World Neurosurg
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Randomized Controlled Trial
Accuracy of Varioguide frameless stereotactic system against Frame based stereotaxy: Prospective randomized single-centre study.
Frameless stereotactic brain biopsy systems are widely used today. VarioGuide (VG) is a relatively novel frameless system. Its accuracy was studied in a laboratory setting but has not yet been studied in the clinical setting. The purpose of this study was to determine its accuracy and diagnostic yield and to compare this with frame-based (FB) stereotaxy. ⋯ The VG system proved to be comparable in terms of the trajectory accuracy, rate of complications and diagnostic yield compared with the "gold standard" represented by the traditional FB stereotaxy for patients undergoing brain biopsy. VG is also better accepted by patients.
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Review Case Reports
Unusual intra-parenchymal pontomedullary epidermoid cyst in a 2 year-old: case report and literature review.
Intrinsic brainstem epidermoid cysts are rare, benign, slow-growing lesions. Their eloquence precludes complete excision; however, subtotal resection often will result in prolonged or sometimes permanent relief of presenting symptoms and signs. We describe an unusual case and review the literature of this pathology in the pediatric population. ⋯ Our case, supported by the literature, shows that brain stem epidermoid cysts may have atypical radiologic characteristics and that near-total resection remains safe and can improve outcome.
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Multicenter Study
Outcome of Endoscopic Transsphenoidal Surgery for Acromegaly.
Endoscopic transsphenoidal surgery has recently been introduced in pituitary surgery. We investigated outcomes and complications of endoscopic surgery in 2 referral centers in Korea. ⋯ Endoscopic transsphenoidal surgery for acromegaly presented high remission rates and a low incidence of endocrine deficits and complications. Regardless of surgical techniques, invasive pituitary tumors were associated with poor outcome.
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Comparative Study
Drain Insertion in Chronic Subdural Hematoma: An International Survey of Practice.
To investigate whether, after the publication of grade I evidence that it reduces recurrence rates, the practice of drain insertion after burr-hole drainage of chronic subdural hematoma has changed. Further, we aimed to document various practice modalities concerning the insertion of a drain adopted by neurosurgeons internationally. ⋯ The publication of grade I evidence in favor of drain use influenced positively this practice worldwide. Some surgeons are still reluctant to insert a drain, especially when the subdural space is narrow after drainage of the hematoma. The insertion of a subperiosteal drain could be a good alternative solution. However, its outcome and efficacy must be evaluated in larger studies.
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Laser interstitial thermal therapy has become increasingly popular for targeting epileptic foci in a minimally invasive fashion. Despite its use in >1000 patients, the long-term effects of photothermal injury on brain physiology remain poorly understood. ⋯ Prolonged incompetence of the blood-brain barrier produced by thermal ablation may provide a path for delivery of macromolecules into perilesional tissue, which could be exploited for therapeutic benefit, but rarely it may result in autoimmune central nervous system inflammatory conditions.