World Neurosurg
-
Parasagittal meningiomas are either treated with conservative surgery or aggressive surgery with extensive vascular reconstructions to achieve radicality. The optimal management is subject to controversy. A prerequisite for good management and for design of relevant studies is the knowledge of natural history after radical and subtotal surgery. ⋯ A 25-year follow-up was necessary to estimate the long-term outcomes of parasagittal meningiomas. It is necessary to consider long-term recurrences and morbidity as important factors when managing patients with parasagittal meningiomas whose life expectancies are not diminished by old age or co-morbidities. The long-term outcomes must also be considered when evaluating different treatment modes, as "cure" of parasagittal meningiomas cannot be evaluated without sufficient follow-up.
-
Gross total resection (GTR) prolongs survival but is unfortunately not achievable in the majority of patients with glioblastoma multiforme (GBM). Cytoreductive debulkings may relieve symptoms of mass effect, but it is unknown how long such effects sustain and to what degree the potential benefits exceed risks. We explore the impact of surgical morbidity on functional outcome and survival in unselected GBM patients. ⋯ Patients with perioperative complications and surgically acquired deficits were less likely to receive adjuvant therapy. While cytoreductive debulking may not improve survival in GBM, it may decrease the likelihood of patients receiving adjuvant therapy that does.
-
Intracranial large-vessel ischemia is associated with poor clinical outcome and increased mortality. Early reperfusion of ischemic tissue remains the goal of treatment of stroke. Intravenous tissue plasminogen activator (IV tPA) has been shown to improve clinical outcomes for patients who experience ischemic stroke, but it has been shown to be less efficacious for large-vessel occlusions. Mechanical clot extraction provides a therapeutic option for those who are ineligible for, or who do not respond to, conventional ischemic stroke treatment. ⋯ Mechanical clot extraction can be performed safely in patients with large-vessel occlusions, and successful recanalization resulted in better clinical outcomes than those without. Mechanical thrombectomy provides a therapeutic option for ischemic stroke patients who are ineligible for, or who do not respond to, IV thrombolytics. Further studies, including randomized clinical trials, are needed to validate these findings.