Neurosurgical review
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Neurosurgical review · Jan 2011
Case ReportsThe extended retrosigmoid approach for neoplastic lesions in the posterior fossa: technique modification.
Approaches to the cerebellar-pontine angle and petroclival region can be challenging due to intervening eloquent neurovascular structures and cerebellar retraction required to view this anatomic compartment with the standard retrosigmoid technique. As previously described [11], the extended retrosigmoid provides additional access to space ventral to the brainstem through mobilization of the sigmoid sinus. We report our further experience and modifications of this approach for neoplastic pathology. ⋯ Requiring a fundamental change in the management of the venous sinuses, the extended retrosigmoid craniotomy permits mobilization of the sigmoid and transverse sinuses. In this process, the entire cerebellar-pontine angle extending from the tentorium to the foramen magnum can be visualized with minimal cerebellar retraction. This technical modification over the standard retrosigmoid approach may provide a useful advantage to neurosurgeons dealing with these complex lesions.
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Neurosurgical review · Jan 2011
ReviewRecanalization therapy for acute ischemic stroke, part 1: surgical embolectomy and chemical thrombolysis.
Cerebral revascularization approaches for acute ischemic stroke greatly expanded during the past decade. Many new revascularization strategies are currently being assessed, while others continue to gain in popularity, offering hope to those with an otherwise refractory disease. We discuss historical and current progress toward successful recanalization, as well as the efforts being made to develop a safe and efficacious method of revascularization in the treatment of acute ischemic stroke.
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Nail-gun injuries have become an increasingly prevalent source of penetrating intracranial trauma. Few cases of intracranial nail-gun injuries disturbing major cerebrovascular structures have been reported, and none entailing basilar artery involvement. ⋯ Operative removal was accomplished under direct vision using a double concentric cranioorbital zygomatic osteotomy for a trans-Sylvian approach. We highlight the principles involved in removing foreign bodies penetrating critical neurovascular structures.
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Neurosurgical review · Oct 2010
Prognostic factors for long-term outcome of patients with surgical resection of skull base chordomas-106 cases review in one institution.
Skull base chordoma are still challenging. Between May 1993 and June 2005, 106 consecutive patients with skull base chordoma underwent surgical removal at Skull Base Division of Neurosurgery, Beijing Tiantan Hospital, China. Retrospective analysis included medical charts and images. ⋯ Although there is no statistic significant role of tumor adherent to vital structure for outcome (p = 0.051), it can not exclude its importance for favorable outcome. Gender, age, tumor size and staging are not independent risk factors for outcome. Surgical technique leading to radical tumor resection with less morbidity is advocatory and beneficial for patients with skull base chordoma with long term outcome, if the tumor could be exposed and resected completely, the recurrence rate was very low for most benign chordomas.
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Neurosurgical review · Oct 2010
Multicenter StudyFirst-line treatment of malignant glioma with carmustine implants followed by concomitant radiochemotherapy: a multicenter experience.
Randomized phase III trials have shown significant improvement of survival 1, 2, and 3 years after implantation of 1,3-bis (2-chloroethyl)-1-nitrosourea (BCNU) wafers for patients with newly diagnosed malignant glioma. But these studies and subsequent non-phase III studies have also shown risks associated with local chemotherapy within the central nervous system. The introduction of concomitant radiochemotherapy with temozolomide (TMZ) has later demonstrated a survival benefit in a phase III trial and has become the current treatment standard for newly diagnosed malignant glioma patients. ⋯ Our data demonstrate that combination of local chemotherapy and concomitant radiochemotherapy carries a significant risk of toxicity that currently appears underestimated. Adverse events observed in this study appear similar to complication rates published in the phase III trials for BCNU wafer implantation followed by radiation therapy alone, but further add the toxicity of concomitant radiochemotherapy with systemic TMZ. Save use of a combined approach will require specific prevention strategies for multimodal treatments.