Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Dec 2014
Cavernous sinus cavernous hemangioma: imaging features and therapeutic effect of Gamma Knife radiosurgery.
To investigate the imaging features of cavernous sinus cavernous hemangioma (CSCH) and evaluate the therapeutic effect of Gamma Knife radiosurgery (GKRS) in treatment of CSCH. ⋯ Although bright hyper-intensities on T2WI and significant homogeneous enhancement on contrast-enhanced T1WI are considered as typical imaging characteristics of CSCH, the dynamic process of progressive delayed enhancement on contrast-enhanced MR is more persuasive in diagnosis. According to our study, GKRS could be chosen as an effective and safe alternative treatment for CSCH. We consider that using relatively low marginal dose may get better effects in tumor shrinkage and protection of cranial nerves.
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Clin Neurol Neurosurg · Dec 2014
Current practices in vestibular schwannoma management: a survey of American and Canadian neurosurgeons.
Comprehensive therapy for vestibular schwannomas has changed dramatically over the past fifty years. Previously, neurosurgeons were most likely to treat these tumors via an independent surgical approach. Currently, many neurosurgeons treat vestibular schwannomas employing an interdisciplinary team approach with neuro-otologists and radiation oncologists. This survey aims to determine the current treatment paradigm for vestibular schwannomas among American and Canadian neurosurgeons, with particular attention to the utilization of a team approach to the surgical resection of these lesions. ⋯ The majority of neurosurgeons in the United States and Canada surgically resect vestibular schwannomas via an interdisciplinary approach with the participation of a neuro-otologist. Neurosurgeons in the South appear more likely to surgically treat these tumors alone than neurosurgeons in other regions of the U.S. and Canada.
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Clin Neurol Neurosurg · Dec 2014
Cervical and cervicomedullary spinal cord stimulation for chronic pain: efficacy and outcomes.
The role for spinal cord stimulation (SCS) in the management of chronic spinal cord forms of pain involving cervical dermatomes or the cervicomedullary junction (CMJ) for facial pain remains largely uncharted. ⋯ Cervical and CMJ SCS are safe and efficacious and may provide greater relief along the upper extremities than axially, and in the head rather than in the occipital region.
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Clin Neurol Neurosurg · Dec 2014
Review Meta Analysis Comparative StudyA meta-analysis of interlaminar minimally invasive discectomy compared to conventional microdiscectomy for lumbar disk herniation.
A meta-analysis was conducted to evaluate the evidence that compared the safety and efficacy of interlaminar minimally invasive discectomy (ILMI) and conventional microdiscectomy (MD) for treating lumbar disk herniation (LDH) patients and to develop GRADE based recommendations for using the procedures to treat LDH. Eleven studies, encompassing 1012 patients, met the inclusion criteria. Overall, the results of the meta-analysis indicated that there were significant differences between the two groups in blood loss (SMD=-0.93, 95% CI -1.84, -0.02; p=0.05), and the number of days stays in hospital (SMD=-0.79, 95% CI -1.55, -0.04; p=0.04). ⋯ Compared with MD, ILMI can shorten days in hospital, decrease the mounts of blood loss during surgery. However, the overall GRADE evidence quality was very low. Therefore, further validation is required, and medical institutions should conduct high-quality studies.
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Clin Neurol Neurosurg · Dec 2014
Comparative StudyWide-bore 1.5 T MRI-guided deep brain stimulation surgery: initial experience and technique comparison.
We report results of the initial experience with magnetic resonance image (MRI)-guided implantation of subthalamic nucleus (STN) deep brain stimulating (DBS) electrodes at the University of Wisconsin after having employed frame-based stereotaxy with previously available MR imaging techniques and microelectrode recording for STN DBS surgeries. ⋯ Our initial experience confirms the safety of MRI-guided DBS, setting the stage for future investigations combining physiology and MRI guidance. Further follow-up is required to compare the efficacy of the MRI-guided surgery cohort to that of traditional frame-based stereotaxy.