World Neurosurg
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Comparative Study
A comparison of cell-cycle markers in skull base and sacral chordomas.
Despite refinement of surgical techniques and adjuvant radiotherapy, the prognosis for patients with a chordoma remains poor. Identification of prognostic factors related to tumor biology might improve this assessment and result in molecular markers for targeted therapy. Limited studies have been performed to unravel the impact of cell-cycle markers in chordoma, and those performed have shown inconclusive results. In the current study, we aimed to discover the impact of cyclin-dependent kinase 4 (CDK4) expression and its relation to prognosis and other cell-cycle markers in chordoma. ⋯ Our results show that the expression of CDK4 and p53 are related to cell proliferation capacity and worse outcome in patients with chordoma.
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This study sought to show and analyze the main authors' experience (P.R. and J.M.C.) in previously coiled aneurysm surgery as an emerging challenge in today's neurosurgical practice. ⋯ Surgical management of previously coiled aneurysms is an emerging challenge in neurosurgery. Incomplete or ineffective embolizations pose an increased risk for the patient, thus requiring surgical treatment. Although not advisable, coil removal might be necessary when in the vicinity of the aneurismal neck in order to place the clip correctly. The authors believe that adequate patient selection and careful preoperative planning are essential to reduce the incidence of patients with unsuccessful coils who will later need surgical treatment.
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With the use of fluorescence-guided resection with 5-aminolevulinic acid (5-ALA), the rate of complete resection of the contrast-enhancing part of malignant gliomas could be increased from 36% to 65%. Because the visualization of 5-ALA-induced fluorescence depends on a sufficient exposure to fluorescent light, residual tumor tissue in deep-seated resection cavities might not be detected. In addition, subcortical parts of a large spherical tumor might not be visualized, owing to a tangential position at the periphery of the microscopic field. With the availability of a specially designed endoscope with the capability to visualize 5-ALA fluorescence, we investigated the impact of this new technique on the visualization of residual glioma tissue. ⋯ As an additional instrument, fluorescence-guided endoscopic visualization might help to overcome technical limitations of the conventional microscopic exposure of 5-ALA-positive tumor tissue. The false-positive 5-ALA tissue indicates that endoscopic visualization may overestimate the amount of tumor, so further analyses to ascertain the sensitivity and specificity of this technique are required.
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To report a newly developed intraluminal triple-balloon shunt designed to preserve the blood flow of both the internal carotid artery (ICA) and the external carotid artery (ECA) during carotid endarterectomy in patients with a previous ipsilateral extracranial-intracranial bypass, in whom hemodynamic cerebral ischemia might be caused by cross-clamping at the ICA as well as the ECA. ⋯ This novel shunt device can be used safely and effectively in cases requiring preservation of the blood supply to both the ICA and the ECA during carotid endarterectomy.