Neurosurgery
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Vestibular schwannomas (VS) are uncommon lesions that are a substantial challenge to the neurosurgeons, otologists, and radiation oncologists who undertake their clinical management. A starting point to improving the current knowledge is to define the benchmarks of the current research studying VS management using evidence-based techniques in order to allow meaningful points of departure for future scientific and clinical research. ⋯ This series of guidelines was constructed to assess the most current and clinically relevant evidence for the management of VS. They set a benchmark regarding the current evidence base for this type of tumor while also highlighting important key areas for future basic and clinical research, particularly on those topics for which no recommendations could be formulated. The full guidelines can be found at: https://www.cns.org/guidelines/guidelines-management-patients-vestibular-schwannoma.
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Though endovascular techniques and procedural devices continue to advance, recurrence of embolized aneurysms is still problematic. Enlarging size during follow-up is the presumed basis of recanalization in some lesions, but such growth has not been adequately investigated. ⋯ Our data suggest that aneurysms presenting with hemorrhage and small-sized aneurysms (<7 mm) are predisposed major recanalization by growth after coil embolization, as opposed to coil compaction.
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Practice Guideline
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Hearing Preservation Outcomes in Patients With Sporadic Vestibular Schwannomas.
What is the overall probability of maintaining serviceable hearing following stereotactic radiosurgery utilizing modern dose planning, at 2, 5, and 10 yr following treatment? ⋯ Level 3: Individuals who meet these criteria and are considering observation should be counseled regarding probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, as well as nongrowth of the tumor. Tumor size at the time of diagnosis, age, and sex do not predict future development of nonserviceable hearing during observation. The full guideline can be found at: https://www.cns.org/guidelines/guidelines-manage-ment-patients-vestibular-schwannoma/chapter_3.
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What sequences should be obtained on magnetic resonance imaging (MRI) to evaluate vestibular schwannomas before and after surgery? ⋯ Level 3: For patients receiving gross total resection, a postoperative MRI may be considered to document the surgical impression and may occur as late as 1 yr after surgery. For patients not receiving gross total resection, more frequent surveillance scans are suggested; annual MRI scans may be reasonable for 5 yr. Imaging follow-up should be adjusted accordingly for continued surveillance if any change in nodular enhancement is demonstrated. The full guideline can be found at https://www.cns.org/guidelines/guidelines-management-patients-vestibular-schwannoma/chapter_5.
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Biography Historical Article
Commentary: Giuseppe Campani (1635-1715, Rome, Italy): the First Use of a Microscope in Medicine and Surgery.
Giuseppe Campani (1635-1715) was a polymath in Rome, Italy, during the Scientific Revolution in the XVIIth century. In particular, he forged the screw barrel microscope and was manufacturing his own lenses for microscopes and telescopes. He mastered the art of lens grinding. ⋯ This letter dates back to 15 August 1686 and is the first evidence of the use of microscopes to analyze wounds, sores, and anatomic specimens in medical and surgical settings. MG Yasargil previously showed the lithography accompanying this letter and was the first to recognize its great importance. We accessed this original letter in the Vatican Library, and for the first time we have translated it from Latin to English in order to unveil its significance in the context of the Scientific Revolution and the history of medicine and surgery.