Neurosurgery
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Papillary meningioma (PM) is an uncommon meningioma subtype, and the clinical characteristics remain unclear. ⋯ PM is a rare subtype of meningioma with a tendency of recurrence. The extent of resection is an important prognosis factor. The presence of positive histopathological index increases the recurrence risk. Positive PR combined with negative Bcl-2 immunoreaction might predict a good prognosis. Postoperative radiotherapy may play a vital role in prolonging the time to tumor recurrence.
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Stereotactic radiosurgery is ideal for treating small cerebral arteriovenous malformations (AVMs) that are surgically inaccessible. However, given the inherent delay of AVM obliteration and the potential for radiosurgical failure, detailed evaluation of the neurovascular architecture is necessary to monitor persistence of residual flow. Modern imaging systems such as magnetic resonance imaging (MRI) and angiography allow clinicians to assess transnidus flow after radiosurgical intervention. ⋯ MRI is a useful diagnostic system for assessing AVM obliteration, but its accuracy is inherently linked to the nidus volume it is measuring. These results suggest that MRI may be able to take on an increasingly independent role in the evaluation of AVM regression.
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Phosphodiesterase 4D (PDE4D), through the regulation of cyclic AMP, modulates inflammation and other processes that affect atherosclerosis and stroke. A PDE4D polymorphism, single-nucleotide polymorphism (SNP) 83 (rs966221), is associated with ischemic stroke. The association of SNP 83 with postoperative cognitive dysfunction has never been investigated. ⋯ The C/C genotype of SNP 83 is significantly associated with the highest incidence of cognitive dysfunction 1 day following CEA in comparison with the C/T and T/T genotypes. This PDE4D genotype may lead to accelerated cyclic AMP degradation and subsequently elevated inflammation 1 day after CEA. These observations, in conjunction with previous studies, suggest that elevated inflammatory states may be partially responsible for the development of cognitive dysfunction after CEA, but more investigation is required.
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Primary brain tumors in motor eloquent areas are associated with high-risk surgical procedures because of potentially permanent and often disabling motor deficits. Intraoperative primary motor cortex mapping and corticospinal tract (CST) monitoring are well-developed and reliable techniques. Imaging of the CST by diffusion tensor tractography (DTT) is also feasible. ⋯ The linear current-distance correlation was found both in pre-iMRI and in post-iMRI data. Intraoperative image distortion appeared in 36%. Neurophysiological subcortical mapping remains superior to DTT. Combining these 2 methods in selected cases can help increase the safety of tumor resection close to the CST.
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Temporal lobe arteriovenous malformations (AVMs) represent a subgroup of intracranial AVMs with particular characteristics and management issues. ⋯ Seizure control is usually underappreciated in the surgical management of AVMs. However, in temporal lobe AVMs, good outcomes with low morbidity and good visual field preservation can be accomplished.