Neurosurgery
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Multicenter Study
Distal anterior cerebral artery aneurysms: treatment and outcome analysis of 501 patients.
This study presents the combined experience of two Finnish neurosurgical centers in the treatment of 501 consecutive patients with distal anterior cerebral artery (DACA) aneurysms. Our aim was to compare treatment outcomes of these lesions with intracranial aneurysms in general and to identify factors predicting the outcome. ⋯ Despite their specific features, with modern treatment methods, ruptured DACA aneurysms have the same favorable outcome and lower mortality at 1 year as ruptured aneurysms in general.
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Multicenter Study Classical Article
Cyberknife radiosurgery for trigeminal neuralgia treatment: a preliminary multicenter experience.
Radiosurgery has gained acceptance as a treatment option for trigeminal neuralgia. We report our preliminary multicenter experience treating trigeminal neuralgia with the CyberKnife (Accuray, Inc., Sunnyvale, CA). ⋯ The results of this study suggest the following optimal radiosurgical treatment parameters for treatment of idiopathic trigeminal neuralgia: a median maximal dose of 78 Gy (range, 70-85.4 Gy) and a median length of the nerve treated of 6 mm (range, 5-12 mm).
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Randomized Controlled Trial
Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias.
The influence of the degree of resection on survival in patients with glioblastoma multiforme is still under discussion. The highly controlled 5-aminolevulinic acid study provided a unique platform for addressing this question as a result of the high frequency of "complete" resections, as revealed by postoperative magnetic resonance imaging scans achieved by fluorescence-guided resection and homogeneous patient characteristics. ⋯ Treatment bias was demonstrated regarding resection and second-line therapies. However, bias and imbalances were controllable in the cohorts available from the 5-aminolevulinic acid study so that the present data now provide Level 2b evidence (Oxford Centre for Evidence-based Medicine) that survival depends on complete resection of enhancing tumor in glioblastoma multiforme.
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Open lumbar spinal surgery in overweight or obese patients has been associated with increased risk of perioperative complications. The impact of minimally invasive spinal (MIS) surgery on the incidence of perioperative adverse events in overweight or obese patients, however, has not been well evaluated. ⋯ There does not appear to be an increased risk of developing perioperative complications in overweight or obese patients undergoing MIS surgery, which may reflect a potential benefit of the MIS approach.
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Clinical Trial
Dynact soft-tissue visualization using an angiographic C-arm system: initial clinical experience in the operating room.
DynaCT is a clinical application protocol to create computed tomographic (CT)-like images allowing soft-tissue visualization acquired from an angiography system. A cone beam three-dimensional CT reconstruction is produced from the acquisition of two-dimensional projection images by rotating the c-arm with x-ray source and image receptor around the patient. The purpose of this study is to evaluate the clinical efficacy of DynaCT in the operating room. ⋯ DynaCT has the potential to be used as a powerful tool for endovascular and neurosurgical procedures and will open new possibilities for neurosurgical management.