World Neurosurg
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Chronic subdural hematoma or nonacute subdural hematoma (NASH) remains a common neurosurgical disease, with an incidence of 1.7-20.6:100,000 individuals. Surgical evacuation of chronic subdural hematoma can be complicated by inadequate drainage and recurrence rates up to 20%-30% in some series. We examine the safety and efficacy of endoscope-assisted NASH evacuation and review the literature on the technique. ⋯ Endoscopic visualization can be a useful adjunct in the modern treatment of NASH. Reduced risk of recurrence was seen compared with those of historical surgical drainage methods including burr holes (20-30%). The inclusion of endoscopic visualization in the modern era with middle meningeal artery embolization may potentially combine methods that can dramatically reduce the recurrence of NASH.
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Magnetic resonance imaging-guided laser interstitial therapy (MrLITT) presents a new valuable treatment alternative when the in-field recurrence (IFR) of metastatic brain tumors is difficult to safely access with open surgery or maximum radiation therapy has already been completed. ⋯ MrLITT is an effective treatment option for IFR after radiosurgery for metastatic brain tumors. The benefits of more aggressive gross total ablations of deep targets near eloquent cortices are limited compared with effective subtotal ablations, but the amount of residual tumor volume left must be appropriately balanced.
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Statins have been reported to reduce the rates of recurrence and improve the resolution of chronic subdural hematomas (cSDHs) treated surgically or conservatively. No studies have investigated the effect of statins in patients treated with middle meningeal artery embolization. ⋯ Patients treated with middle meningeal artery embolization alone who were on statin therapy had no differences in cSDH resolution or recurrence compared to those who were not on statin therapy. It is possible that the anti-inflammatory effects of statins may not be relevant when supply to the dura is interrupted by treatment with embolization.
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To assess volumetric changes in the spinal cord at the cervicomedullary junction, diameter of the cervicomedullary cord, and width of the brainstem following posterior fossa decompression (PFD). ⋯ The volume of the cervical cord at the cervical-medullary junction, width of the cervicomedullary cord, and diameter of the brainstem increase following PFD.
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Chordomas of the skull base are aggressive locally destructive tumors that arise from the remnants of the fetal notochord. Current guidelines recommend maximal safe surgical resection followed by adjuvant radiation therapy. However, because of the rarity of these tumors, the optimal radiotherapeutic regimen regarding dose and modality is unclear. ⋯ Our multi-institutional analysis supports the use of partial and radical surgical resection to improve survival in patients with skull base chordomas. Among patients who receive radiotherapy, higher radiation dose is associated with improved survival.