World Neurosurg
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Opportunity exists for improved local control rates of grade 2 meningiomas that recur despite maximal surgical resection and adjuvant fractionated radiotherapy. We describe a dose escalation strategy of increasing the total tumor radiation dose by adding a stereotactic radiosurgery (SRS) boost targeting gross disease to fractionated radiotherapy. ⋯ We found 100% in-field local control at three years from an SRS boost to fractionated radiotherapy targeting gross disease with an acceptable toxicity profile, suggesting this may be an effective and improved adjuvant treatment strategy in patients with grade 2 meningioma.
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Neuropathic pain affects approximately 7-10% of the general population. Its risk tends to rise with age and can impact individuals of any gender. Managing neuropathic pain often requires a combination of strategies. Surgical treatment is considered for patients who fail medical therapy and develop chronic symptoms. The posterior part of the central lateral nucleus (CLp) represents a promising target for the treatment of these cases. We present our experience in using Gamma Knife Surgery (GKS) on the posterior part of the central lateral nucleus (CLp) for refractory neuropathic pain, examining its long-term efficacy and safety in patients with one of the longest pre-treatment pain duration in the literature. Furthermore, we examined certain factors that might influence the outcome of this technique. ⋯ Our findings suggest that bilateral ablation of the CLp using GKS is both effective and safe for treating drug-resistant neuropathic pain.This simple,accurate and non-invasive surgical technique effectively achieves pain control across various localized areas and sustains a lasting clinical response,even in patients with multiple previous surgical interventions or prolonged pain duration. These findings encourage us to consider this technique as a highly beneficial strategy for these patients.
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Chiasmatic cavernous hemangioma(CCH) is a rare disease. Most cases are treated with surgical resection through approaches such as pterional and orbitozygomatic craniotomy. However, with advancements in surgical technique and heightened patient demand for improved postoperative quality of life, there have been reports in recent years exploring more minimally invasive surgical approaches, such as the subfrontal trans-eyebrow keyhole and endoscopic endonasal transsphenoidal approach. In this paper, the cases of CCH in the reported literature are reviewed, the indications and techniques of minimally invasive surgery for the removal of CCH through the subfrontal trans-eyebrow keyhole approach are discussed, and the effects of different surgical approaches are analyzed. ⋯ According to our results, the subfrontal trans-eyebrow keyhole approach for the resection of CCH is mainly suitable for cases in which the lesions are located above and anterior to the optic chiasm, the medial or superior aspect of the intracranial segment of the optic nerve is involved, and there is no invasion into the optic nerve canal. Compared with the traditional surgical approach, the minimally invasive subfrontal trans-eyebrow keyhole approach has demonstrated better clinical outcomes in the resection of CCH. However, according to the specific conditions of different patients, it is still necessary to comprehensively consider the choice of surgical approach. This study provides a valuable reference for further exploration of the treatment of CCH.
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Segmental arterial mediolysis (SAM) is a non-atherosclerotic, non-inflammatory vascular disease, initially reported in 1976 by Slavin and Gonzalez-Vitale. SAM-associated cerebral aneurysms have been reported in limited cases, and the disease entity is not fully understood. Therefore, we propose a diagnostic and treatment strategy with a systematic review of previous reported cases and our cases. ⋯ SAM-associated cerebral aneurysms can be life-threatening due to the risk of rupture, and can lead to successive IAH following SAH. However, prognosis is relatively good if operation is accomplished. Therefore, precise diagnosis is required for suspected cases at first, and appropriate surgical treatment is required. Moreover, appropriate management on the alert of successive IAH is required among SAH cases.
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Review
Machine Learning Algorithms for Neurosurgical Preoperative Planning: A Comprehensive Scoping Review.
Preoperative neurosurgical planning is a keen step to avoiding surgical complications, reducing morbidity, and improving patient safety. The incursion of machine learning (ML) in this domain has recently gained attention, given the notable advantages in processing large data sets and potentially generating efficient and accurate algorithms in patient care. Herein, we evaluated the evolving applications of ML algorithms in the preoperative planning of brain and spine surgery. ⋯ ML algorithms for preoperative neurosurgical planning are being developed for efficient, automated, and safe treatment decision-making. Enhancing the robustness, transparency, and understanding of ML applications will be crucial for their successful integration into neurosurgical practice.