World Neurosurg
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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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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.
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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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Radiographic worsening in patients with glioblastoma undergoing treatment may be due to tumor recurrence or treatment effect. The overall prognosis of these patients based on histologic findings at the time of repeat resection is not well established. ⋯ In patients with worsening imaging, the absence of tumor on histologic diagnosis is associated with improved survival from the time of second surgery.
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Vertebrobasilar artery nonsaccular aneurysms (VBANSAs) are associated with a 13% annual mortality. Revascularization and flow diversion are life-saving options in select cases; technical failures and rapid hemodynamic changes may contribute to unwanted outcomes. We describe a technique and report clinical outcomes of patients treated with an experimental slow-closing clip (SCC). ⋯ In this small case series, use of SCC overcame the natural history of VBANSAs when treatment timing and aneurysm anatomy were suitable. The SCC potentially favors aneurysm thrombosis and collateral reactivation. More studies are necessary to better develop the SCC.