volume regression than FRT. GKRS series reported an improvement in visual acuity in 21% of the cases. GKRS, Linac, and FRT provided similar clinical post therapeutic outcomes for the trigeminal and oculomotor CN.
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Acta neurochirurgica · Dec 2018
Spinal cord stimulation modulates descending pain inhibition and temporal summation of pricking pain in patients with neuropathic pain.
Spinal cord stimulation (SCS) is an established treatment option for patients with refractory chronic pain conditions. While effects of SCS on dorsal horn neuronal circuitries are intensively studied, current knowledge on the impact of SCS on descending pain pathways is scarce and relies on preclinical data. We aimed to address this topic and hypothesized a significant effect of SCS on descending pain modulation. In light of current efforts to determine the sensitivity of "static" versus "dynamic" somatosensory parameters to characterize pathophysiological pain conditions, all SCS patients were carefully investigated using both classes of somatosensory outcome parameters. ⋯ Our study provides first human evidence for an impact of SCS on descending pain pathways in the dorsolateral funiculus and emphasizes the significance of "dynamic" pain measures like "CPM"-efficacy and "temporal summation" to evaluate SCS treatment effects. Future prospective studies may use these measures of nociceptive processing to predict SCS therapy response.