World Neurosurg
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To develop a method to distinguish atypical meningiomas (AMs) with malignant progression (MP) from primary AMs without a clinical history. ⋯ Low Cx43 expression and irregular tumor shape were independent predictors of the presence of MP. The relevant logistic regression model was found to be effective in distinguishing MP-AMs from primary AMs.
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The number of metastases that can be treated safely and effectively with Gamma Knife stereotactic radiosurgery (SRS) remains controversial despite continuing evidence to support its expanded utilization. We endeavored to elucidate the survival outcomes for patients who presented with ≥15 brain metastases at the time of initial SRS. ⋯ SRS is an effective means of managing extensive brain metastases, particularly in patients with breast cancer. The primary tumor type, systemic disease, and performance status heavily influence survival outcomes.
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Observational Study
Enhanced hematoma membrane on DynaCT images during middle meningeal artery embolization for persistently recurrent chronic subdural hematoma.
Chronic subdural hematoma (CSDH) is generally treated by burr-hole irrigation, but it can recur despite repeating these procedures. Embolization of the middle meningeal artery (MMA) has recently been proposed as a curative treatment for CSDH, but evidence for the indication and timing of MMA embolization is not definitive. The present study retrospectively analyzed the effects and safety of MMA embolization among patients with persistent CSDH recurrence. ⋯ Repeatedly recurrent CSDH can be safely treated and cured by MMA embolization. Hematoma membrane enhancement pattern using DynaCT images can predict repeated recurrences CSDH.
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Stereotactic radiosurgery (SRS) is the reference standard for radiotherapy for pituitary adenomas but has been limited to lesions with sufficient distance (i.e., >3 mm) from the optic apparatus. We used marginless, fractionated (i.e., 25-28 fractions) stereotactic radiotherapy and the CyberKnife to treat pituitary adenomas that were not eligible for SRS. We present the clinical outcomes, including local control, endocrine function, and toxicity from modern fractionated radiotherapy. ⋯ Marginless, fractionated CyberKnife radiotherapy demonstrated excellent local tumor control and endocrine control rates, comparable to those with SRS, with preservation of vision in patients with adenomas in close proximity to the optic pathway.
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Delayed cerebral ischemia (DCI) is significantly related to death and unfavorable functional outcome in patients with aneurysmal subarachnoid hemorrhage (SAH). The association between alpha-delta ratio (ADR) on quantitative electroencephalography (EEG) and DCI has been reported in several previous studies, but their results are conflicting. This meta-analysis was conducted to assess the accuracy of ADR for DCI prediction in patients with aneurysmal SAH. ⋯ Worsening ADR on quantitative EEG is a reliable predictor of DCI in patients with aneurysmal SAH. Further studies are still needed to confirm the role of quantitative EEG in DCI prediction.