World Neurosurg
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The study of quality of life (QOL) in patients with asymptomatic diseases receiving interventional treatment provides an essential metric for the assessment of procedural benefits in the surgical patient population. In this study, we analyzed QOL data collected from patients with unruptured intracranial aneurysms (UIAs) before and after endovascular coiling in the HEAT Trial, alongside a systematic review on QOL in unruptured brain aneurysms. ⋯ Our analysis has revealed that patients with 3- to 14-mm UIAs had improvements in some physical and emotional components of QOL at 18-24 months following aneurysm coiling in the HEAT study. The literature remains indeterminate on this issue. Further studies are needed to better understand the effects of the diagnosis of UIAs and their treatment on QOL.
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Relative risk is insufficient to guide treatment decision-making for unruptured intracranial aneurysms. Our objective was to introduce a novel risk assessment methodology called the Rupture Criticality Index (RCI), which allows for concurrent evaluation of groups of risk factors (RFs). ⋯ We introduce the concept of RCI and compare how RF combinations are associated with aneurysmal rupture. This novel approach to aneurysmal rupture identifies high-risk clinical presentations and can be used to guide clinical decision-making in patients with non-traditional risks.
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We sought to introduce an anterior surgical technique for cervical ossification of posterior longitudinal ligament (OPLL) extending to C2. ⋯ For patients with cervical OPLL extending to C2, exclusion of ossified ligaments behind C2 combined with anterior controllable antedisplacement and fusion below C2 is an effective and alternative technique.
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Review
The Role of Neoadjuvant Therapy to Improve the Extent of Resection in "Unresectable" Gliomas.
Surgical resection plays a pivotal role in the management of glial tumors and a greater extent of resection (EOR) should be the goal in most surgeries to improve overall survival. Many factors may limit the EOR. A potential role for preoperative chemotherapy to decrease the volume and/or infiltration of gliomas, thereby facilitating a safe radical resection, has been recently suggested. This review aims to provide an overview of the current state of neoadjuvant therapy in the field of glioma surgery. ⋯ Neoadjuvant chemotherapy has played a role in overcoming obstacles that limit the EOR in patients with complex gliomas, especially low-grade gliomas.