World Neurosurg
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Clinical and/or neuroimaging changes after whole-brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) for metastatic brain tumor(s) present the clinical dilemma of differentiating tumor recurrence from radiation necrosis. Several imaging modalities attempt to answer this clinical question, including magnetic resonance spectroscopy (MRS) and positron emission tomography (PET) computed tomography (CT). We evaluated our experience regarding the ability of MRS and PET CT to differentiate tumor recurrence from radiation necrosis in patients who have received WBRT or SRS. ⋯ MRS has better accuracy than PET CT and a high negative predictive value, therefore making it more useful in distinguishing recurrent tumor from radiation necrosis. We encourage correlation with symptoms at imaging to aid in clinical decision making.
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We sought to compare the outcomes of single-position (SP) circumferential lumbar interbody fusion in lateral decubitus versus dual-position (DP) fusion. ⋯ Literature comparing SP versus lateral-then-prone lumbar fusion shows a tendency toward shorter operating time and hospital stays in SP lumbar fusion while maintaining similar perioperative outcomes.
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Radiation therapy (RT) is the cornerstone of management of malignant brain tumors, but its efficacy is limited in hypoxic tumors. Although numerous radiosensitizer compounds have been developed to enhance the effect of RT, progress has been stagnant. Through this systematic review, we provide an overview of radiosensitizers developed for malignant brain tumors, summarize their safety and efficacy, and evaluate areas for possible improvement. ⋯ Progress in radiosensitizers for malignant CNS tumors has been limited. Only 2 radiosensitizers have shown limited improvement in survival. Alternative strategies such as synthetic drug design, based on a mechanism of action that is independent of crossing the blood-brain barrier, may be necessary. Use of drug development strategies using new technologies to overcome past challenges is necessary.
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Late surgical correction of meningoencephalocele is a rare scenario that remains challenging for surgeons. Three-dimensional models can mimic the correct anatomical relationships, and technological systems have brought advances to medicine. This study aims to present a novel preoperative planning modality that combines augmented reality with a hybrid model for complex malformation associated with late correction. ⋯ The authors believe this new multimodality preoperative platform could be a useful method to improve multidisciplinary discussion as well as a powerful tool for teaching and planning.