Journal of neurosurgery
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Journal of neurosurgery · Feb 2020
Intraoperative 3D ultrasound-guided resection of diffuse low-grade gliomas: radiological and clinical results.
Extent of resection (EOR) and residual tumor volume are linked to prognosis in low-grade glioma (LGG) and there are various methods for facilitating safe maximal resection in such patients. In this prospective study the authors assess radiological and clinical results in consecutive patients with LGG treated with 3D ultrasound (US)-guided resection under general anesthesia. ⋯ Three-dimensional US-guided LGG resections under general anesthesia are safe and HRQoL is preserved in most patients. Effectiveness in terms of EOR appears to be consistent with published studies using other advanced neurosurgical tools. Avoiding intraoperative vascular injury is a key factor for achieving good functional outcome.
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Journal of neurosurgery · Feb 2020
Locating the foramen ovale by using molar and inter-eminence planes: a guide for percutaneous trigeminal neuralgia procedures.
The first attempt to cannulate the foramen ovale is oftentimes unsuccessful and requires subsequent reattempts, thereby increasing the risk of an adverse event and radiation exposure to the patient and surgeon. Failure in cannulation may be attributable to variation in soft-tissue-based landmarks used for needle guidance. Also, the incongruity between guiding marks on the face and bony landmarks visible on fluoroscopic images may also complicate cannulation. Therefore, the object of this study was to assess the location of the foramen ovale by way of bony landmarks, exclusive of soft-tissue guidance. ⋯ The results of this study provide a novel means of identifying the location of the foramen ovale. Unlike the soft-tissue landmarks used in the many variations of the route of Härtel, the bony landmarks identified in this study can be palpated, marked on the face, appreciated fluoroscopically, and do not require any measurement from soft-tissue structures. Utilizing the molar and inter-eminence planes as cannulation guides will improve the approach to the foramen ovale and decrease the amount of radiation exposure to both the patient and surgeon.
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Journal of neurosurgery · Feb 2020
Local tumor response and survival outcomes after combined stereotactic radiosurgery and immunotherapy in non-small cell lung cancer with brain metastases.
Concurrent use of anti-PD-1 therapies with stereotactic radiosurgery (SRS) have been shown to be beneficial for survival and local lesional control in melanoma patients with brain metastases. It is not known, however, if immunotherapy (IT) confers the same outcome advantage in lung cancer patients with brain metastases treated with SRS. ⋯ Unlike patients with melanoma, patients with NSCLC with brain metastases undergoing SRS showed no significant benefit-either in terms of survival or total amount of lesional response-when anti-PD-1 therapies were used. However, in lesions with volume > 500 mm3, combining SRS with IT may result in a faster and better volumetric response which may be particularly beneficial in lesions causing mass effect or located in neurologically critical locations.
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Journal of neurosurgery · Feb 2020
Improved survival of glioblastoma patients treated at academic and high-volume facilities: a hospital-based study from the National Cancer Database.
The present study was designed to explore the association between facility type (academic center [AC] vs non-AC), facility volume (high-volume facility [HVF] vs low-volume facility [LVF]), and outcomes of glioblastoma (GBM) treatment. ⋯ This study provides evidence of superior outcomes when GBM patients are treated at AC and HVF. Standardization of health care across facility type and/or volume and comprehensive neuro-oncological care should be a potential goal in the management of GBM patients.
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Journal of neurosurgery · Feb 2020
Quantitative assessment of secondary white matter injury in the visual pathway by pituitary adenomas: a multimodal study at 7-Tesla MRI.
The objective of this study was to investigate microstructural damage caused by pituitary macroadenomas by performing probabilistic tractography of the optic tracts and radiations using 7-T diffusion-weighted MRI (DWI). These imaging findings were correlated with neuro-ophthalmological results to assess the utility of ultra-high-field MRI for objective evaluation of damage to the anterior and posterior visual pathways. ⋯ Imaging-based quantification of secondary neuronal damage from adenomas strongly correlated with neuro-ophthalmological findings. Diffusion characteristics enabled by ultra-high-field DWI may allow preoperative characterization of visual pathway damage in patients with chiasmatic compression and may inform prognosis for vision recoverability.