Neurosurg Focus
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An aging population will require that surgeons increasingly consider operative intervention in elderly patients. To perform this surgery safely will require an understanding of the factors that predict successful outcomes as well as complications. ⋯ Surgery in patients older than age 75 years can be conducted safely and with similar outcome rates as in younger patients. The Charlson Weighted Comorbidity Index score and operative time were predictive of the risk of complications.
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Comparative Study
Evaluation of factors predicting accurate resection of high-grade gliomas by using frameless image-guided stereotactic guidance.
Frameless image-guided stereotaxy is often used in the resection of high-grade gliomas. The authors of several studies, however, have suggested that brain shift may occur intraoperatively and result in inaccurate resection. To determine the usefulness of frameless stereotactic image-guided surgery of high-grade gliomas, the authors correlated factors predictive of brain shift, such as tumor size, periventricular location, and patient age (as an indicator of brain atrophy) with the extent of resection. ⋯ Frameless image-guided stereotactic techniques can be reliably used for accurate resection of high-grade gliomas when the tumor is less than 30 ml in volume and not adjacent to the ventricular system. In cases involving tumors larger in volume or located near the ventricles, intraoperative ultrasonography or MR imaging updates should be considered.