British journal of neurosurgery
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Cluster headache is a disabling severe headache syndrome, with a prevalence of 0.12%. Occipital nerve stimulation (ONS) is a recognized treatment for medically intractable cluster headache, composed of two electrodes in contact with the greater occipital nerves and connected to an Implantable Pulse Generator (IPG). The battery can be non-rechargeable or rechargeable, which has a longer total lifespan. This is, to our knowledge, the largest patient survey to examine the level of satisfaction with rechargeable batteries. ⋯ These data suggest that ONS with rechargeable IPG may be considered the system of choice for patients undergoing ONS implant.
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The literature reflects a resurgence of interest in endoscopic and keyhole endoscope-assisted neurosurgical approaches as alternatives to conventional microsurgical approaches in carefully selected cases. The aim of this study was to assess the technical challenges of neuroendoscopy, and the scope for technological innovations to overcome these barriers. ⋯ Results of this qualitative survey provide consensus amongst the technology end-user community such that unambiguous goals and priorities may be defined. Systems integrating these advances could improve the safety and efficacy of endoscopic and endoscope-assisted neurosurgical approaches.
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The developed world has an aging population with an increasing neurosurgical demand. The benefit of neurosurgical intervention in the octogenarian population and the outcome is unclear. The 2010 NCEPOD report on all surgical care for the elderly (> 80 years) concluded that extreme age was an additional risk for which care was often lacking. ⋯ Patient selection is crucial when considering neurosurgery in the octogenarian population. Our octogenarian patients had higher complication rate and 30-day mortality than those < 80 year old, demonstrating the additional risk and need for enhanced peri-operative care.
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The recognition of anaplastic foci within low-grade gliomas is of extreme importance in patients under follow-up for Grade II gliomas. We present the algorithm of MR spectroscopy (MRS)-guided brain biopsy and its correlation with tumour histology. ⋯ Strong correlation was demonstrated between Cho/Cr and Ch/NAA ratios. Strong correlation was demonstrated between histological parameters of biopsy samples taken using Cho/Cr ratio and those from total tumour examination. Diagnostic accuracy of MRS-guided biopsy was 84%. Sensitivity and specificity of MRS combined with structural MR reaches 86% and 80%.
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The management of Spetzler-Martin Grade-IV and -V arteriovenous malformations (AVMs) is controversial due to their uncertain natural history, the high rate of morbidity and mortality associated with microsurgical resection, and the relatively low rate of successful obliteration from less invasive approaches such as radiosurgery and embolization. We present our radiosurgical results for high-grade AVMs. ⋯ Single-session radiosurgery is an acceptable treatment option for select patients harboring high-grade AVMs for which microsurgery or conservative management are associated with an unacceptably high risk of adverse outcomes.