World Neurosurg
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Moyamoya is a rare, yet classic etiology of stroke in young adults, affecting predominately women of childbearing age. The impact of pregnancy on the natural history of symptomatic moyamoya remains a matter of extensive debate, however. ⋯ The risk of moyamoya-related stroke during pregnancy, delivery, and the postpartum period appears to be similar to or lower than that suggested by published natural history studies in symptomatic patients. A neuroprotective effect of pregnancy in moyamoya patients cannot be excluded.
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Review
A bibliometric study of the most cited papers in central nervous system arteriovenous malformations.
We performed a bibliometric analysis of studies reporting cases of brain and spinal arteriovenous malformations (AVMs). ⋯ Brain and spinal AVM research was centralized in the United States, has been mainly reported in specific neurosurgical journals, and has been more often related to treatment and natural history and/or clinical features. It is possible that high impact AVM research has been decreasing recently. Because the best approach to these pathological entities remains controversial, research stimulation within this field should be encouraged.
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Surgical resection continues to predominate as the primary treatment modality in glioblastoma (GBM). Effective chemotherapeutic/biologic agents capable of targeting GBM have yet to be developed in part because of the exceptionally heterogeneous nature and unique microenvironmental conditions associated with this malignant neoplasm. Temozolomide and bevacizumab represent the only U. ⋯ Given the high therapeutic resistance of GBM to current therapies, as well as the failure of bevacizumab to prolong overall survival, new therapeutic agents are urgently warranted and are now in the preclinical and clinical phases of development. Accordingly, clinical trials evaluating the efficacy of immune checkpoint inhibition, chimeric antigen receptor T cell therapy, virotherapies, and tumor vaccination therapy are all under way in GBM. Herein, we review the application of current/novel therapeutics in GBM and in so doing attempt to highlight the most promising solutions to overcome current failures.
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Surgical indications for patients with pineal cysts are controversial. There are absolute indications such as hydrocephalus or tectal compression; otherwise, it is difficult to decide whether surgery would be beneficial when symptoms are not distinct. ⋯ We suggest that pineal cysts without ventriculomegaly are an indication for surgery when patients present with headache and/or visual disturbances and other causes have been excluded. Resolution of symptoms and quality of life in our cohort may denote a good indication for resection. However, we must admit that there is still no evidence to recommend this technique as a treatment of headache in these patients.
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Postoperative hemorrhage (POH), an uncommon complication after cranial operation, may result in prolonged postoperative hospitalization, severe neurologic impairment, or even death. Most models in studies detecting risk factors for POH include all kinds of cranial lesions; however, factors associated with POH may vary among intracranial diseases. There is a paucity of large sample studies focusing solely on POH after intracranial tumor surgery. Therefore, this study was designed to investigate the preoperative risk factors for POH after surgery for intracranial tumor. ⋯ Older age, higher INR, and larger tumor size were identified as independent risk factors for POH after resection of intracranial tumor in adults.