World Neurosurg
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The giant intracranial meningioma (GIM) constitutes a different spectrum of brain tumors that invade the vital neurovascular structures, which makes the primary mode of treatment, surgery, a technically challenging one. The surgery for GIM is unique because of the large size of the tumor, prominent vascularity, entangling and limited visualization of various neurovascular structures, and severe cerebral edema. This study reports the authors surgical experience of 80 GIM cases, the operative challenges and surgical outcome. ⋯ The surgery for GIM is unique in different ways. As surgery for GIM is formidable, radiologic characteristics can be useful adjuncts for planning an effective and safe surgical strategy. The factors such as young age, male sex, use of neuronavigation, and skull base location positively influenced RFS, whereas Simpson grade 3 or 4 and poor histologic grade adversely influenced RFS. A careful preoperative evaluation, understanding of the risk factors, effective surgical approach, and judicious use of intraoperative adjuncts are the key factors with pivotal roles in GIM resection.
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Case Reports
Prognostic factors for the survival outcome of bilateral thalamic glioma: An integrated survival analysis.
The aim of this study was to perform an integrated survival analysis of patients with bilateral thalamic glioma and to assess the influence of various prognostic factors on overall survival. ⋯ This comprehensive analysis of rare BTG patients revealed that a longer duration of symptoms (≥2 months) and low WHO grade were significantly associated with improved survival and were independent prognostic factors for overall survival.
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Endoscopic transsphenoidal surgery (ETPS) has become increasingly popular for resection of pituitary tumors, whereas microscopic transsphenoidal surgery (MTPS) also remains a commonly used approach. The economic sustainability of new techniques and technologies is rarely evaluated in the neurosurgical skull base literature. The aim of this study was to determine the cost-effectiveness of ETPS compared with MTPS. ⋯ ETPS appears to be cost-effective when compared with MTPS because the ICER falls below the commonly accepted $50,000 per QALY benchmark. Model limitations and assumptions affect the generalizability of the conclusion; however, ongoing efforts to improve rhinologic morbidity related to ETPS would appear to further augment the marginal cost savings and QALYs gained. Further research on the cost-effectiveness of ETPS using prospective data is warranted.
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Supraclinoid blister aneurysms (BAs) of the internal carotid artery are uncommon and deadly, and appropriate treatment is controversial. Endovascular reconstruction may allow treatment through aneurysm isolation. We report a single-institution experience in the use of Enterprise stent-assisted coiling (ESAC) for treating BAs to appraise the safety and efficacy of this technique. ⋯ ESAC to treat BAs is safe, effective, and provides good clinical outcomes. ESAC with telescoping stents has a higher follow-up complete occlusion rate compared with ESAC with single stents.
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Microvascular decompression (MVD) is an effective method for directly treating the etiology of trigeminal neuralgia (TGN). This study aims to investigate the factors that predict complete pain relief after MVD for treatment of TGN, and to study efficacy and safety in older patients. ⋯ Presence of typical type TGN was the only factor found to independently predict a pain-free outcome in the early postoperative period. No factors were associated long-term pain-free outcome. MVD is an effective and safe operative procedure, and it should be regarded as a safe and viable alternative for treating intractable TGN in older patients.