World Neurosurg
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The latency period from stereotactic radiosurgery (SRS) to obliteration of arteriovenous malformations (AVM) requires continuous imaging surveillance. Magnetic resonance (MR) perfusion is promising for noninvasive monitoring of AVMs after SRS. We studied longitudinal MR perfusion changes of brain AVMs treated with SRS. ⋯ There is a gradual decrease of rCBV and rCBF in the AVM nidus after SRS. MR perfusion imaging is promising for monitoring of hemodynamic changes of AVMs after SRS. Larger studies investigating clinical value of MR perfusion imaging for AVMs after SRS are warranted.
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Intracranial aneurysms (IAs) are occasionally associated with moyamoya disease (MMD). The purpose of this study was to elucidate differences between patients with MMD with and without IAs and differences between patients with IAs at different locations. ⋯ Patients with MMD with IAs had different clinical and hemodynamic features compared with patients with MMD without IAs. CoW aneurysms and peripheral aneurysms may occur at different stages of MMD, which may explain their differences in anatomical location, type of hemorrhage, and treatment strategy.
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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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The consistency of meningioma is a factor that may influence surgical planning and the extent of resection. The aim of our study is to develop a predictive model of tumor consistency using the radiomic features of preoperative magnetic resonance imaging and the tumor elasticity measured by intraoperative ultrasound elastography (IOUS-E) as a reference parameter. ⋯ We have developed a high-precision classification model that is capable of predicting consistency of meningiomas based on the radiomic features in preoperative magnetic resonance imaging (T2-weighted, T1-weighted post-contrast, and apparent diffusion coefficient map).
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In the era of value-based payment models, it is imperative for neurosurgeons to eliminate inefficiencies and provide high-quality care. Discharge disposition is a relevant consideration with clinical and economic ramifications in brain tumor patients. We developed a predictive model and online calculator for postoperative non-home discharge disposition in brain tumor patients that can be incorporated into preoperative workflows. ⋯ A strongly performing predictive model and online calculator for non-home discharge disposition in brain tumor patients was developed. With further validation, this tool may facilitate more efficient discharge planning, with consequent improvements in quality and value of care for brain tumor patients.