World Neurosurg
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Case Reports
The Feasibility Analysis for Treatment of Infancy Giant Intracranial Benign Tumor by Delayed-Operation.
The survival rate and prognosis in infants with giant intracranial tumors are significantly worse than in older children. This study aimed to analyze the feasibility of delayed operation for infants with giant intracranial benign tumor by evaluating the initial clinical presentations, expectant treatment measures, perioperative vital signs, and recuperation after surgery. ⋯ Delayed operation enabled infant patients to gain a better physical state, with a stage of full preoperative preparation that may reduce intraoperative/postoperative morbidity and mortality.
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To examine the efficacy of spheno-orbital meningioma (SOM) resection aimed at symptomatic improvement, rather than gross total resection, followed by radiation therapy for recurrence. ⋯ Among this cohort, surgery provided a lasting improvement in proptosis and improved or stabilized visual deficits. Surgery followed by radiation at recurrence provided excellent tumor control and lends credence to the growing body of literature demonstrating effective control of subtotally resected skull base meningiomas.
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In some cases of drug-resistant focal epilepsy, noninvasive presurgical investigation may be insufficient to identify the ictal onset zone and the eloquent cortical areas. In such situations, invasive investigations are proposed using either stereotactic electroencephalography (SEEG) or subdural grid electrodes. Meta-analysis suggests that SEEG is safer than subdural grid electrodes, but insular implantation of SEEG electrodes has been thought to carry an additional risk of intraparenchymal hemorrhagic complications. Our objectives were to determine whether an insular SEEG trajectory is a risk factor for intracranial hematoma and to report the global safety of the procedure and provide some guidelines to prevent and detect complications. ⋯ SEEG is a safe procedure. Insular trajectories cannot be considered an additional risk of intracranial bleeding.
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Case Reports
Multilevel spinal stabilization as a treatment for Hirayama disease: Report of an experience with 5 cases.
To analyze the role of multisegmental spinal instability in the pathogenesis of Hirayama disease. ⋯ From the observations, it appears that atlantoaxial and subaxial spinal instability plays a major role in the pathogenesis of Hirayama disease.
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Even with great advances in surgery and improved clinical outcome, morbidity and mortality are still high for large-volume intracranial meningiomas (MNGs). Recently, Gamma Knife radiosurgery (GKS) has proven to be a safe and effective treatment for many patients with intracranial MNGs. However, single-session GKS may increase the risk of radiation-induced toxicity for large MNGs. Recently, fractionated GKS (FGKS) has been performed for an increasing number of patients with surgically high-risk and large intracranial tumors. In this study, we report our results on the efficacy and safety of FGKS for large MNGs. ⋯ When the large-volume (>10 cm3) intracranial MNGs are expected to have high morbidity after microsurgery and for patients that have a poor medical status for surgery, FGKS can be considered an alternative with good tumor control and lower complications rates compared with single-session GKS (P = 0.017).