Neurosurgery
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Tumors of the central nervous system are now thought to be the most common form of childhood malignancies. Previous studies suggested that delays might exist between symptom onset and the diagnosis of pediatric brain tumors. In the Maritime Provinces of Canada (New Brunswick, Nova Scotia, and Prince Edward Island), there are only two pediatric neurosurgical centers; therefore, the Maritime Provinces are ideal for study of the epidemiological features of pediatric brain tumors. The aim of this study was to examine the incidence rates of pediatric brain tumors in eastern Canada, as well as factors important in their diagnosis. ⋯ The incidence rates for pediatric brain tumors in the Maritime Provinces are similar to those of other reported series. The correct diagnosis of pediatric brain tumors still generally requires a number of months and frequent visits to various physicians. The majority of pediatric brainstem tumors might no longer be of a diffuse malignant nature but might represent more-focal benign lesions.
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THE TRANSSPHENOIDAL APPROACH for sellar tumors has evolved significantly since it was described initially during the first decade of the 20th century. The approach currently incorporates technological advancements and refinements in patient selection, operative technique, and postoperative care. ⋯ This variability is a reflection of surgeon's preference, the lessons of experience, and the bias inherent in neurosurgical training. The methods and preferences described herein embody the distillation of an experience gained from 3900 transsphenoidal operations.
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Previous reports of seizure outcomes after arteriovenous malformation (AVM) treatment have involved single-treatment modality (surgery, radiosurgery, or embolization) series. Such series reflect only selected lesions, of certain sizes, locations, and other clinical and anatomic characteristics, that are amenable to the single therapy, limiting the analysis of those factors. We report the results of AVM treatment using a multimodality approach that we think encompasses a broader spectrum of treatable brain AVMs. We tested for factors associated with seizure presentation and seizure outcomes. ⋯ Certain factors, as identified in an analysis of a wide spectrum of treatable brain AVMs, can facilitate predictions of the incidence of seizure presentation with AVMs, as well as seizure outcomes after multimodality treatment.