Journal of neurosurgery
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Journal of neurosurgery · Jan 2012
Review Meta AnalysisHypertonic saline for treating raised intracranial pressure: literature review with meta-analysis.
Currently, mannitol is the recommended first choice for a hyperosmolar agent for use in patients with elevated intracranial pressure (ICP). Some authors have argued that hypertonic saline (HTS) might be a more effective agent; however, there is no consensus as to appropriate indications for use, the best concentration, and the best method of delivery. To answer these questions better, the authors performed a review of the literature regarding the use of HTS for ICP reduction. ⋯ The available data are limited by low patient numbers, limited RCTs, and inconsistent methods between studies. However, a greater part of the data suggest that HTS given as either a bolus or continuous infusion can be more effective than mannitol in reducing episodes of elevated ICP. A meta-analysis of 8 prospective RCTs showed a higher rate of treatment failure or insufficiency with mannitol or normal saline versus HTS.
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Journal of neurosurgery · Jan 2012
Review Case ReportsReducing hemorrhagic complications in functional neurosurgery: a large case series and systematic literature review.
Hemorrhagic complications carry by far the highest risk of devastating neurological outcome in functional neurosurgery. Literature published over the past 10 years suggests that hemorrhage, although relatively rare, remains a significant problem. Estimating the true incidence of and risk factors for hemorrhage in functional neurosurgery is a challenging issue. ⋯ Age and a history of hypertension are associated with an increased risk of hemorrhage in functional neurosurgery. Surgical factors that increase the risk of hemorrhage include the use of MER and sulcal or ventricular incursion. The meticulous use of neuroimaging-both in planning the trajectory and for target verification-can avoid all of these surgery-related risk factors and appears to carry a significantly lower risk of hemorrhage and associated permanent deficit.
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The purpose of this ongoing study is to compare the safety and efficacy of microsurgical clipping and endovascular coil embolization for the treatment of acutely ruptured cerebral aneurysms and to determine if one treatment is superior to the other by examining clinical and angiographic outcomes. The authors examined the null hypothesis that no difference exists between the 2 treatment modalities in the setting of subarachnoid hemorrhage (SAH). The current report is limited to the clinical results at 1 year after treatment. ⋯ One year after treatment, a policy of intent to treat favoring coil embolization resulted in fewer poor outcomes than clip occlusion. Although most aneurysms assigned to the coil treatment group were treated by coil embolization, a substantial number crossed over to surgical clipping. Although a policy of intent to treat favoring coil embolization resulted in fewer poor outcomes at 1 year, it remains important that high-quality surgical clipping be available as an alternative treatment modality.
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Journal of neurosurgery · Jan 2012
ReviewCerebral aneurysms with intrasellar extension: a systematic review of clinical, anatomical, and treatment characteristics.
Intrasellar aneurysms are rare lesions that often mimic pituitary tumors, potentially resulting in catastrophic outcomes if they are not appropriately recognized. The authors aimed to characterize the clinical and anatomical details of this poorly defined entity in the modern era of neuroimaging and open/endovascular neurosurgery. ⋯ Aneurysms with intrasellar extension typically present due to mass effect on surrounding structures, and they can be classified as infradiaphragmatic cavernous or clinoid segment ICA aneurysms, or supradiaphragmatic ophthalmic ICA or anterior communicating artery aneurysms. Varying approaches exist for treating these complex aneurysms, and intervention strategies depend substantially on the anatomical subtype.
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Journal of neurosurgery · Jan 2012
Gamma Knife surgery for nonvestibular schwannomas: radiological and clinical outcomes.
Most intracranial schwannomas arise from cranial nerve (CN) VIII. Stereotactic radiosurgery is a mainstay of treatment for vestibular schwannomas. Intracranial schwannomas arising from other CNs are much less common. We evaluate the efficacy of Gamma Knife surgery on nonvestibular schwannomas including trigeminal, hypoglossal, abducent, facial, trochlear, oculomotor, glossopharyngeal, and jugular foramen tumors. ⋯ Gamma Knife surgery is a reasonably effective treatment option for patients with nonvestibular schwannomas. Patients require careful follow-up for tumor progression and signs of neurological deterioration.