Journal of neurosurgery
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Journal of neurosurgery · Mar 2024
Long-term oncological outcomes for endoscopic endonasal versus open surgical approaches for anatomically matched, locally advanced stage T4 sinonasal malignancies with skull base involvement.
Expanded endoscopic approaches (EEAs) are increasingly used for the definitive management of sinonasal malignancies. EEAs, in appropriately selected cases, provide similar oncological outcomes but are associated with lower complication rates compared with open surgical approaches. Selection bias is a limitation reported in previous studies comparing EEAs and open surgical approaches for the management of sinonasal malignancies. To address this issue, in this study the authors compared the long-term oncological outcomes of an anatomically matched cohort of patients with locally advanced sinonasal malignancies with skull base involvement (T4 stage). The specific objective of this study was to investigate the extent of resection (EOR), overall survival (OS), and disease progression between the EEA and open surgical cohorts. ⋯ The EEA was found to be associated with lower risks of complications than conventional craniofacial surgical approaches. There were no significant differences in OS and progression-free survival between the EEA and conventional surgical cohorts when comparing anatomically matched cohorts of patients with stage T4 sinonasal malignancies and skull base involvement.
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Journal of neurosurgery · Mar 2024
Zabramski classification in predicting the occurrence of symptomatic intracerebral hemorrhage in sporadic cerebral cavernous malformations.
The authors aimed to investigate the evolutionary characteristics of the Zabramski classification of cerebral cavernous malformations (CCMs) and the value of the Zabramski classification in predicting clinical outcome in patients with sporadic CCM. ⋯ This study suggests that the Zabramski classification is helpful in estimating clinical outcome and can assist with surgical decision-making in patients with sporadic CCM.
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Journal of neurosurgery · Mar 2024
Evaluation of spatial precision and accuracy of cone-beam CT using an in vitro phantom model.
High accuracy and precision are essential in stereotactic neurosurgery, as targeting errors can significantly affect clinical outcomes. Image registration is a vital step in stereotaxis, and understanding the error associated with different image registration methods is important to inform the choice of equipment and techniques in stereotactic neurosurgery. The authors aimed to quantify the test-retest reliability and stereotactic accuracy of cone-beam CT (CBCT) compared with the current clinical gold-standard technique (i.e., CT). ⋯ Accuracy and precision were comparable between CBCT and CT image registrations. These findings suggest that CBCT registration can be used as a clinically equivalent substitute to gold-standard CT acquisition.
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Journal of neurosurgery · Mar 2024
Consistency is key: influence of skull density ratio distribution on the formation of clinically effective lesions and long-term tremor suppression following treatment with MR-guided focused ultrasound.
Skull density ratio (SDR) influences the permeability of the skull to the ultrasound waves used in magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of tremor. SDR values vary across the skull and the mean value is known to be predictive of sonication thermal increase. The aim of this investigation was to explore the effects of the SDR distribution on clinical outcomes following treatment with MRgFUS. ⋯ Greater SDR kurtosis was associated with larger, more stable lesions at 12 months posttreatment and increased tremor suppression at long-term follow-up. SDR kurtosis may provide a more meaningful prognostic factor than the mean SDR.
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Journal of neurosurgery · Mar 2024
Hemodynamic and morphological differences in cerebral aneurysms between before and after rupture.
Although it has been proposed that aneurysm morphology is different after rupture, detailed research of the morphological changes using 3D imaging acquired before and after rupture has not been conducted because of the difficulty of data collection. Similarly, hemodynamic changes due to morphological alterations after rupture have not been analyzed. The aim of this study was to investigate the changes in morphology and hemodynamics observed after aneurysm rupture. ⋯ Aneurysm morphology was found to change after rupture into an elongated and irregular geometry, accompanied by an increase in aneurysm volume. These morphological changes were also associated with statistically significant hemodynamic alterations that produced low wall sheer stress by stagnant flow. The authors' results also provide the opportunity to explore and develop a risk evaluation method for aneurysm rupture based on prerupture morphology and hemodynamics by further exploration in this direction.