Neurosurgical review
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Neurosurgical review · Oct 2009
Multicenter StudySurvival following stereotactic radiosurgery for newly diagnosed and recurrent glioblastoma multiforme: a multicenter experience.
Despite decades of clinical trials investigating new treatment modalities for glioblastoma multiforme (GBM), there have been no significant treatment advances since the 1980s. Reported median survival times for patients with GBM treated with current modalities generally range from 9 to 19 months. The purpose of the current study is to retrospectively review the ability of CyberKnife (Accuray Incorporated, Sunnyvale, CA, USA) radiosurgery to provide local tumor control of newly diagnosed or recurrent GBM. ⋯ Survival time and recursive partitioning analysis class were not correlated (P = 0.07). Patients with more extensive surgical interventions survived longer (P = 0.008), especially those who underwent total tumor resection vs. biopsy (P = 0.004). There is no apparent survival advantage in using CyberKnife in initial management of glioblastoma patients, and it should be reserved for patients whose tumors recur or progress after conventional therapy.
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Neurosurgical review · Oct 2009
Editorial Review Historical ArticleNeurosurgery in Italy: the past, the present, the future.
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Neurosurgical review · Oct 2009
Case ReportsTrans-cerebellomedullary fissure approach with special reference to lateral route.
The trans-cerebellomedullary fissure (CMF) approach provides good exposure of the fourth ventricle without splitting the inferior vermis. The popularly utilized trans-CMF approach is performed in the midline suboccipital approach. However, the trans-CMF approach actually has two routes: medial and lateral. ⋯ Based on the anatomic findings, we adopted the lateral route of the trans-CMF approach for four patients, each with a tumor near the jugular tubercle extending into the fourth ventricle through the CMF. Our study demonstrated that the lateral route of the trans-CMF approach enables sufficient exposure of not only unilateral cerebellopontine cistern but also of the lateral part of the fourth ventricle. A tumor is safely removed by this approach with easy feeder or tumor bed controls, especially if it is anchored at the lateral part of the CMF as is the jugular tubercle meningioma.
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Neurosurgical review · Oct 2009
A standardised evaluation of pre-surgical imaging of the corticospinal tract: where to place the seed ROI.
The aim of the study was to compare the different approaches of pre-operative diffusion-tensor-imaging-based fibre tracking (FT) of the corticospinal tract (CST) focusing on the positioning of the seeding region of interest (seed ROI). Thirty-nine patients with brain lesions in the vicinity of the CST were evaluated pre-operatively. Imaging comprised a 3D T1-weighted sequence, a gradient echo echo-planar imaging sequence for functional magnetic resonance imaging (fMRI), and a diffusion-weighted sequence for diffusion tensor (DT) tractography. ⋯ Upward FT may fail to track fibres, whereas the successful tracking results may be superior to downward FT. Hence, upward FT of the CST should be preferred in patients with space-occupying lesions. Downward FT should be performed if upward FT fails.
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This technical note presents the advantages of a modified nasal speculum for the translabial-endonasal transsphenoidal approach to the sphenoid sinus and sella for surgery on lesions of the pituitary. The width of the upper lateral wings of the speculum was reduced by half over approximately three fourths of their length. This increases interior clearance and makes it easier to introduce the instruments used during transsphenoidal operations. ⋯ Three experienced surgeons evaluated the visual field and instrument passage through it, and they found it superior to the conventional design. The modification resulted in marked reduction of the overall operation duration. In conclusion, the more open translabial-transnasal speculum described here definitely facilitates the transsphenoidal approach to the pituitary.