Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Jan 2015
Skull base atypical meningioma: long term surgical outcome and prognostic factors.
The aim of this study was to examine the clinical outcomes of treating atypical meningioma at the skull base region following surgical resection and adjuvant radiotherapy, and to analyze the association between clinical characteristics and progression free survival. ⋯ For patients with skull base atypical meningiomas, GTR is desirable for longer PFS, unless radical excision is expected to lead to severe complications. Adjuvant radiation therapy is advisable to reduce tumor recurrence regardless of the extent of surgical resection. Age of disease onset and the MIB-1 index of the tumor were both independent prognostic factors of clinical outcome.
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Clin Neurol Neurosurg · Jan 2015
Clinical outcomes after neurogenic stress induced cardiomyopathy in aneurysmal sub-arachnoid hemorrhage: a prospective cohort study.
Neurogenic stress cardiomyopathy (NCM) has been associated with poor outcomes in the setting of aneurysmal subarachnoid hemorrhage (aSAH). Much less is known regarding recovery of cardiac function. The aim of this prospective cohort study was to study the rate of early cardiac recovery after NCM and the potential effect of NCM on short term functional recovery. A secondary aim sought to determine whether certain biomarkers may be associated with the development of NCM. ⋯ NCM is a frequent complication associated with aSAH. The onset of the disease occurs early in the course of aSAH and an elevated BNP and troponin may be associated with the onset of NCM. Cardiac function often remains impaired during the acute recovery phase potentially impeding resuscitation during this period. The routine use of short term follow-up echocardiography may be recommended.
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Clin Neurol Neurosurg · Jan 2015
Case ReportsIntegrated functional neuronavigation-guided resection of small meningiomas of the atrium via the paramedian parieto-occipital approach.
Small meningiomas located in the atrium of the lateral ventricle remain a challenge for neurosurgeons due to the eloquent nature of the surrounding anatomy. Functional MRI (fMRI) and diffusion tensor tractography (DTT) allow for in vivo demonstrations of eloquent cortical structures and neuronal fiber tracts, respectively. Our objective is to evaluate the contribution of functional neuronavigation combined with fMRI and DTT results to surgical outcomes. ⋯ With the aid of the neuronavigation that incorporates fMRI and DTT results, small meningiomas located in the atrium of the lateral ventricle can be safely resected through the paramedian parieto-occipital approach.
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Clin Neurol Neurosurg · Jan 2015
Treatment results and outcome in elderly patients with glioblastoma multiforme--a retrospective single institution analysis.
Although glioblastoma multiforme is more common in patients older than 65 years, the elderly population is often excluded from clinical studies. Decision making in this subgroup can be challenging due to the lack of evidence for different neurosurgical and adjuvant treatment strategies. ⋯ It appears that more aggressive treatment regimens can lead to longer overall survival in elderly glioblastoma multiforme patients. Gross total resection should be offered whenever safely possible; otherwise, biopsy may be preferred. Non-surgical treatment should consist of postoperative radiotherapy and concomitant and/or adjuvant chemotherapy. Possibly higher rates of hematological side effects in concomitant chemotherapy need to be further investigated.
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Clin Neurol Neurosurg · Dec 2014
Peripheral field stimulation for thoracic post herpetic neuropathic pain.
Post herpetic neuralgia is a chronic, debilitating pain with very few management options and is often refractory to treatment. We present our experience with a series of 4 patients who underwent subcutaneous peripheral field stimulation for treatment of thoracic post herpetic neuropathic pain. ⋯ Peripheral field stimulation for the treatment of post herpetic neuropathic pain is a safe and effective method for pain relief for an extremely complex problem with very few solutions. Patient selection and proper lead placement is most important for the success of treatment.