Journal of neurosurgery
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Journal of neurosurgery · Feb 2015
Comparative StudyAttrition rates in neurosurgery residency: analysis of 1361 consecutive residents matched from 1990 to 1999.
The objective of this study is to determine neurosurgery residency attrition rates by sex of matched applicant and by type and rank of medical school attended. ⋯ Overall, neurosurgery training attrition rates are low. Women have had greater attrition than men during and after neurosurgery residency training. International and private medical school alumni had higher attrition than public medical school alumni.
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Journal of neurosurgery · Feb 2015
Comparative StudyDetection of p53 mutations in proliferating vascular cells in glioblastoma multiforme.
Glioblastoma multiforme (GBM), one of the most aggressive tumors in humans, is highly angiogenic. However, treatment with the angiogenesis inhibitor bevacizumab has not significantly prolonged overall patient survival times. GBM resistance to angiogenesis inhibitors is attributed to multiple interacting mechanisms. Although mesenchymal transition via glioma stem-like cells has attracted attention, it is considered a poor biomarker. There is no simple method for differentiating tumor-derived and reactive vascular cells from normal cells. The authors attempted to detect the mesenchymal transition of tumor cells by means of p53 and isocitrate dehydrogenase 1 (IDH1) immunohistochemistry. ⋯ Some microvascular proliferation clusters in GBM result from mesenchymal transition. The identification of useful markers might reveal this phenomenon as an infrequent event in GBMs.
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Stereotactic radiosurgery (SRS) has become a common treatment modality for intracranial meningiomas. Skull base meningiomas greater than 8 cm3 in volume have been found to have worse outcomes following SRS. When symptomatic, patients with these tumors are often initially treated with resection. For tumors located in close proximity to eloquent structures or in patients unwilling or unable to undergo a resection, SRS may be an acceptable therapeutic approach. In this study, the authors review the SRS outcomes of skull base meningiomas greater than 8 cm3 in volume, which corresponds to a lesion with an approximate diameter of 2.5 cm. ⋯ Stereotactic radiosurgery affords a reasonable rate of tumor control for large skull base meningiomas and does so with a low incidence of neurological deficits. Those with a tumor less than 14 cm3 in volume and without presenting CN deficit from III to VI were more likely to have effective tumor control.
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Journal of neurosurgery · Feb 2015
Biography Historical ArticleMarching beyond the sella: Gerard Guiot and his contributions to neurosurgery.
Gerard Guiot (1912-1998) was one of the most renowned and innovative neurosurgeons of the 20th century. His pivotal and revolutionary role in advancing transsphenoidal surgery has been recorded in many historical vignettes, yet his outstanding contributions to the advancement of neurosurgery outside the confines of the sella have not been described in a detailed fashion. In this article, the authors discuss the life and achievements of Professor Guiot and present a comprehensive description of his contributions to the field of neurosurgery, including cerebrovascular, spine, craniofacial, stereotactic functional, and endoscopic surgery.
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Journal of neurosurgery · Feb 2015
Treatment by specialist surgical neurooncologists improves survival times for patients with malignant glioma.
Surgeries for CNS tumors are frequently performed by general neurosurgeons and by those who specialize in surgical neurooncology. Subspecialization in neurosurgical practice has become common and may improve patient morbidity and mortality rates. However, the potential benefits for patients of having their surgeries performed by surgical neurooncologists remain unclear. Recently, a shift in patient care to those who practice predominantly surgical neurooncology has been promoted. Evidence for this practice is lacking and therefore requires fundamental investigation. ⋯ The prognosis for glioblastoma multiforme remains dire, and improved treatments are urgently needed. This study provides evidence for a survival benefit when surgery is performed by specialist neurooncology neurosurgeons. The benefit might be attributable to increased tumor resection. Furthermore, specialist neurooncology surgical care may reduce the number of surgical patient deaths and length of inpatient stay. These findings support the recommendations for subspecialization within surgical neurooncology and advocate for care of these patients by specialists.