Journal of neurosurgery
-
Journal of neurosurgery · Mar 2011
Functional mapping-guided resection of low-grade gliomas in eloquent areas of the brain: improvement of long-term survival. Clinical article.
Low-grade gliomas (LGGs) frequently infiltrate highly functional or "eloquent" brain areas. Given the lack of long-term survival data, the prognostic significance of eloquent brain tumor location and the role of functional mapping during resective surgery in presumed eloquent brain regions are unknown. ⋯ Presumed eloquent location of LGGs is an important but modifiable risk factor predicting disease progression and death. Delineation of true functional and nonfunctional areas by intraoperative mapping in high-risk patients to maximize tumor resection can dramatically improve long-term survival.
-
Journal of neurosurgery · Mar 2011
Results with judicious modern neurosurgical management of parasagittal and falcine meningiomas. Clinical article.
The management of parasagittal and falcine meningiomas centers around the relationship between the tumor and the venous anatomy of the superior sagittal sinus (SSS) and the bridging veins. The present study aims to address surgical outcomes in a focused cohort of these patients for which there is not clinical equipoise between radiosurgery and transcranial resection. ⋯ Importantly, these data provide a more modern estimate of the expected outcomes that can be obtained with treatment of these tumors, in which a combination of image guidance, advanced microsurgical tools, and conformal radiation treatments is used.
-
Journal of neurosurgery · Mar 2011
Cardiac standstill for cerebral aneurysms in 103 patients: an update on the experience at the Barrow Neurological Institute. Clinical article.
The aim of this study was to clarify the surgical indications, risks, and long-term clinical outcomes associated with the use of deep hypothermic circulatory arrest for the surgical treatment of intracranial aneurysms. ⋯ Cardiac standstill remains an important treatment option for a small subset of complex and giant posterior circulation aneurysms. Compared with the natural history of the disease, the risk associated with this procedure is acceptable.
-
Journal of neurosurgery · Mar 2011
Postoperative seizures following the resection of convexity meningiomas: are prophylactic anticonvulsants indicated? Clinical article.
Seizures in the perioperative period are a well-recognized clinical entity in the setting of brain tumor surgery. At present, the suitability of antiepileptic prophylaxis in patients following brain tumor surgery is unclear, especially in those without prior seizures. Given the paucity of tumor-type and site-specific data, the authors evaluated the incidence of postoperative seizures in patients with convexity meningiomas and no prior seizures. ⋯ While it is thought that the routine use of prophylactic antiepileptics may prevent new seizures in patients undergoing surgery for a convexity meningioma, the rate of new seizures in untreated patients is probably very low. Data in this study call into question whether the cost and side effects of these medications are worth the small benefit their administration may confer.
-
Journal of neurosurgery · Mar 2011
Sixteen-year single-surgeon experience with coil embolization for ruptured intracranial aneurysms: recurrence rates and incidence of late rebleeding. Clinical article.
Over a 16-year period, 570 patients presenting with acute aneurysmal subarachnoid hemorrhage were successfully treated using endosaccular coil embolization within 30 days of hemorrhage by a single surgeon. Patients were followed to assess the stability of aneurysm occlusion and its longer-term efficacy in protecting against rebleeding. ⋯ Periodic follow-up with angiographic studies after coil embolization is recommended to identify aneurysm recurrence and patients at a high risk of late rebleeding in the medium term. More frequent follow-up is recommended for patients harboring coincidental unruptured aneurysms.