World Neurosurg
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The optimal surgical management of meningiomas involving the major venous sinuses represents a therapeutic dilemma. The decision is whether to leave a fragment of the lesion and have a higher recurrence rate, especially for World Health Organization classification II/III tumors, or to attempt total removal and potentially increase risk to the venous circulation. We present the surgical strategies we follow in managing meningiomas involving the major venous sinuses and the potential benefit of these techniques for higher grade tumors. ⋯ The surgical strategies presented, achieving minimal morbidity, support the practice of aggressive removal of tumors invading the sinus, particularly in the case of higher grade meningiomas.
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Concussion and sports-related cranial and spine injuries recently have garnered increased attention from the media, public, and sports' governing bodies. Although concussion has been well-studied, there are minimal data on return to play for structural neurosurgical lesions. ⋯ The results presented here are the first effort to study current practice on return to play for structural neurosurgical lesions. They establish an early foundation for neurosurgical guidelines on these patients.
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Case Reports
An updated assessment of the risk of radiation-induced neoplasia after radiosurgery of arteriovenous malformations.
Gamma Knife radiosurgery (GKRS) is a minimally invasive technique employed in the treatment of intracranial arteriovenous malformations (AVMs). Patients experience a low incidence of complications following treatment. As long-term follow-up data became available, some late adverse effects have been reported. However, the exact incidence of radiosurgically induced neoplasia is not known. ⋯ Although radiosurgery is generally considered a safe modality in the treatment of AVMs, radiation-induced neoplasia is a rare but serious adverse event. The possibility of GKRS-induced tumors underscores the necessity of long-term follow-up in AVM patients receiving radiosurgery.
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There is increasing literature supporting the importance in triaging patients to teaching hospitals for complex surgical procedures. This study analyzes the effect of teaching hospital status on outcome of endovascular coiling and microsurgical clipping of ruptured and unruptured intracranial aneurysms using the Nationwide Inpatient Sample database. ⋯ Our results suggest that the teaching status of a hospital is an independent factor for favorable outcome in the treatment of ruptured aneurysms. The difference in in-hospital death is accentuated in patients who underwent microsurgical clipping.
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Suprasellar meningiomas have been resected via various open cranial approaches. During the past 2 decades, the endoscopic endonasal approach has been shown to be an option in selected patients. We wished to examine the learning curve for parameters such as extent of resection, visual outcome, and complications. ⋯ Once the learning curve is overcome, surgeons performing endonasal endoscopic resection of suprasellar meningiomas can achieve high rates of GTR with low complication rates in well-selected cases.