Neurosurgery
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Treatment of wide-necked internal carotid artery aneurysms is frequently associated with incomplete occlusion and high recurrence rates. Furthermore, platinum coils cause strong beam-hardening artifacts, hampering subsequent image analyses. ⋯ FDS-assisted microsphere embolization of fusiform and sidewall aneurysms is feasible and yields virtually complete aneurysm occlusion while avoiding coil-associated beam-hardening artifacts.
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Contralateral aneurysm clipping can be applied to bilateral intracranial aneurysms of the anterior circulation and to selected aneurysms on the medial wall of the internal carotid artery (ICA). ⋯ The contralateral approach for ICA-opht aneurysms remains a treatment option for intracranial aneurysms. Its feasibility depends on specific anatomic parameters related to the aneurysm itself and to the prechiasmatic distance, interoptic distance, and relationship of the ICA with the anterior clinoid process.
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Peritumoral edema (PTE) in skull base meningiomas correlates to the absence of an arachnoid plane and difference in outcome. In vestibular schwannomas (VS), PTE and its significance for microsurgery and outcome have never been systematically evaluated. ⋯ PTE in VS does not correlate with the degree of tumor adhesion and the presence of an arachnoid dissection plane. The radicality of tumor removal and long-term functional outcome in patients with and without PTE was similar. VS with PTE are more vascular and prone to cause postoperative hemorrhages. Therefore, meticulous hemostasis is advisable.
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The energy index (EI) is a measure of dose homogeneity within a target volume calculated by the integral dose divided by the product of prescription dose and tumor volume. ⋯ GKRS for BM results in a high rate of local control with an 11-month rate of 86.5%. A higher EI was not significantly associated with a higher rate of local control on multivariate analysis. Prescription dose was found to be the only significant predictor of local control on multivariate analysis.