World Neurosurg
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Review Meta Analysis Comparative Study
Comparison of the Therapeutic Efficacy of Surgery with or without Adjuvant Radiotherapy versus Radiotherapy Alone for Metastatic Spinal Cord Compression: A Meta-Analysis.
Spinal metastases are 20 times more common than primary spinal tumors and often cause metastatic spinal cord compression (MSCC). Clinical manifestations (e.g., pain and neurologic dysfunction) adversely affect patients' quality of life. Radiotherapy (RT), chemotherapy, and surgery are the major therapeutic strategies for MSCC. There is some evidence that combining surgery with adjuvant RT may be a better option. ⋯ Further studies are needed to investigate the effects of these interventions on quality of life and to identify the best therapeutic strategy for patients with MSCC.
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Review
Patients Experience High Levels of Anxiety 2 Years Following Aneurysmal Subarachnoid Hemorrhage.
To explore anxiety levels during the first 2 years after rupture of aneurysmal subarachnoid hemorrhage. ⋯ Levels of anxiety remained high and stable throughout the first 2 years after rupture of aSAH. High levels of anxiety may reduce health-related quality of life substantially. Identification of individuals with high levels of anxiety and supportive care could therefore potentially improve long-term outcome.
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To review the pathophysiology and therapeutic modalities availble for Nelson syndrome. ⋯ An up-to-date understanding of the pathophysiology underlying Nelson Syndrome and evidence-based management is imperative. Early detection may allow for more successful therapy in patients with Nelson Syndrome. Improved radiotherapeutic interventions and rapidly evolving pharmacologic therapies offer an opportunity to create targeted, multifocal treatment regiments for patients with Nelson Syndrome.
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Fungal granulomas of the central nervous system are rare and have a high rate of mortality and morbidity, irrespective of treatment. The authors report their experience of managing 66 patients during 15 years and discuss the clinical, radiological, surgical, and pathologic findings. This series is among the largest reported. ⋯ ICFGs have high rates of morbidity and mortality. Early diagnosis, radical surgery, and antifungal treatment for 6 weeks may improve outcome. Poor neurologic status of patients at the time of presentation, immunocompromised state, contamination of ventricular cerebrospinal during surgery, and renal failure (attributable to amphotericin-B) are associated with poor outcome.