World Neurosurg
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Patients with intracranial meningiomas can experience neurocognitive dysfunctions in specific cognitive domains depending on tumor location and size. The literature regarding cognitive function surrounding the resection of frontal meningiomas is sparse. ⋯ Patients with frontal meningiomas display preoperative and postoperative deficits in perceptual speed, executive function, short-term memory, and verbal fluency. The risk for cognitive deterioration owing to surgical resection is low. Within the first two months after surgery, executive function and short-term memory appear to recover.
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Case Reports
Surgical Treatment of Traumatic Intracranial Aneurysms: Experiences at a Single Center over 30 Years.
Traumatic intracranial aneurysm (tIA) is rare and is associated with high rates of morbidity and mortality. We describe our experiences with tIA at our institution. ⋯ tIA is an uncommon complication of head trauma. tIA should be considered when unexpected new symptoms develop in patients with head trauma. Early diagnosis and prompt treatment could help to improve final clinical outcomes.
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Stimulus-evoked electromyography (EMG) has been developed to increase the safety of transpedicular placement of screws. There is more consensus about this monitoring method in open surgery. Alarm thresholds for minimally invasive surgery are based on referential value for open surgery. Nevertheless, there are no uniform alarm criteria on this modality for minimally invasive surgery. Using an analysis of alarm threshold, methodology and clinical effectiveness on stimulus-evoked EMG monitoring for minimally invasive transpedicular implantation of screws in the lumbosacral spine, this study aims to reflect and recommend for optimizing accuracy. ⋯ In minimally invasive surgery, continuous stimulation of instrumentation devices is recommended. A minimum 5-mA threshold should be used for stimulation of the pedicle access needle. Use of higher-stimulation thresholds during tapping and incorporation of an adapted continuous suction system may optimize the accuracy of stimulus-evoked EMG.
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Review
Radiation-induced sarcomas of the central nervous system: an exhaustive review of the literature.
Radiation-induced sarcomas (RISs) of the central nervous system are an uncommon late risk of irradiation. We conducted a systematic review of individual patient data to characterize RISs. ⋯ The risk of secondary sarcomas in patients treated with cranial radiotherapy warrants longer follow-up periods beyond the standard time frame typically designated for determining the risk of primary tumor relapse. Moreover, chemotherapy should be considered a potential treatment option for RISs.
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Randomized Controlled Trial
Evaluation of Meropenem Penetration into Cerebrospinal Fluid in Patients with Meningitis after Neurosurgery.
Meropenem is important for management of postneurosurgical meningitis, but the data about its penetration into cerebrospinal fluid (CSF) are inadequate. This prospective, open-label study investigated the pharmacokinetic profile of meropenem in patients with postneurosurgical meningitis, especially its CSF penetration. ⋯ Dosing regimens of meropenem 1 g every 6 hours and 2 g every 8 hours provided higher CSF penetration than 1 g every 8 hours. A higher dose and shorter dosing interval of meropenem may be more useful for clearance of pathogens.