World Neurosurg
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Central nervous system lymphoma (CNSL) is typically treated with chemotherapy and external beam radiation therapy (EBRT). Optimal management of recurrent CNSL is poorly defined. ⋯ Stereotactic radiosurgery for patients with recurrent CNSL is well tolerated and has a high rate of radiographic response. A marginal dose of 15.5 Gy or greater, a Karnofsky score of 80 or greater, and the absence of pre-SRS WBRT were associated with significantly longer overall survival. Stereotactic radiosurgery may be beneficial as an initial salvage therapy in the treatment of recurrent CNSL for properly selected patients.
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The treatment goal for vestibular schwannomas (VS) has been changed from total removal of the tumor to functional preservation with long-term tumor growth control. The small- to medium-sized VS can be treated by stereotactic radiosurgery, but large VS require surgical decompression for the relief of cerebellar dysfunction and increased intracranial pressure. We have been performing planned partial surgical resections followed by gamma knife radiosurgery (GKS) for large VS. Here, we evaluate a recent series of such cases from the standpoint of functional outcomes. ⋯ Planned partial removal of large VS followed by GKS achieved a high rate of facial nerve and hearing preservation. To achieve long-term tumor growth control, the tumor volume at GKS after planned partial surgical resection should be smaller than 6 cm(3). Our results revealed that patients with hearing preservation postoperatively have a chance of maintaining hearing function, even though the possibility exists of deterioration by long-term follow-up after surgical intervention and GKS. Furthermore, some patients with severe hearing loss before treatment have the chance of hearing improvement, even those with large VS.
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Monitoring pharyngeal motor evoked potential (PhMEP) with a modified endotracheal tube is useful for predicting postoperative swallowing dysfunction. However, the relationship between intraoperative PhMEP findings and recovery from postoperative swallowing dysfunction has not been clarified. The aim of this study was to determine whether PhMEP monitoring predicts swallowing dysfunction not only immediately after surgery but also in the postoperative recovery period. ⋯ PhMEP monitoring allowed us to predict not only immediate swallowing dysfunction but also recovery from the dysfunction in the postsurgery period.
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The aim of this study was to investigate the feasibility and effectiveness of endoscopic neurosurgery for patients with third ventricular colloid cysts but without ventriculomegaly. ⋯ Endoscopic resection of third ventricular colloid cyst in patients without hydrocephalus seems to be feasible, effective, and not contraindicated.
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Treatment options for patients with glioblastoma at progression have remained controversial, and selection criteria for the appropriate type of intervention remain poorly defined. The objectives were to determine which factors favor the decision for second surgery and which factors are associated with overall survival (OS) and to evaluate the National Institutes of Health (NIH) recurrent glioblastoma scale. The scale includes tumor involvement of eloquent brain regions, functional status, and tumor volume. ⋯ Surgery of progressive glioblastoma and postoperative treatment at the time of progression is associated with improved OS in some patients. The addition of age may improve survival prediction of the NIH recurrent glioblastoma scale.