Neurosurgery clinics of North America
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The goal of pituitary adenoma radiosurgery is to halt tumor growth, normalize hormonal hypersecretion if present, maintain normal pituitary function, and preserve important structures around the sella. The radiation dose necessary to stop tumor growth is lower than the dose necessary to achieve normalization of hormonal hypersecretion. The minimum distance required between the irradiated target and the optic pathway should be 2 mm for secreting adenomas, but in cases of nonsecreting adenomas this distance is even lower. The current role of radiosurgery in most cases is as an adjuvant treatment of residual or recurrent adenomas after previous microsurgery.
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Neurosurg. Clin. N. Am. · Oct 2013
ReviewStereotactic radiosurgery for epilepsy and functional disorders.
Stereotactic radiosurgery is used for many indications. In functional neurosurgery, it is used to modulate the function of axons, neurons, and related brain circuits. In this article, indications, current techniques, and outcomes are discussed.
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Neurosurg. Clin. N. Am. · Oct 2013
ReviewStereotactic radiosurgery of intracranial chordomas, chondrosarcomas, and glomus tumors.
Chordomas and chondrosarcomas are rare, slow-glowing, locally aggressive tumors with high recurrence rates. Stereotactic radiosurgery (SRS) is an important management option for patients with recurrent or residual chordomas and chondrosarcomas. ⋯ Because of their highly vascular nature and surgically formidable anatomic location, curative resection often proves challenging. SRS can be used as an up-front treatment or as an additional treatment for patients with recurrent or residual glomus jugulare tumor after surgical resection.
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Neurosurg. Clin. N. Am. · Jul 2013
ReviewSurgical treatment of elevated intracranial pressure: decompressive craniectomy and intracranial pressure monitoring.
Surgical techniques that address elevated intracranial pressure include (1) intraventricular catheter insertion and cerebrospinal fluid drainage, (2) removal of an intracranial space-occupying lesion, and (3) decompressive craniectomy. This review discusses the role of surgery in the management of elevated intracranial pressure, with special focus on intraventricular catheter placement and decompressive craniectomy. The techniques and potential complications of each procedure are described, and the existing evidence regarding the impact of these procedures on patient outcome is reviewed. Surgical management of mass lesions and ischemic or hemorrhagic stroke occurring in the posterior fossa is not discussed herein.
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Neurosurg. Clin. N. Am. · Jul 2013
ReviewParenchymal brain oxygen monitoring in the neurocritical care unit.
Patients admitted to the neurocritical care unit (NCCU) often have serious conditions that can be associated with high morbidity and mortality. Pharmacologic agents or neuroprotectants have disappointed in the clinical environment. ⋯ This strategy is based on a variety of monitoring techniques including use of intraparenchymal monitors. This article reviews parenchymal brain oxygen monitors, including the available technologies, practical aspects of use, the physiologic rationale behind their use, and patient management based on brain oxygen.