Journal of neurosurgery
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Journal of neurosurgery · Sep 2016
The falling rates of hospital admission, case fatality, and population-based mortality for subarachnoid hemorrhage in England, 1999-2010.
OBJECTIVE In this study, the authors examined trends in population-based hospital admission rates, patient-level case fatality rates (CFRs), and population-based mortality rates for nontraumatic (spontaneous) subarachnoid hemorrhage (SAH) in England. METHODS Population-based admission and mortality data (59,599 people admitted to a hospital with SAH, 1999-2010; 37,836 people whose death certificates mentioned SAH, 1995-2010) were analyzed. RESULTS Hospital admission rates for SAH per million population declined by 18.3%, from 100.4 (95% CI 97.6-103.1) in 1999 to 82.0 (95% CI 79.7-84.4) in 2010. ⋯ It is also, in part, attributable to increased survival after SAH. The available data do not allow us to compare the effects of different treatment methods for SAH on case fatality and mortality. During the period of study, mortality rates declined by almost 40%, and it is likely that there are a number of factors contributing to this substantial improvement in outcomes for SAH patients in England.
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Journal of neurosurgery · Sep 2016
Case ReportsA preliminary study of the clinical application of optic pathway diffusion tensor tractography in suprasellar tumor surgery: preoperative, intraoperative, and postoperative assessment.
OBJECT Visual impairments are the most common objective manifestations of suprasellar lesions. Diffusion tensor imaging (DTI) is a noninvasive MRI modality that depicts the subcortical white matter tracts in vivo. In this study the authors tested the value of visual pathway tractography in comparison with visual field and visual acuity analyses. ⋯ CONCLUSIONS Visual pathway DTI tractography appears to be a promising adjunct to the standard clinical and paraclinical visual examinations in patients with suprasellar mass lesions. The intraoperative findings, in particular the distance between optic tract fibers, can predict visual outcome after tumor resection. Furthermore, postoperative application of this technique may be useful in following anterior optic pathway recovery.
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Meningiomas are the most common primary intracranial neoplasms in adults. Current histopathological grading schemes do not consistently predict their natural history. ⋯ Furthermore, the recent application of unbiased next-generation sequencing approaches has implicated several novel genes whose mutations underlie a substantial percentage of meningiomas. These insights may serve to craft a molecular taxonomy for meningiomas and highlight putative therapeutic targets in a new era of rational biology-informed precision medicine.
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Journal of neurosurgery · Sep 2016
Case ReportsNeuroendoscopic stent placement for cerebrospinal fluid pathway obstructions in adults.
OBJECTIVE Since its revival in the early 1990s, neuroendoscopy has become an integral component of modern neurosurgery. Endoscopic stent placement for treatment of CSF pathway obstruction is a rarely used and underestimated procedure. The authors present the first series of neuroendoscopic intracranial stenting for CSF pathway obstruction in adults with associated results and complications spanning a long-term follow-up of 20 years. ⋯ Currently, routine stent placement after endoscopic fenestration of ACs is not recommended. Stent placement for treatment of CSF disorders due to tumor is a good option for avoiding CSF shunting. To avoid stent migration and dislocation, and to allow for easy removal if needed, the device should be fixed to a bur hole reservoir.