Journal of neurosurgery
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Journal of neurosurgery · Apr 2014
Observational StudyEffects of cerebral magnetic resonance imaging in outpatients on observed incidence of intracranial tumors and patient survival: a national observational study.
It is assumed that the observed increase in brain tumor incidence may at least partially be explained by increased use of MRI. However, to date no direct estimate of this effect is available. The authors undertook this registry-based study to examine whether regional frequencies of cerebral MRI use correlate to regional incidence rates of intracranial tumors and survival of patients with these lesions. ⋯ Presumably due to the incidental discovery of benign extraaxial tumors, regional differences in the use of cerebral MRI in outpatients affect observed incidence rates of intracranial tumors.
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Journal of neurosurgery · Apr 2014
An extent of resection threshold for recurrent glioblastoma and its risk for neurological morbidity.
Despite improvements in the medical and surgical management of patients with glioblastoma, tumor recurrence remains inevitable. For recurrent glioblastoma, however, the clinical value of a second resection remains uncertain. Specifically, what proportion of contrast-enhancing recurrent glioblastoma tissue must be removed to improve overall survival and what is the neurological cost of incremental resection beyond this threshold? ⋯ For recurrent glioblastomas, an improvement in overall survival can be attained beyond an 80% EOR. This survival benefit must be balanced against the risk of neurological morbidity, which does increase with more aggressive cytoreduction, but only in the early postoperative period. Interestingly, this putative EOR threshold closely approximates that reported for newly diagnosed glioblastomas, suggesting that for a subset of patients, the survival benefit of microsurgical resection does not diminish despite biological progression.
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Journal of neurosurgery · Apr 2014
Subtle structural change demonstrated on T2-weighted images after clipping of unruptured intracranial aneurysm: negative effects on cognitive performance.
The mechanisms underlying neurocognitive changes after surgical clipping of unruptured intracranial aneurysms (UIAs) are poorly understood. The aim of this study was to investigate factors that determine postoperative cognitive decline after UIA surgery. ⋯ Minimal structural damage visualized on T2-weighted images at 6 months as a result of factors such as pial/microvascular injury and excessive retraction during surgical manipulation could cause subtle but significant negative effects on postoperative neurocognitive function after surgical clipping of a UIA. However, this detrimental effect was small, and based on the group-rate analysis, the authors conclude that successful and meticulous surgical clipping of a UIA does not adversely affect postoperative cognitive function.
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Journal of neurosurgery · Apr 2014
Hemorrhagic complications of ventriculostomy: incidence and predictors in patients with intracerebral hemorrhage.
Ventriculostomy--the placement of an external ventricular drain (EVD)--is a common procedure performed in patients with acute neurological injury. Although generally considered a low-risk intervention, recent studies have cited higher rates of hemorrhagic complications than those previously reported. The authors sought to determine the rate of postventriculostomy hemorrhage in a cohort of patients with intracerebral hemorrhage (ICH) and to identify predictors of hemorrhagic complications of EVD placement. ⋯ Advanced age is predictive of EVD-related hemorrhage in patients with ICH. While postventriculostomy hemorrhage is common, it appears to be of minor clinical significance in the majority of patients.
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Journal of neurosurgery · Apr 2014
Stereotactic radiosurgery for Spetzler-Martin Grade III arteriovenous malformations.
The purpose of this study was to define the outcomes and risks of stereotactic radiosurgery (SRS) for Spetzler-Martin (SM) Grade III arteriovenous malformations (AVMs). ⋯ Treatment with SRS was an effective and relatively safe management option for SM Grade III AVMs. Although patients with residual AVMs remained at risk for hemorrhage during the latency interval, the cumulative 10-year 9% hemorrhage risk in this series may represent a significant reduction compared with the expected natural history.