World Neurosurg
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We used microscopy to conduct qualitative and quantitative analysis of 4 surgical approaches commonly used in the surgery of the ambient cistern: infratentorial supracerebellar (SC), occipital interhemispheric, subtemporal (ST), and transchoroidal (TC). In addition, we performed a parahippocampal gyrus resection in the ST context. ⋯ This study has demonstrated that surgical approaches expose dissimilarly the different regions of the ambient cistern and an approach should be selected based on the specific need of anatomic exposure.
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We hypothesize that re-do craniotomy for recurrent grade IV glioblastomas improves survival while preserving outcome in selected patients. ⋯ Our results show that in a select group of patients with recurrent grade IV glioblastomas, repeated excision, aiming for gross total resection where safely possible, has significant survival benefit without severely compromising functionality and should be considered.
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The state of value-based management of spinal disorders and ongoing Brazilian strategies toward its implementation are highlighted in this article. ⋯ The paradigm of value-based management of spinal disorders is still incipient in Brazil. Some issues from our analysis must be emphasized: (1) Brazil presents many regional disparities and scarce resources for health care; it is crucial for the health system to allocate resources based on the value of interventions; (2) because of the high economic and social burden of developing new technologies for diagnosis and treatment, research in health economics of spine care in Brazil should be prioritized; (3) these efforts would help to provide a more accessible and effective health system for patients with spinal problems.
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We present a new case of angioleiomyoma, with detailed preoperative magnetic resonance imaging and digital subtraction angiography studies. A 36-year-old man was referred to our hospital for headache and diplopia. ⋯ The residual tumor was treated with CyberKnife, which, to our knowledge, is the first use of CyberKnife treatment for intracranial angioleiomyoma. At 20 months postoperatively, the size of the residual tumor had been reduced.
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The resection of foramen magnum meningiomas (FMMs) presents neurosurgical challenges. We propose a simple classification of the tumor location and the operating space created by the tumor to help treatment planning. ⋯ The simple classification of the tumor location helped to assess surgical difficulties. Knowledge of the space created by the FMMs between the condyle and the neuraxis is useful for planning the approach strategy, especially for estimating the available working space without resection of the occipital condyle.