Neurosurgical review
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Neurosurgical review · Apr 2012
ReviewOlfactory groove meningiomas: a retrospective study on 59 surgical cases.
We report here a retrospective study of 59 consecutive patients with olfactory groove meningiomas admitted and operated on between 1991 and 2008. Our goal was to characterize clinical features, treatment strategies, and outcome of these lesions. The surgical resection grade, the histological type and the presence of recurrences in the follow-up period were analyzed. ⋯ The olfactory groove is a relatively frequent location for intracranial meningiomas, accounting for 9.1% of all intracranial meningiomas in our experience. Olfactory groove meningiomas tend to be clinically silent tumors until they are very large when symptoms or other abnormalities become evident. A surgical procedure adapted to the size and the extension of the tumor combined with microsurgical techniques allows total meningioma removal with good neurological outcome.
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Chronic subdural hematoma (cSDH) is an increasingly common neurological disease process. Despite the wide prevalence of cSDH, there remains a lack of consensus regarding numerous aspects of its clinical management. We provide an overview of the epidemiology and pathophysiology of cSDH and discuss several controversial management issues, including the timing of post-operative resumption of anticoagulant medications, the effectiveness of anti-epileptic prophylaxis, protocols for mobilization following evacuation of cSDH, as well as the comparative effectiveness of the various techniques of surgical evacuation. ⋯ There is also conflicting evidence to support seizure prophylaxis in patients with cSDH, although the existing literature supports prophylaxis in patients who are at a higher risk for seizures. The published data regarding surgical technique for cSDH supports primary twist drill craniostomy (TDC) drainage at the bedside for patients who are high-risk surgical candidates with non-septated cSDH and craniotomy as a first-line evacuation technique for cSDH with significant membranes. Larger prospective studies addressing these aspects of cSDH management are necessary to establish definitive recommendations.
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Neurosurgical review · Apr 2012
ReviewChordomas of the skull base and cervical spine: clinical outcomes associated with a multimodal surgical resection combined with proton-beam radiation in 40 patients.
Previous studies of chordoma have focused on either surgery, radiotherapy, or particular tumor locations. This paper reviewed the outcomes of surgery and proton radiotherapy with various tumor locations. Between 2001 and 2008, 40 patients with chordomas of the skull base and cervical spine had surgery at our hospital. ⋯ Among the survivors, the median of the last Karnofsky Performance Scale score was 80 with 25.7% of patients experiencing an increase and 11.4% experiencing a decrease. Multimodal surgery and proton therapy thus improved the chordoma treatment. The CCJ location and a younger age are risks for disease progression.