World Neurosurg
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Review Case Reports
Spinal Cord Compression Secondary to Epidural Fibrosis Associated with Percutaneously Placed Spinal Cord Stimulation Electrodes: Case Report and Review of the Literature.
Spinal cord stimulation is a safe method for treating chronic pain syndromes. Spinal cord stimulators can be placed either surgically by creating a laminectomy defect for paddle leads or percutaneously by inserting electrodes. They are usually not associated with major complications. ⋯ We also reviewed the PubMed and Medline databases for all cases of significant epidural fibrosis related to spinal cord stimulator lead placement, including both surgically implanted paddles and percutaneously implanted leads. This is an uncommon complication after placement of spinal cord stimulators, but it can carry a clinically significant impact and be the source of severe morbidity. It should especially be suspected if the successful placement of the device is followed by development of a "tolerance" phenomenon, with progressive loss of satisfactory pain control and development of new myelopathic symptoms.
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Review
Penetrating Bihemispheric Traumatic Brain Injury: A Collective Review of Gunshot Wounds to the Head.
Head injuries that cross midline structures of the brain are bihemispheric. Other terms have been used to describe such injuries, but bihemispheric is the most accurate and should be standard nomenclature. Bihemispheric head injuries are associated with greater mortality and morbidity than other penetrating traumatic brain injuries (TBIs). Currently, there is a tendency to manage severe gunshot wounds (GSWs) to the head nonoperatively, despite reports of improved outcome in military patients treated aggressively. Thus, controversy exists in the management of civilian TBI. ⋯ Bihemispheric injuries have greater mortality rates than other penetrating TBI. Violation of midline brain structures such as the diencephalon and mesencephalon, increased rate of self-inflicted wounds, and lack of a standard management algorithm may increase the lethality of these injuries. Although bihemispheric injuries historically have been considered nonsalvageable, an aggressive surgical approach has been shown to improve outcomes, particularly in the military population.
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Comparative Study Observational Study
A survival analysis with identification of prognostic factors, in a series of 110 patients with newly diagnosed glioblastoma, pre and post-introduction of the Stupp regimen: a single-center observational study.
Current treatment protocol for glioblastoma multiforme (GBM) is based on maximal safe resection followed by the Stupp protocol. In Serbia, temozolomide was introduced as adjuvant therapy in 2011. The aims of this study were to confirm the safety and efficacy on overall and progression-free survival of the Stupp protocol and evaluate the influence of prognostic factors in one of the largest series of patients with GBM treated over a 2-year period. ⋯ Adoption of the Stupp protocol had a favorable impact on overall, but not on progression-free, survival rate. Wider surgical resection involving the peritumoral brain zone, as confirmed by univariate and multivariate analysis, represents the most favorable prognostic factor.
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There is no facile quantitative method for monitoring hydrocephalus (HCP). We propose quantitative computed tomography (CT) ventriculography (qCTV) as a novel computer vision tool for empirically assessing HCP in patients with subarachnoid hemorrhage (SAH). ⋯ qCTV is a reliable means of quantifying ventricular volume and hydrocephalus. This technique offers a new tool for monitoring neurosurgical patients for hydrocephalus, and may be beneficial for use in future research studies, as well as in the routine care of patients with hydrocephalus.
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Radiation-induced benign peripheral nerve sheath tumors are uncommon late complications of irradiation. We conducted the largest systematic review of individual patient data. ⋯ The risk of incidence of secondary benign peripheral nerve sheath tumors in patients treated with radiotherapy should be considered in long-term follow-up periods. At present, complete surgical resection is the main stay for the treatment of radiation-induced benign peripheral nerve sheath tumors.