World Neurosurg
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Vestibular schwannomas (VSs) are benign, slowly growing tumors. The management strategy, however, remains unclear for both primary VS and remnant VS after subtotal or partial resection. In this study, we analyzed the radiographical tumor growth to elucidate factors possibly predicting growth or regrowth of their tumors. ⋯ Small remnant VS after surgery could be conservatively managed without additional treatment, and relatively large remnant VS should be followed up with close serial imaging or might be a possible candidate for radiosurgery during the early postoperative period.
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Bifrontal craniotomy is effective for the treatment of anterior skull base lesions. However, the frontal sinus (FS) is often opened during this surgery, and various postoperative complications may occur as a result of the open FS, including cerebrospinal fluid leakage and infection. We describe our procedure for maintaining the patency of the nasofrontal duct and direct suture of the exposed and violated FS mucosa. ⋯ The present results indicate the effectiveness of our technique for the prevention of FS-related postoperative complications.
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In this study, we investigated the potential prognostic role of morphologic and quantitative diffusion tensor imaging (DTI) in patients with brainstem cavernoma (BSC) in terms of postoperative outcome. ⋯ Intact CST morphology in DTI predicts a favorable postoperative outcome in patients with BSC. Interrupted CSTs and decreased FA values correlate well within BSC lesion level; nevertheless, morphologic characteristics and diffusion parameter changes at lesion level cannot predict poor prognosis. Caudal and rostral diffusion parameters can provide more information of the integrity of CSTs compared with morphologic study alone.
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Despite recent progress, prognosis for the elderly (defined as aged ≥70 years) afflicted by traumatic brain injury (TBI) is unfavorable and surgical intervention remains controversial. Research during the past decade on the mortality rates or prognostic factors for survival in the elderly is limited. ⋯ Selected patients aged ≥70 years can benefit from surgical intervention for closed TBI. Level of consciousness, radiologic type of injury, mechanism of injury, and pupil abnormalities should be carefully evaluated. There also seems to exist a group of patients in whom surgical intervention offers little benefit, as mortality rate is low without surgical intervention.
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Spinal nerve sheath tumors (SNSTs) are the most common lesions in the extramedullary intradural compartment. Complex and large lesions may pose technical difficulties for the operating surgeons. We discuss the management of SNSTs and technical issues including surgical approaches, spinal fixation, and dural handling with the goal of achieving good clinical outcomes while minimizing the risk of complications. We also propose a new classification for SNSTs to guide surgical treatment of these tumors. ⋯ Lesions with large extraforaminal extension pose technical difficulty. Spinal fixation with fusion should be supplemented whenever necessary. Complications related to dura mater may be associated with significant morbidity, and all possible efforts should be made to prevent them.