Neurosurgery
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Review
Extent of surgical resection predicts seizure freedom in low-grade temporal lobe brain tumors.
Achieving seizure control in patients with low-grade temporal lobe gliomas or glioneuronal tumors remains highly underappreciated, because seizures are the most frequent presenting symptom and significantly impact patient quality-of-life. ⋯ Gross-total lesionectomy of low-grade temporal lobe tumors results in significantly improved seizure control over subtotal resection. Additional tailored resection including the hippocampus and/or adjacent cortex may further improve seizure control, suggesting dual pathology may sometimes allow continued seizures after lesional excision.
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Decompressive craniectomy (DC) is performed as a life-saving procedure in patients with intractably increased intracranial pressure after traumatic brain injury, bleeding, cerebral infarction, or brain swelling of other causes. However, the application of DC is as controversial in the pediatric population as it is in adults. ⋯ The current data indicate that DC in children with traumatic or nontraumatic brain swelling might be warranted, regardless of the underlying cause. Despite mydriasis, a favorable outcome might be achieved in a significant number of pediatric patients. Nevertheless, careful individual decision making is needed for each patient, especially when signs of cerebral herniation have persisted for a long time.
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The ventrolateral thalamus (ventral intermediate nucleus [Vim]) is the traditional target for neurosurgical treatment of essential tremor. The target, however, has varied substantially among different neurosurgeons. ⋯ More contacts yielding an optimal effect were found in the PSA group than in the Vim. Many patients operated on in the Vim got the best effect from a contact located in the PSA. This might suggest that the PSA is a more efficient target than the Vim.
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Cervical laminoplasty is often used for the decompression of multilevel cervical spondylotic myelopathy without creating spinal instability and kyphosis. ⋯ Laminoplasty for 4 or more cervical levels was associated with more axial pain and consequently poorer quality of life than laminectomy. There was a similar loss of sagittal alignment in both the laminectomy and laminoplasty groups over time. Our results suggest there is no clear benefit of laminoplasty over laminectomy in patients who do not have spinal instability.
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Comparative Study
Incremental contribution of size ratio as a discriminant for rupture status in cerebral aneurysms: comparison with size, height, and vessel diameter.
Aneurysm size ratio (SR), variably defined as the ratio of dome height (H) or maximal dimension (D(max)) over average parent vessel diameter (PV) diameter, has been proposed as a promising aneurysm rupture status predictor. ⋯ SR provides an uneven performance that depends strongly on the BIF/SW distribution of the data and is not useful for bifurcation lesions. In the SW subset, the incremental contribution of the SR over its H or D(max) individual component measurements could not be validated, suggesting prior findings of its utility to be the result of aneurysm-type selection bias.