World Neurosurg
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As interest and enthusiasm for the use of the endoscope in transsphenoidal anterior skull base and pituitary surgery increases, neurosurgeons are increasingly adopting endoscopic technology and associated novel concepts. Often this involves a transition from the standard operating microscope as the main means of visualization to the operating endoscope (2D or 3D) during surgery. ⋯ The endoscopic approach and its allied technology are here to stay. They are useful and occasionally preferable methods for treating a variety of suitable lesions involving the anterior skull base. The importance of incorporating the basic principles of skull base surgery is emphasized.
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This study sought to assess clinical outcomes in patients receiving gamma knife radiosurgery (GK) for treatment of brain metastases from melanoma and evaluate for potential predictive factors. ⋯ GK achieves excellent local control and may improve outcomes as a component of a multidisciplinary treatment strategy. Distant brain failure and neurologic demise remain problematic and prospective trials are necessary.
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This article demonstrates the experience with endoscopic transphenoidal anterior skull base surgery for lesions other than pituitary adenomas. The spectrum of lesions, results, and complications are presented. ⋯ The endoscopic anterior skull base approach is highly effective in treating a large variety of lesions other than pituitary adenomas. The adoption of the nasoseptal flap for closure has markedly reduced the incidence of spinal fluid leaks, and is used routinely for lesions that violate the intracranial compartment.
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The current approach for the diagnosis and repair of spontaneous and traumatic anterior skull-base defects is oulined, highlighting the controversies that exist in the field and describing the strategies required to access different segments of the anterior cranial fossa. ⋯ Endoscopic endonasal repair of CSF leaks and encephaloceles has evolved significantly during the past decade. The versatility of different endoscopic approaches through the four endonasal corridors allows for the endoscopic repair of almost all skull-base defects. The use of vascularized pedicled mucosal flaps has evolved to cover these defects as part of multilayered closure strategies.
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Multicenter Study
Multicenter registry of liquid embolic treatment of cerebral aneurysms.
The Cerebral Aneurysm Multicenter European Onyx trial was the first multicenter prospective case series using liquid embolization for cerebral aneurysms. It suggested a possible decreased risk for recanalization of smaller aneurysms compared with coil embolization. After publication of that trial, the Onyx HD embolic agent, injection devices, and treatment protocols have all been updated and improved to increase efficacy and decrease adverse events. We present the results from a multicenter registry of liquid embolization treatments using the current method and materials. We hypothesize that the evolution of this technique will result in lower complication and recanalization rates when compared with earlier series. ⋯ Recent advances in liquid embolization have led to decreased recanalization and complications. Liquid embolization is more likely to achieve a durable result in smaller aneurysms that have not been previously treated.